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10060074CITY OF CUPERTI BUILDING ADDRESS: 10131 ALHAMBRA AVE VNER'S NAME: HENRY KEYS I OWNER'S PHONE: 4084461739 LICENSED CONTRACTOR'S DECLARATION License ClassAe/lV Lic. # fi�;k Contractor / Az LI "A to I hereby affirm that I am lice under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. v0 BUILDING PERMIT CONTRACTOR: PELLE HEATING & AC PERMIT NO: 10060074 INC 3728 C CHARTER PARK DR DATE ISSUED: 06/11/2010 SAN JOSE, CA 95136 PHONE NO: (408)978 -7060 JOB DESCRIPTION: RESIDENTIAL COMMERCIALE] I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self - insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relatir g to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. n ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self - insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shal not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I m Ast forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relat ng building construction, and hereby authorize representatives of this city to enter i the above mentioned property for inspection purposes. (We) agree to save ...uemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date FURNACE CHANGEOUT Sq. Ft Floor Area: I Valuation: $1500 APN Number: 32623027.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPEC Issued by: Date: / RE- ROOFS: 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 all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &Safety Code, bons 25505, 2 3 and 25534. / Owner or authorized agent Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 4 ITEMS OF 4 CITY OF CUPERTINO PERMI" RECEIPT Sec: Twp: Rng: Sub: B1}:: Lot: APN ........: 32623027.00 DATE ISSUED.......: 06,'11/2010 RECEIPT #......... BS0)00010611 REFERENCE ID # ...: 10060074 SITE ADDRESS .....: 10131 ALHAMBRA AVE SUBDIVISION ...... CITY CU: ?ERT INO IMPACT AREA ...... OPERATOR: SylviaM COPY # : 1 OWNER HE14RY KEYS ADDRESS 10131 ALHAMBRA AVE CITY /STATE /ZIP ...: CU?ERTINO CA, 95014 -1203 RECEIVED FROM CONTRACTOR ... COMPANY ...... ADDRESS ...... CITY /STATE /ZIP TELEPHONE .... PE ALE HEATING STEVE PELLE PE ALE HEATING 3728 C CHARTE SAI JOSE, CA (438) 978 -7060 & AIR LIC # 27593 & AC INC R PARK DR 95136 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT - - - -- THIS REC ---- - - - - -- NEW BAL ---- - - - - -- ---- - - - - -- 1BCBSC ------- - - - - VALUATION -- ---- - - - - -- 1,500.00 ---- - - - - -- 1.00 ---- - 0.00 1.00 0.00 1MFR = <100 UNITS 1.00 126.00 0.00 126.00 0.00 1MPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 ---- - - - - -- 42.00 ---- - - - - -- 0.00 ---- - - - - -- TOTAL PERMIT ---- - - - - -- 211.00 0.00 211.00 0.00 METHOD OF PAYMENT --------------- -- CHECK TOTAL RECEIPT AMOUNT --------------- 211.00 --------------- 211.00 VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER --------------- - - - -- 4376 VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 507 FINAL PLUMBING CUPERTINO V"NTR ACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 JOB ADDRESS: OWNER'S NAME: C/j/� .1 GENERAL CONTRACT �� '.c E IT # E # �G�`'%�9 ESS LICENSE # ADDRESS: %�h�e t ZIPCODE: r __ _r �___ •. h.. .r.ncc lirnncn *Our municipal code requires all businesses working M the city a �., - _r -____ _ NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Date Si mat c.,hrnntractors and comDlete the following information: Sheet Rock Tile wner I Contr for Signature ,./a — /X —/'o Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring /-Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile wner I Contr for Signature ,./a — /X —/'o Date CCkTY OF CUPERTINO CITY OF CUPERTINO FURNACE /AC PERMIT APPLICATION FORM /l APN # r ; �� , �/. /� Date: Bu RN ddress: � A �/1Q m b v-� Ow is Name: V� S Phone #: �-� 08• ��co . n 3 Contracto Phone #: L-t0% .CL� • �OC� Fax #: 9-1 41 'qv Contractor License #: Cupertino Business License #: Contact: Phone #: r V coe I'C C/1/ i S�QI'1 rr Fax #: ��`g. 'Ll43 . 'J� Building Permit Info: Elect � Plumb Mech Residential Commercial Job Description: �, �L1, y-Vt -C<i CAA -a v' rf � For Residential Installations: Attic F1 15` floor j" 2 °d floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight F] Additional weight (structural calcs) E] Structural Calculations required for new installation New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): 4 LJoD . N Ac' -.lv Strapped H On Platform Bonded F1 New Location Replacement Project Size: Express ❑ Standard Large Major ❑ Valuation: Green Building: Please complete relevant portio n of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. v- „__....,.a Al /n7/nn AGv1JGUVI/viiv-� t 0 3 C � TO ( - f(-f, 7'�'-4 e, , - CITY OF CITY OF CUPERTINO FURNACE/AC '�oiii i FEE SCHEDULE CUPERTINO floor mounted unit heater. Quantity Fee ID Fee Description Fee Group Permit Type 1MRAPPVNT Residential for the install /relocate/ or replacement of ea ;appliance vent install & not incl in an appl permit. M FURNACE FURN /AC 1 PGASRES Residential for ea gas piping system of 1 -4 Outlets P 1 BPGAS For each gas pip: ng system of 5 or more per outlet. P 1BCBSC Cal Bldg Standard,; Commission Fee B ALL PERMIT TYPES 1BSEISMICR Residential Seismiz B 1 MECPLNCK Mechanical Plan Check M r I 1MFR = <100 Furnace Syst < =IG0k BTU install or relocate ea forced- air /gravity type furnace/burner, inc 1 ducts /vents attached to such aI pliance up to and include 100,000 Bl u/h M IMFRN >100 Furnace Syst > 100k BTU install or relocate ea forced- air /gravity type furnace/burner, inc 1 ducts /vents attached to such appliance over 100,000 Btu/h M I EPERMITFEE Electric Permit Fee E 1 MPERMITFEE Mechanical Permil Fee M 1 PPERMITFEE Plumbing Permit P ITRAVDOC Travel Documentation B