07100128 CITY OF CUPERTINO �^ ' ' �q� +�?T
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BU[LDING UIVISION PERMIT 4:��� ��� �����`Y,��il��* :
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PERMIT NO.
� BUIL � r ��� ES �ENEY CREEK PL VALLEY F[EATING & COOLING 07100128 .
:R'S NAME: PERMIT LSSUE DATE
MAHITO TAKAHASHI 1171 N�: TH ST 10/17/2007
SANiTARY NO. CONTROL NO.
PHONE: �4OH�29
BUILDING PERMIT INFO
ARCHITECTlENGINEER: BLDG ELECT PLUMB MECH
0 0 0 0
; o o LICHNSED CONTRACTOR oec►aRnr�or, Job Description
� V� I hcrcby aCtirm �hat I am liccnsed undcr provisions oC Chaptcr 9(commencing
; Z� wiih Sccdon 7000) of Division 3 of ihc Business and Profcssions Codc. and my liccnsc is RE P LAC E] ) FURNAC E
�� y in fu0 Corce and effec
� � ? Licensc CI ' Lic. #
: F p Dam ConUaclor
� � ARCHRECI'S DECLA 1 N
j a ,�
e 1 undcrswnd my plans shall Uc uscd as public rccord4
)yV
' u. y Licensed Pnifcssional
: � < OWNER-BUILDER DECLARATION
'r � 1 hcrc6y alTirm that 1 am cxcmpt Crom thc Convactor's Liccnsc Law far thc
� p O (ollowing rcasoa (Sccuoa 7b31.5, Busincss and Professions Ca1c: Any city or county
�,° � which rcquiccs a pccmit to cnnswct, allcr, improve, dcmnlish, or rcpair any swcture
°" ti prior ui i� issuancc, alsu rcyuircc thc applicant for such pertnit to filc a signcd statcmcn� Valuation
'?< tha� hc is liccnscd pursuanl to thc provisions of the Conlracwr's Lic�cnsc Law (Chaptcr 9 � iq. Ft. Floor Area $ 3 9 4 5
r t �(commcncing wiih Section 7000) of Division 3 of ihc Busincss and Profcssions Cadc) or
y�� that he is e�cempt theccfrom and ihe basu for We allcgcd exemplion. Any violation ot
Secuon 7031.5 by airy applicant far a pertnit subjecu the applicant to a civi] penalty of 3 4 2 4 8 0 3���(� Number Oceupaney Type
not more chan 6vc 6undrcd dollars (5500).
❑ I, az owner oC tt�e property, or my employces with wages u the'v solc compensadon,
wili do the wo�1c, and �he suuctu�e is not intended or oRered forsale {Sec. 7044. Business Required Inspeetions
and Professions Code: The Conuacwr's Licenu Law docs not aPP�Y � an owner of
property wha builds or impraves thereon, and who das such work himsel[ ar Wough his
own employces, providcd that such improvemenls are not intended or oftered [or sata I[,
however, the building or improvement is wld within one year of completion, ihe ownu-
builder will have the burden oC proving LLwt hc did no� build or improvc Cor pmpose ot
sakJ.
❑ I, as awner of the property. am udusivcly convacting with licensed convxtors to
conswct the projen (Set. 7044. Business and Pro[essions Cade:) The Contrxrnrs Li-
ccnse Caw dacs aot apply w an owner o( propeny who builds ar improves 14emon, and ,
who contrac�s Cor such projec�s with a conuactoKs) Iicenud pursuant to the Coouxtor's
License Law.
❑ 1 am wcempt undu Sec . B 8c P C for �his rrason
� Da�e _.. _
WORKER'S WMPENSATiON DECLARATION
1 hereby atTirm under penalty of pe�ury one of the fallowing dtclarations:
❑ i hs.�e and will maimain a Certifcam of Conscn� to ulf-insum Cw WorkcrsCompen-
satian, as provided for by Section 3700 of the Labor Code, for the performanoc of the
work [or which �his permit is issued.
`'(�av and will maintain Worker's Compensatian Insunnce, u mquircd by Scction .
ff thc Labor Codc, Cor �hc performancc of �he work !or which U�is permii is issue�•
,.,y Worke� mpensation surance carticr and Policy n�ber azc:
i
Cartier. � Poliry No.:
CERTI CATE OF EXEMPI'[ON FROM WORK R' .
COMPENSAT[ONiNSURANCE
(7'his section necd not hc complc�cd if ttie permit is for onc hundred dotlaca (S1U0)
or IcssJ
I tertify Ihat in the performanee of lhe work Cor which U�is permi� is issued, I shall not
nnploy any person in any manncr so as to bccomc subject io Uie Workers' Compensation
Laws of Gli(omia. Datc
Applicant
NOTICE TO APPLICANT: If, aftcr making this Ccrti(icate of ExcmpGon, you shauW
become subjcct to the Worker's Compcnsation provisions of Nc La6or Codc, you must
� O forthwith comply with such provisions or this pertnit shall hc dccmcd revokcd.
z "' CONSTRUCTION LENDING AGENCY
[.�-� � I hcrcby affirm Ihat thcre is a conswction Icnding agcncy Cor thc perfwmancc of �
(Y, � ihc work Cur which this permit is issucd (Scc. 3097, Civ. C.) ,
W Q Lendcr's Namc
� z L,ender's Address
U � ► certi(Y �hal 1 have read this application and stam that thc above infamaliun is
�� cortect. I agree �o comply with all ciry and counry oniinar�ces and statc laws relating w
O� building conswction, and hercby authori�e representa�ives of Uiis city to enter upon the
� W aAovc-mcntioncd property for inspccuon pur4wses.
a (Wc) agree io save, indemnify and kecp hartnless the Ciiy of Cupenino against
H � liabilitia, judgmcnts, costs and expenscs which may in any way acccuc agains� said City
�,} z in consequence oC �c granung of Ihis permit. DSLe
+� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULAT(ONS.
Re-roofs
Signature af ApplianUContractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of F.00f
Will the applican� or futwc building occupant store or handlc ha•rardous mucrial
�Icfi�d by thc Cupenino Municipal Codc. Chapicr 9.1Z, and thc Hcalth and Safcty
c.Scction25532(a)? All roofs shall be inspected prior to any roofing material being installed.
� �� If a roof is installed without first obtaining an inspection, I agree to remove •
Will the applicant or futu uilding occupant use equipment or �k.wices which
cmii hazatdous air coniaminan as Jcfincd by the Bay Arca Air Quality Managcment all new R �aterials for inspecr.ion.
District? / �
Q Ycs Nu
I havc rcad the hazardous matcrials requircmcn�5 undcrChaptcr 6.95 of �hc Cali(or- /�f� ���
Hcalth & Safety Codc, Scctions 25505, 25533 anJ 25534.1 undcrstand �hat iCUu hui�dinB G ` v
�ocs not curtcn�ly havc a tc 4 ihat i� is cspo�ibility w notify thc occupartt of �hc -�'--�
rcyuircmcn�s which �' uancc of a Ccrtifica�c of Occupancy. gn [a Of icant Date
Owncr ur aut ii a nt
Datc � All roof coverings to be Class "B" or better
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, CITY OF CUPERTINO � ,�
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.�:... FURI�dA� a
�UP��TtfiJt� PERMIT APPLICATION FORM
APN # � �� C �c� ��~'� Date: � d 'J ? ` 0 �
Building Address: "
o ��tiC����..P�,
Owner's Name: Phone #: �'
l�`1 c�.� ►-�-`� 1 �.`�'l - 1; ► �-�'�� �{ y l.� - 4-'�`�
ontractor: License #:
t�t. �. -L� e�.. d o2SS5�
Conta�t: Cupertin�� siness License #:
h�
Building Pernut Info:
Bld ❑ Elect ❑± Plumb ❑ Mech CC�
Job Description: � � ,�
Q-G�I ��l c�� �
Residential Commercial ❑
For Residential Installations:
Attic � l floor � 2" floor �
Adhere to min set back re uirement [�
For Commercial Installations:
Replacement same weight ❑ Additional weight ( structural calcs) �
Structural Calculations required for new installation �
New installation Plannin A roval Re uired
Cost of Project:�,� � Type of Construction: Occupancy group:
Strapped n Platform Bonded ( Sq.Ft. Floor Area:
New Location � Re lacement �
Qty. if
Applicable Fee ID Fee Description Fee Group
J BENERGY Ener BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
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_ ---BSEISMICRE____ __ _.__ _ ------- Seismic Fee Res- __ _ _ ---- BUIL�
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Pernut Issuance MECHANICAL
PPERMITFEE Plumbin Permit Issue PLUMBING
BPERMFEE Bld Pernut Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC , Business License BUILDING
CITY OF CUPERTINO
5 ITEMS OF 10 PERMIZ RECEIPT OPERATOR: suew
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 34248034.00
DATE ISSUED.......: 10/17/2007
RECEIPT #•••-•••••: BS000003019
REFERENCE ID # •••: 07100128
SITE ADDRESS .....: 10382 HENEY CREEK PL
SUBDIVISION .......
CITY .............: CUFERTINO
IMPACT AREA .......
OWNER ............: MAFITO TAKAHASHI
ADDRESS ..........: 10382 HENEY CREEK PL
CITY/STATE/ZIP ...: CUFERTINO, CA 95014
RECEIVED FROM ....: VAILEY HEATING
CONTRACTOR .......: ATI�.INSON, THOMAS LIC # 141
COMPANY ..........: VAILEY HEATING & COOLING
ADDRESS ..........: llil N 4 TH ST
CITY/STATE/ZIP ...: SAi� JOSE, CA 95112
TELEPHONE ........: (4C8)294-6290
FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00
BSEISMICRE VALUATION 3,945.00 0.50 0.00 0.50 0.00
EPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00
MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
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TOTAL PERMIT : 157.73 0.00 157.73 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
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CHECK 315.46 16857
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TOTAL RECEIPT : 315.46
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
204 UNDERFLOOR FRAME 301 ROUGH PLUMBING
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS