04120014 CITY OF CUPERTINO a.�s/�a' �♦�^I 'P gypa'�' ' T/,�f��TT''> ,
BUILDING DIVISION 'PERMIT- VVl\riVTR�1l0Ti�lA✓LA
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BUILDING ADDRESS: A PERFECT CLIMATE PERMITNG04120014
•, 10330 VICKSBImn DR - 'P�2MIT ISSUE DATA
OWNER'S NAME: -
. PARK YU 10570 S DEANZA 12/01/2004
ONE: - SANITARY NO. CONTROL NO.
(408) 861=9545
ARCHITECT/ENGINEER: '- - .. BUILDING PERMIT INFO - —
BLDG ELECT PLUMB MECH
ymoa LICENSED CONTRACTOR'S DECLARATION - Job Description --
, a1r I hereby afRrre that 1 am licensed under provisions of Chapter 9(rommencing -'
ith Sc g1U)ofDrvoom Softhc Bus(nlMal`Professiana Code.end mylicense is
ygi in uan la¢sderraL C�Qj oda aS REPLACE FURNACE
ip a
1—k DConuacmr4( �rj
- AR CHIT be TS DECLARA
. .I undersand my plana.hell be Add sspulaiarccnrds
Wt; Licensed ProfeSaional
3OWNER-BUILDER DECLARATION
mene
'1 hereby affirm
Nat 1 am exempt from the Commences License Law for the /� 1I
p0following reamn.(Setfim 7113 I.S.Business end Pmfe¢siuns Code:Any city.,county of.✓
u�$ which reclaims a Permit to construct,eller,improve,demolish,or repair any swcwm - l../ ,�1 '8340S -_
Fiy prior in its issuance.also,requires the applicant torsion Permit to rile a signed statement y
g G
that he is licensed Purmem to the powlsiune of the Commcturc License Law(Chapter9 ` - Sq:.Ft..Floor Area _ .. vt;;l )';Valuation _
N $ (commencing with Section 7000)of Division 3 of Ne Busimesand Profes¢inna Cede)ur .(f a 'l 'i'al�
3 that he u exempt therefrom and the Auer for the alleged exemption.Any violation of -
Section 7031.5 by any applicant for a permit subjects We applicant to a civil Penalty Of 3 5ia�) IIUQ 0 Occupancy--Type -- -
act more than fve hundred dollars(SSW): -
❑I.Ba owner of the pmpeny,ar my employees wit wages n their vile compemalme.
will do lite,work,and ammocture is not intended or.Rercd for Sale(See.7044,Business _ -
Bud Pmressimts Code:The Commemfs License Law docs not apply to an owner of Required Inspections 07tei. 4._,,,
pmpeny who bui lds or i mpmves them en,and who does such work himsel f or lluough his
own employers,provided thetauch improvements a¢not Intended oranercd forsete.If.
however,the Building.,improvement is sold within one year of completion,the owner-
builder will have the burden of proving Net he did not build or improve for purpose of
sale.).
1,as owner of du property.am=elusively eommeting with licensed contractors m _
consbuct Ne project(Sec.7044,Business and Professions Cade:)The Commicmr's Li-
came Law dos not apply to an owner of pmpeny who builds or imprown,theme .and, -who contracts for such projects with a comnctor(s)licemed pursuant m the Convactorb
Licenee Lew.
❑1 am exempt under Sec. .B k P C for Nis mann
Owner Data
WORKER'S COMPENSATION DECLARATION -
I hereby affhm under penalty of perjury oro of the following dacWuons:
I have and will maintain a Certificate of Consent to self-insum for Worker's Compen. -
737M
ion,A provided for by Section 37W of Ne labor Code.for Ne performance of be -
rkforwhichNispermitisarmed.1 ban and will maintain Werkees Compensation Insurance,A required by SectionofNeLaborCode,for the performance of Ne work for which Shia pored is issud.y orkcNa nmpemeuon lnmrantt cenier�end��oli/cy numbera�m:r. POI ..: Nq IJP za -
CERTIFICATE OF EXEMPTION FROM WORKERS'i, - -
COMPENSATIONINSURANCE
(This section need motto completed lithe permit is forum,hundred dollars($100)
or less.)
I certify that in the Performance of the work for which this permit is issued,1 shall not
employ any permit in any mannerso u in become subject to the Workers'Compensation
Law,of California.D¢¢ .-- - -
Applicant
NOTICE TO APPLICANT:If.Surer making Nis CcniRcase of Exemption,you should
beeome Subject m the Worker's Compensation previsions of She Labor Code,you must r
.�7z forthwith comply with such provision or this permit shall be deemed revoked.
7. CONSTRUCTION LENDING AGENCY
[-i 114 1 hereby affmm that there is a comtmction lending agency for the pe,rormenco of
ai the work for which this permit Is issued(Sec.309'i,Co.C.)
W� 0 Lender's Name ,
z Lender's Addmsa.
U C) I certify Net I have read this application Bad sum that Ne above information is
V. f•" co ociA agree in comply with all city and county on ineaces and Scale laws relating to - •- - - -- - -- -- . - _.. - - �.
OO building consWclion,and hereby motorize represematives of this city to enter upon the ._
1 move-mentioned pmpeny for inspection purposes _
(We)agree to save,indemnify and I¢ep harmless the City of Cupcninn against _
,Hy ti liabilities,judgments,coats and expanses which may in any way acema against said City
in conssgno coo'the ung at this pnmit.
APPLICANT U STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE NS.
I of I i Re-roofs
Sig t a Applicam/Conuaclor Dam
HAZARDOUS MATMALS DISCLOS R Type of Roof
Will the applicant or future building ocupant nme or handle haramous materiai
az defined by She Cupenina u ZBl Code,Chapter 9.13,and the Health Bud Safely .. .. '
mde,See ltiOne ne zss3z(a7 All roofs shall be inspected prior to any roofing material being installed.
�
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
not haaardom air common US defined by the Bay Area Air Quality Management all new materials for inspection.
DISIrICt7
❑Yes _
I have mad the ha,a,dods materials nomiroments under Chapter 6.95 clue,Calife,
itis HCalth&SefctyCodc,Secuom 255115,35533 and 25534.1 undcmtsnd lhmifthc building `
does not curemly have 10mot7thakft is my responsibility In amity the OCCUNIM of the
mood ksw '-h ane ' rmisseance,of eniricam or occupancy Signature of Applicant Date
o <,or ammmrived.sent i f Date All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
" Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPEt�TINO
Building De artment
JOB ADDRESS: PERMIT #
v ue cS VJA�r rJ `v-� o4 12 bel/
OWNER'S NAME: 02LL PHONE # 40� W I- Sq{S
GENERAL CONTRACTOR: FAX # r
I am not using any subcontrac -- I -� d 1
�!//o
Signature � Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass /Glazing
Heating ct 1 y
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
CITY OF FLfRNACE/AC
UPERTINO PERMIT APPLICATION FORM
APN # � Date:'�_1
Buildin Address:
o ` cry qso�
Owner's Name: Phone #:
rK (A A -
Contractor: Phone: License#:
e o� -73isFS
Contact: Phone: Cupertino Business License #:
air
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech
Job Description:
ke"NOV-0- (✓tack r w�
Residential [1,5._ Commercial ❑
For Residential Inst Mations:
Attic ❑ I" floor 2nd floor❑
Adhere to min set back requirement El,
or Commercial Installations:
eplacement same weight ❑ Additional weight (structural calcs) Eltructural Calculations required for new installation EDNew installation Planning Approval Required E]Cost of Project: "34osoS Type of Construction: Occupancy group:
�
Strapped = On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
A li 1i1e Fee ID Fee Description Fee Group
ENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMAI ROAN A/C Units <= 10, 000 cfr, MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
1 BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
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