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07020132CITY OF C;UFL-K111-1 BUILDING DIVISION PERMIT BUILDING ADDRESS: 1129 STAFFORD DR OWNER'S NAME: JAILING LIU )NE: ARCHITECT/ENGINEER Ice LICENSED CONTRACTOR'S DECLARATION 00 U3 0 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing Z tU„ with Section 70(10) of Division 3 of the Business and Professions Code, and my license is > > y in full force and effect Z License __ Lic. N F p Date Contractor ARCHITECTS DECLARATION j a < 1 understand my plans shall be used as public records )yU U. f- Licensed Professional G < OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the p O following reason. (Section 7031.5, Business and Professions Code: Any city or county < m 9 which requires a permit to construct. alter, improve, demolish, or repair any structure u " - prior to its issuance, also requires the applicant for such permit to file a signed statement - ? < that he is licensed pursuant to the provisions of the Contractor's License law (Chapter 9 _ (commencing with Section 7000) of Division 3 of the Business and Professions Code) or i that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 0 L 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 and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractor's U- rty who s or improves thereon. and who c contrLaw acts Cor sucnot h ply to an owner of rojects with a contractors) licensed dpursuant to the Contractor's License Law. B & P C for this mason 0 T am exempt under Sec. Owner Date WORKER'S COMPENSATION DECLARATION .7 C) Z� Q. A �z UO 0 >' a rte-' V. U2 e— PERMIT NO. AIR QUALITY HEATING & 07020132 ATR170N--- PERMrr ISSUE DATE 714 NORIHRUP ST 02/26/2007 SANITARY NO. CONTROL NO. (408)293-7138 BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description REPLACE FURNACE & DUCT WORK. ADD AIR CONDITIONING. El 32606013: I hereby affirm under penalty of perjury one of the following declarations: ] I have and will maintain a certificate of Consent to self -insure for Worker's Compen- atin, as provided for by Section 3700 of the Labor Code, for the performance of the vork for which this permit is issued. ►rave and will maintain Workefs Compensation Insurance, as required by Section 5700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier andiPolicy number carrier. i� r / �U i. y No..—g— C RTIFICATE OF EXEMPTION FRO WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (See. 3097, Civ. C.) Lender's Name Lender's Address 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 relating to building construction, and hereby authorize representatives of this city to enter upon the ahove-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 in any way accrue against said City in consequence of the granting of this permit. APPLI NT UNDERSTANDS AND WILL COMPLY WITH AL . NON POINT SOURY EGULATIO Sign re f Applicant/Con for te HAZARDOUS MATERIALS CLOSURE Will the applicant or future building occupant store of handle harArdous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)7 0 Yes o Will the applicant o future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management District? Ycs I have read the haz rdous materials requirements under Chapter 6.95 of the Califor- nia Health & SafctyCode, Sections 25505.25533 and 25534.1 understated thatif the building does not currently have a tenant, that it is my responsibility to notify the occupant of the muuircrriants which mtyt# met prior to#uancrAof a Certificate of "fancy. I _ authorized Issued b, Re -roofs Type of'Zoof Area $13300 Valuation ber Occupancy Type Required Inspections .-, — r '1 All roof:, 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 "B" or better Buildin Department JOB ADDRESS: PERMIT # OWNER'S NAME:.�� ' L u PHONE # qo3 GENERAL CONTRACTOR. , r I'L. 1 FAX # 410q,, _ ,p& I am not using any subcontractors: r �a o Signature Date Please check applicable subcontractors and con plete the followin information SUBCONTRACTOR Community Development BUSINESS LICENSE # 10300 Torre Avenue Cabinets & Millwork Cupertino CA 95014 C1Tll OF Telephone (408) 777-3228 ..UPE�TINO , Fax (408) 777-3333 Buildin Department JOB ADDRESS: PERMIT # OWNER'S NAME:.�� ' L u PHONE # qo3 GENERAL CONTRACTOR. , r I'L. 1 FAX # 410q,, _ ,p& I am not using any subcontractors: r �a o Signature Date Please check applicable subcontractors and con plete the followin information Owner/Contracto ignature Date SUBCONTRACTOR BUShvESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation 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 Owner/Contracto ignature Date 7 ITEMS OF 7 CITY OF CUPERTINO PERMIT' RECEIPT Sec: Twp: Rng: Sub:.Bll:: Lot: APN ........: 32606013.00 DATE ISSUED.......: 02/26/2007 RECEIPT #......••.: BSI)00000543 REFERENCE ID # ...: 07020132 SITE ADDRESS 11:?9 STAFFORD DR SUBDIVISION ...... CITY CU:?ERTINO IMPACT AREA ...... OWNER ............: JAILING LIU ADDRESS ........... CITY/STATE/ZIP ...: \U?ERTINO, CA 95014 OPERATOR: suew COPY # : 1 RECEIVED FROM ....: RE = PT INTERFACE CONTRACTOR .......: MATTHEW FARBER LIC # 22791 COMPANY ..........: AI2 QUALITY HEATING & AIRCON ADDRESS ..........: 711 NORTHRUP ST CITY/STATE/ZIP ...: SA9 JOSE, CA 95128 TELEPHONE ........: (408)293-7138 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT ---------- THIS REC - NEW BAL ---------- BENERGY ------------- PERMIT FEE ---------- 1.00 ---------- 34.86 0.00 34.86 0.00 BREMAIRHAN NO.UNITS 1.00 10.26 0.00 10.26 0.00 BREMFURN NO UNIT 1.00 14.31 0.00 14.31 0.00 BSEISMICRE VALUATION 13,300.00 1.40 0.00 1.40 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 MPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 ---------- 38.37 ---------- 0.00 ---------- TOTAL PERMIT ---------- 175.94 0.00 175.94 0.00 METHOD OF PAYMENT ---------------- CHECK TOTAL RECEIPT AMOUNT --------------- 175.94 --------------- 175.94 VOICE ID DESCRIPTION -------- ---------------------------- 303 ROUGH MECHANICAL REFERENCE NUMBER -------------------- 52978 VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF CUPERTINO FURNACE/AC UPER,TINO PERMIT APPLICATION FORM APN # 4-5 Date: Building Ad ress: Owner's ame: L-1 Phone #: q0 0 - 5 i ") - 68c� ]i CLA BREMACOVER Contracto . Phone: License #: i C jVC Units <= 10, 000 cfm Contact: Phone: ffi v�S4:) 05 - 9--V 3 - V/33 Cupertino Business License #: Building Permit Info: ELECTRICAL Bldg ❑ Elect Plumb ❑ Mech Job Description: f Icc t=� ,ti }—�ti_r uc-,tf- (-z. (cc C j -CL, c..U,)r Residential Commercial C] BUILIDNG For Residential VIlations: Attic C31S` floor2"d floor ❑ i �- G c :-lec Permit Issuance Adhere to min set back requirement- -CNS CL MPERMITFEE, 'or Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) MECHANICAL Structural Calculations required for new installation ❑ Plumbing Permit Issue New installation Planning Approval Required BPERMFEE Cost of Proje � Type of Construction: Occupancy ou 4-13 3� Flan Check Fee Strapped El On Platform LJ Bonded Ur Sq.Ft. Floor Area: d PLUMBING New Location Replacement 3usiness License Qty. if FP- n,-cnii-ntinn Fee Groun L i IV( aum- 1 VV 1L BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER iVC Unit > 10,000 cfrn MECHANICAL BREMAIRHAN jVC Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE "eismic Fee Res BUILDING BSEISMICOM ;seismic Commercial BUILIDNG EPERMITFEE :-lec Permit Issuance ELECTRICAL MPERMITFEE, Idech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE 131d2 Permit Fees BUILDING BPLANCHK Flan Check Fee BUILDING BPGAS Sas Piping Sy stem Fee PLUMBING BUSLIC 3usiness License BUILDING 1 q ou .__ (-V e- C- r) Ir c_.rm ICUq f