04070086 CITY OF CUPERTINOr � a�r ,
BUILDING DIVISION PERMIT CIONTRACTUR INFURMATI,ON :»
BUILDING ADDRESS: VALLEY HEATING & COOLING PERMIT"904070086
10325 STONYDALF DR
OWNER'S NAME: PERMIT ISSUE DATE
WRIGHT WHITELAW AND BARBA
JE: _ SANITARY NO. CONTROL NO.
(408) 294-6290
ARCHITECT/ENGINEER: BUILDING PERMMNFO
BLDG ELECT PLUMB MECH
0 0 0 0
LOO Lm ENSEDCONnsedunDR'SDECLs at Chap
1 Mmhy affirm j that I em licensed under provislom of Chapter 9(commencing Job Description
ZZ wide Sation]a,%ot idon Sof the Bmlrmcea o(csslor Codc.and my is is
in roll o and erfa ��/ REPLACE FURNACE 100K BTU
\ Llc.N
Date ARCHIE DECLA A
raunJm Jupuhlic
U
Licensed Pmfes al W ER- /
BUILDER DECLARATION
y 1 here y affirm Net I me exempt from the Cnnuecme.License Lew for the
i O o following,Coon.(Swoun](D 1.5,Business and Profession Cale:Any city or County V
y$E! which requlma a Permit N en stroa miter,improve,demolish,or repair any smicture
Fly prior in its issuance.arm requires he applicant(nrtuch permit to rile a signed Comment
that he is lkened pursomno the,powisi.mrsf the Cwtumistor'e Licenu law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section]TDO)of Division 3 or the Bumnessand Prefcumus Calc)or
Nat he u exempt therefrom and the basis for the alleged ommptlon.Any vlole0bn of
Sectionmom than foe hundred dollars(MI it subjects be epplkantmeCivil penalty of e100 Occupancy Type
❑I.as owner of the property,or my employees wide wages u their sets Compensation, e
will do the work and the structae is not intended.,offered for sale(Sm.7094,Business
and Professions ua
sions Code The Concmrs La
Lice. w does not apply N an owner of - Required Inspections
propemy who builds or Improves thereon,end who does suc h work himself or through his
own employees,provided that such improvements tie notimmnded oroRxotl fa Wa If.
however,the Wilding or improvement is mid within one year of compledon,Nc owner.
builder will have the burden of proving Net he did not build or improve for purpose of
axle.).
❑1,as owner of the properly,em exclusively contracting with licensed contractors to
Computer the project(Sec,7W4,Business and Professions Code:)The Contracme.U.
cense Law does not apply in an owner of property,who Wilds or improves decmon,and
who convects for such projects with a eunuactoro)licensed pursuant on the Contractor's
License law.
❑1 am exempt under See ,B&P C for this moon
Owner Dam
WORKER'S COMPENSATION DECLARATION -
1hereby aRmm under penilay of perjury oa.f tite following daluui.m:
1
have and will meinuin a Certificateof Coram to self-insure for Workers Compen-
ommi,as provided for by Section 3700 of the Labor Code,for the performance or the
work for which this permit is issued.
❑1 have and will maintain Worimes Compensation Imuran.,u mequued by Section
3700 of the labor Cimm.for the performance of the work for which this permit is issued.
My Workers Cal0on lnfromixg mer and Polity number am:
Carrier.[/ Policy No. C
ERTIFICATE OP^ uM noNFR KERS
COMPENSATION INSURA
(Thr section treed not be complain!If tic permit is from hundmddollars(SIM)
or less.)
I certify Not in the performance of the work for which this permit is issued,l shell not
employ any person in any mmner an m In became subject o the Woriam'Compensation
laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making Nis Cenificam of Exemption,you should
become wbject to the Worker's Compensation previsions of Ne Who,Cade,you mum
.J O forthwith comply with such provisions or this nem n,shall he deemed revoked.
z" CONSTRUCTION LENDING AGENCY
94 I W r which rat thea there is a comarmlion lending agency far Ne performance of
!Yi the wash fur which Ws,permit Is issued(Sec.309'i,Civ.C.)
QLender's Name
z Lenders Address
U Q 1 certify that 1 have mod this application and sum Nu on,and.information u -
U, P coma 141ra to comply with all city and county ordinances,and mate laws relating in
0 building Construction,and hereby Anderson rcpresenofims of this city to enter upon dee
ehovc es nal tiedjudgments,
property t far Inspection purricwhich may
(Wc)spree 10 save.indemnify and keep harmless Bre City of Cupertino against
z inConsequnce of lo,coreand exponsof this permit, may in anyway ettmc against mid City
(„)z A APPLICANT
of UNDERive STANDS
Nis permit.
APPLICANT UNDERSTANDS AND WIL PLY WITH ALL NON-POINT Issued by: Date
SOURCEREGU
SW rs w I roofs
e
OUS MATERIALS DISCLOSURE Type Of Roof
Will split auorfulme Wilding occupsetttom Orbandic haurdom materi6022'al
as aired the Cupertino Municipal Code,Chapter 9,12,and the Health and Safety
Code,ea..25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
Yes
If a roof is installed without first obtainingan inspection,I agree to remove
Will the to,a r foto building acupam esu equipment or devices which P g
it havardnas air conuminanm u fined by Ne Bay Area Air Quality Managcmcnt all new materials for inspection.
District?
E3 Yes
1 have mad the ha andous materials requirements under Chapter 6.95 ofthe Califor. s 1
nix Reath A,SarctyCede.Secures;25505.35533 and 25531.1 undersmnd that if dec Wilding
does not cummn I have Ant.deer it is m respomi flu,of untify or occupant of de
teyuimmcntsw W aanttrsneertiga or(kap Signature of Applicant Date
owner a „ All roof coverings'to be Class "B"or better
CITY OF CUPERTINO
I• 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32637012.00
DATE ISSUED. . . . . . . : 07/16/2004 _
RECEIPT #. . . . . . . . . : 26326
REFERENCE ID # . . . : 04070086
SITE ADDRESS . . . . . : 10325 STONYDALE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WRIGHT WHITELAW AND BARBARA H
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1029
RECEIVED FROM . . . . : JEFFREY FAULKNER
CONTRACTOR . . . . . . . : ATKINSON, THOMAS LIC # 141
COMPANY . . . . . . . . . . : VALLEY HEATING & COOLING
ADDRESS . . . . . . . . . . : 1171 N 4 TH ST
CITY/STATE/ZIP . . SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 294-6290
ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
_____ _____________ __________ __________ __________ __________ __________
BREMFURN NO UNIT 1.00 14.31 0.00 14.31 0.00
BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00
BREMRECEPT NO. OUTLETS 1.00 1.20 0.00 1.20 0.00
MPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
BSEISMICRE VALUATION 1, 000.00 0.50 0.00 0.50 0.00
EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
__________ __________ __________ ----------
TOTAL PERMIT 127.61 0.00 127.61 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ____________ __-_______________
OTHER 127.61 MASTERCARD
TOTAL RECEIPT 127.61
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
46UPERTINO
Building Department
JOB ADDRES5f I PERMIT # Q
z
OWNER'SNAW. PHON-4
GENERAL CONTRACTOR, FAX#
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Ekcavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating �—
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
•
i
Contractor Signature Date
•T � r.
CITY OF CUPERTINO
FURNACE/AC
SPUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
32,C
Owner's Name: hgne :
Wk e, aLO la)/1 vlf PM1# 7 j2 • ��S'�
Contractor• P one:lti License#:
t �vfi h f C,oUI� Sh u
C tact: hone: Cupertino Business License #:
lnl(r IVI((AY� U� Zfi4. U2,1U /*
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description:
11 A KO aQK, TU.
Residential Commercial ❑
For Rmg�idential In llations:
Attic LJ 0 floor 2"d floor❑
Adhere to min set back requirement E]
!or Commercial Installations:
Replacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
N i alla tion Plannjug Approval Required ❑
rojet:t- Type of Construction: r Occupancy u E
Strapped LJ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Re lacemenf
Qty. if
A.ppli a I Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 chn MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec d, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING