07050221 7-7
CITY OF a ERTINO
BUILDING DlvlsloN PERMIT ] GTC3R I � I�Nt
PERMIT NO.
BUILDJN)^rQDD(�$SGE CT TBD - Tt? BE DETERMINED 07050221
OWNER'S NAME:[� PERMIT ISSUEDATE
MAN FU & ALICE YANG 05/22/2007
HONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
!00 LICENSED CONTRACTOR'S DECLARATION Job DOSCrIpUlOn
,w= I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
.z, with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE EXISTING FURNACE, ADD A/C FIRST
a a in full force and effect. G 43
i n? License lass C- 7-C) Lic.ft O CHOICE
w Date z2^� ARCHITECTS DECLARATI N fr hog HVAC PAID FOR A B/L ON 5/22/07 IN FIN DEPT.
a
i z < I understand m plans shall be used as public records
my P R#01000 )37989
)qV
U.H Licensed Professional
y j OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
< which requires a permit to construct,alter,improve,demolish,or repair any structure
Zy prior to its issuance,also requires the applicant for such permit to file a signed statement
_`e that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ,q.Ft.Floor Area $4800 Valuation
f:t— (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 ofNumber Occupancy Type
not more than five hundred dollars(5500). 3590600 3:�1
❑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 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.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Coml3ctor'S Li-
cense Taw does 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.
E]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 Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are: C
Carrier. Oe✓ U a
Policy No.:FVWC V r
CERTIFICATE OF EXEMPTION FROM 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,1 shall not
employ any person in any manner so as to become subject to the Workcrs'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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
E-+►�-+ I hereby affirm that there is a construction lending agency for the performance of
fx n> the work for which this permit is issued(Sec.3097,Civ.C.)
aA Lender's Name
a
Lender's Address
U C) I certify that 1 have read this application and state that the above information is
LL " correct.I agree to comply with all city and county ordinances and state laws relating to
OU building construction,and hereby authorize representatives of this city to enter upon the
U 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 in any way accrue against said City r
U Z in consequence of the granting of this permit. Date
h" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
S-Z21--0 Re-roofs -"
Sig CDc Date
US
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.hall be inspected prior to any roofing material being installed.
0 Yes pit_
If a roof iE installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes Nu
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safcty Codc,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant or the
requirements which must be o ssuance of a Certificate of occupancy. Signature,)f Applicant Date
��'0-7All roof coverings to be Class"B"or better
Own razed agent Date
CITY OF CUPERTINO
8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 1
Sec : Twp: Rng: Sub: Blk : Lot :
APN . . . . . . . . : 35906006 . 00
DATE ISSUED. . . . . . . : 05/22/2007
RECEIPT # . . . . . . . . . BS000001424
REFERENCE ID # . . . : 07050221
SITE ADDRESS . . . . . : 921 SAGE CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MAIC FU & ALICE YANG
ADDRESS 921 SAGE CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : FIRST CHOICE HVAC
CONTRACTOR . . . . . . . : TBE - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBE - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . .
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
BREMRECEPT NO. OUTLETS 1 . 00 1 .20 0 . 00 1.20 0 . 00
BSEISMICRE VALUATION 4, 800 . 00 0 . 50 0 . 00 0 . 50 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 176 .24 0 . 00 176 .24 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 176 .24 1636
---------------
TOTAL RECEIPT 176 .24
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
CITY OF C UPERTINO
y FURNACE/AC p' 5oaa
CUPEkTINO PERMIT APPLICATION FORM
APN# - oo
3a 7
Date-
Building Address:
' ( �
Owner's Name:,___ Phone#:
contractor: -- - — Phone: License #:
��s C
ntact: Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elecvf:jl"- P.umb ❑ Mech Imo'
Job Description:
LIC rC r 2 Cc <
Residential J I
Commercial
For Residential Installations:
Attic ❑ 1"floor 9 2nd floor❑
Adhere to min set back requirement
For Commercial Installations:
.replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation El
New installation Planning Approval Required ❑
Cost of Pro j cy Type of Cg l0onn Occupancy group:
Strapped ❑ On Platform ES- Bonded Sq.Ft. Floor Area:
New Location C�-- Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfin MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL
BREMRECEPT Rccptl, Switch& Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE El-1c Permit Issuance ELECTRICAL
MPERMITFEE M,-,ch Permit Issuance MECHANICAL
( PPERMTTFEE Pliunbing Permit Issue PLUMBING
BPERMFEE BI Ig Permit Fees BUILDING
BPLANCHK Pl;m Check Fee BUILDING
BPGAS G:Ls Piping System Fee PLUMBING
BUSLIC Business License BUILDING
Community Development
,Tt�, 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
MY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT#
OWNER'S NAME: M& ,i PHONE # 3
GENERAL CONTRACTOR: %r j C�r FAX# 2-GS - 2.6 7
I am not using any subcontractors: 5'ZZ -0
Si„nature 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
Tile
Owner/Contractor Signature Date