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06050093 CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: ABC COOLING & HEATING PERMIT NO.0 6 050093 1155 STAFFORD DR OWNER'S NAME: PERMIT ISSUE DATE YI WANG 31845 HAYMAN ST. 05/10/2006 INE: SANITARY NO. CONTROL NO. (510) 471-8181 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH !00Z LICENSED CONTRACTOR'S DECLARATION %m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description Zwith Section 7000)of Division 3 of the Business and Professions Code.and my license is >>y in mu force andef ot3 Z REPLACE EXISTING FURNACE 70K ADD ON A/C 2 TON i n? License s�_Lic.n 3`6 3 8 Date �01 C ntractor f 230 V & 20 AMP CIRCUIT � ARCHITE DFCLA Tl ae l understand my plan shal used ad c o a �yU u.t�7 Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the COO following reason.(Section 7031.5,Business and Professions Code:Any city or county <m V which requires a permit to construct.alter,improve.demolish,or repair any structure Z} 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 Sq.Ft. Floor Area Valuat' 1617 2 t-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y .. 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 ofApN 6 gT 2er 0 0 Occupancy Type Trot more than five hundred dollars 3(5500). 662 00 6 ❑1,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 ns Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q P 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.). ❑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 li- cense Law docs not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 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 Workees Compen- sation,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 Workers Compensation Insurance,as required by Section f 1 I 3700 of the labor Code,for the performance of the work for which this permit is issued ' 1 My Worker's Compensation Insurance carrier and Policy number arc: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Ohis 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 Qforthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY E.r►�-� I hereby affirm that there is a construction lending agency for the performance of _ �Y. > the work for which this permit is issued(Sec.3097,Civ.C.) WCs.Q L.endcr s Namc a z L.endee Address U I certify that I have read this application and slate that the above information is LL I correct.I agree to comply with all city and county ordinances and state laws relating to 0 building construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. >4 W (We)agree to save,indemnify and keep harmless the City of Cupertino against /17 V) liabilities,judgments,costs and expenses which may in any way accrue against said City U z in consequence of th ranting of this pe S4�� APPLICANT U STAND A LL CO Y WIjH ALL N-POINT Issued by: Date SOURCE,AE " '� r o�a Re-roofs Signature of ApplicamUContractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes VA_ 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? �- ❑Yes t}irvo 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not curcn I have a rant tha[itis my responsibility ro notify the occupant of the requirements which met pno =jofaCcrtAiatcofOccupan cy Signature of Applicant Date 7 �o o� All roof coverings to be Class"B"or better Owner or authormcd agent Date CITY OF CUPERTINO .!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36206022 . 00 DATE ISSUED. . . . . . . : 05/10/2006 RECEIPT # . . . . . . . . . : 34344 REFERENCE ID # . . . : 06050093 SITE ADDRESS . . . . . : 1155 STAFFORD DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER YI WANG ADDRESS . . . . . . . . . CITY/STATE/ZIP . . . : RECEIVED FROM . . . . : BONITA JENKENS CONTRACTOR . . . . . . . : GERALD UNRUH LIC # 24643 COMPANY . . . . . . . . . . : ABC COOLING & HEATING ADDRESS . . . . . . . . . . : 31845 HAYMAN ST. CITY/STATE/ZIP . . . : HAYWARD, CA 94544 TELEPHONE . . . . . . . . : (510) 471-8181 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -- ------------- ---------- ---------- ----- 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 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 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BSEISMICRE VALUATION 6, 172 . 00 0 . 70 0 . 00 0 . 70 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 ---------- ---------- ---------- ---------- TOTAL PERMIT 176 .44 0 . 00 176 .44 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 176 .44 VISA TOTAL RECEIPT 176 .44 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL Community Development 10300 Torre Avenue j_ Cupertino CA 95014 Telephone(408)777-3228 CM OF Fax(408)777-3333 ruff �TINO Building Department JOB ADDRESS: -5,_ � (� PERMIT# OWNER'S NAME: Wcrr PHONE # GENERAL CONTRACTOR: ,�C FAX# I am not using any subcontractors:QBC (Qi- k - -� �o 6 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 Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock --TTile Owner/Contra for Signature Date CITY OF CUPERTINO DL0660(A3 F URNA.CE/AC CITY OF CUPERTINO PERMIT APPLICATION FORM APN# Date: Building Address: Owner's Name: Phone#: Contractor: y �./ Phone: L License#: Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Plumb l Mech Job Description: ,�y�O ZG !< 2- ,-,-3 C) z3d K +- 2-d Residential ' Commercial ❑ For Residential Inst ations: Attic ❑ 1 s`floor 2nd floor❑ Adhere to min set back requirement Kr -- For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of struction: Occu�anc oup: 6f7Z � 'c Strapped D On Platform 0 Bonded El Sq.Ft. Floor Area: New Location Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL 1 BREMRECEPT Recptl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL J MPERMITFEE Mech Permit Issuance MECHANICAL 1 PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING