08010016 CITY OF CUPERTINO ns"`� '" »^ •'` �^ r
BUILDING DIVISION PERMITo.
' CON'CRAC�TOR INFQRMA.TION '
N
Bu1L�Ihagf,jjQttFs�,ARALLONE DR CONDITIONED AIR P08010016
OWNER'S NAME: PERMIT ISSUE DATE
JIE ZHANG 1701 LITTLE ORCHARD ST- * 01/03/2008
INNE: - SANITARY NO. CONTROL NO.
(408) 291-2220'
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDOO ELECTO PLO MECH
O
Sop LICENSED CONTRACTOR'S DECLARATION
I Wreby affirm that l w lianaed under provisions of Chapter 9(emmnncing Job Description
n<S wid Sectian7000)of Divfuom3ofthe Badneumd Profons Code,sedmylucnseh REMOVE & REPLACE FURNACE
fret faire and if
3 Deu 11 Vile
Centramar s9A
AA91 mo DECLARATION mI undcnanJ my pure shall W used u public cnNa
O
t Licensed Prefeasienal
b8 OWNER-BUILDER DECLARATION '
.�<E I Wmhy affirm Net 1 em exempt from the Contractors License Law for the
i O o following mason.(Section 7031.3.Bueineas and Professions Code:Any city or county
IRT which m9uiw a Permit to conarucL alar,improve,demulush.or repair any Mature
_Zj, prior it)its issuance.also requires Ou applicant rot such Permit in file a signed saemeni
ss< that W is licensed Foremast to the provisions of the Connector'Liecve Law(Chapmr 9 Sq.Ft. Floor Area Valuation
~3 (commencing with Schon 700g)of Division 3 of the Bmineand Professions Code)or $6750
-. Nu ha is exempt therefrom and de basis for the alleged emmpeon.Any violation of
Section 703"by any applicantfor a permit subjects the applicant to a civil Faulty ofNumber Occupancy
not mem don Ove hundred dollars(SM 36935023 �� Type
❑L u Meter of and
Property,r my empleym or offered
wgu u their",eemFewtiess
will Pr fewon'and e: ah Camra not s License
or a w do forota(Sec.7014,Busies
and Pmhualau code:The CentrMtor'a License Law dch not apply lf rt owner of Required Inspections
propertywho s,provided that
who eausuchwort himselfedthrough his
men employes,provided prove Imps mid wiitamaces oundcemeRered farsesicthe ow.
l(.
Auntie,the building or improvement Ice sold within ore Wild ar comm a for the ower'
builder will have de burtlen of proving do las did an,Wild m improve for purpose of
uu.l.
D I,me ower of the pmpmy.am exclusively conuscting wid licensed conmtmora m
=nstmct the pmjecs(Sec.TOld,8uinm mM Profession Code:)The Contractors U.
cense Law dw not apply in an ower of property who Wilds or improve theremn,and
who covowls for such projects wid a eentraelertU luensed purawnt to the Co rektor',
License Law.
D lamucmptunderSee ,Bd PCr.Misreuon ...
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby antro under penally of perjury,nu of the following declarations:
have and will maintain aCmdOasu of Consent to se161reum far Warkera Campo.
ion,u Provided for by Section 3700 of the Labor Code.for the performance of the
WM for which this Permit is Wised.
1 hm and will maintain Worker's Compensation Issuance,u required by Section
7BD of the Labor Code.for the performance,of de wart for whichg mdta permit Is 0lasyued. '
My Worker's Composr2oad.vyOOhwnmc carrier and Policy nuymsbgr V Old,LM 5 11
Carie DSI VL VNCee. 1 A0 itdf�olicy No.12 11 V
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This Seaton need not W completed if tbu permit Is form=hundred collas($RIO)
or Inca)
1 cenlfY that In the performance of Me wart fm which this permit is issued.l shall=t
employ any person in any m==rso as to become subject to the Worteri CompensNon
Laws of Califomra.Data
Applicant
NOTICE TO APPLICANT:IL after mating this Cenlfrcem of Exemption.you Mould
become Mbleee he the Workers Compensation provisions of too Labor Cade,yen masa
Q O fnMeith comply with such provisiore or this permit shall Wro
dned revoked.
E7) CONSTRUCTION LENDING AGENCY
ti
F I her which rndndem 4oeoruSecd 097,Cing agc=y for do perfonnartce of
fX Le work for which this permit u id=d(Sec.J097,Civ.G)
6Wi 0 lender's Name
r7 Z Lender's Address;
t.9 Q I certify that 1 have mad this application and sou that the&bow;information is -
W MMUL I agree to comply with all city end county and nmcu and sum lawn miming to
Q building construction.and hereby mthode,mpresenlulvm of this city to enter upon the
ahovcmentioned pmpeny for inspection purposes
L1s (We)agree to cave,indemnify and trop harmleas the City of CupeAno agalmi
rA Iimilidm,judgments.emu and upemm which may In any my amus against saidCity
V Z in conseq=nce of the granting of this Permit.
APP (CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:. - Date
SOU CE REGULATIONS. 1
`2 O,v
{� Re-roofs
i alum o(ApplicsnUCan Data
H DO US MATERIALS DISCLOSURE Type of Roof
Will de applicant Or future building aecupaelatore or handle haurdous material
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Heald and Safety
Code.Section 25532(.)7
❑Ym W...IA,NM All roofs shall be inspected prior to any roofing material being installed.
Will do applicant or future building oceupane ase equipment or devices which If a roof is installed without first obtaining an inspection,,I agree to remove
It huardom sir c..i.0 as defined by de Bay Ams Air Quality Management all new materials for inspection.
uict9
Dy. 9�No
I have mW de hicareusr materials mquimmenu under Chapter 695 of the Calif..
nuHulthhSafcty CndeS.ct.M505,25533am125534.1undenwedatifdc wilding
dw wt curmndy have a uncal this B Is my responsibility to nmify M compare of the
our.' =no which a=WmeI 'rtoivuveeafaCenities f Signature of Applicant Date
1131097 All roof coverins to be Class"B"or better
Owocr or mdomcd ager Q Dau 9
o�� C Go ( (,o
CITY OF CUPERTINO
` FURNACE/AC
CITY OF
•CUPEkTINO . PERMIT APPLICATION FORM
APN # 3 6q • 35- OL-5 , Co 0 Date. ( / a /0$
Building Address:
10111 -Far-8hooe Ar• C s• .n0 G4 R%0 14
Owner's Name: Phone#:
-s%q, Z Yi 6 - os C6
Contractor: Phone#: La4 ' Z.?►ZO
Q00d,-Ai% ow. Fax#: a4( • ?,Me(
Contractor License#: Cupertino Business License#:
41kcbl Z-
Contact: Phone#: cbVtm E
�J tYt k*Ae G e l le Fax#:
Building Permit Info:
Elect❑ Plumb ❑ Mech AL
Job Description:
Spey of sv4 a•e ex-ace i'Cu-on ,
Residential Commercial LJ
For Residential Installations:
Attic [ 15`floor ❑ 2nd floor ❑
Adhere to minimum setback requirement ❑
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 Construction (Usage Class):
co ,Z SO . 00
Strapped ❑ On Platform 11 Bonded ff New Location Replacement
Valuation:
Green Building: Must attach Green Building Check list to this application
CITY OF CU
PERTINO
. FURNACE/AC
OF
I&PER,TINO FEE SCHEDULE
FURNACE:
Qty. if
Applicable Fee ID Fee Description Fee Group Permit Type
MCRAA Furnace M FURN/AC
MCREPALT Commercial Mech Repair/alt/add M
MCSUSHTR Commercial Suspend Wall/floor M
Heater
PGASCOM New Gas Piping System 1-4 Outlets P
Commercial
BSEISMICO Seismic Commercial B
MRRAA Residential Mech Repair/alt/add M
MRSUSHTR Residential Suspend Wall/floor M
Heater
BSEISMICRE - Seismic Residential B
MFLRFURN Install/relocate Floor Furnace M
MECPLNCK Mechanical Plan Check M
MFR=<100 Furnace Syst<100k BTU M
MFRN>100 Furnace Syst> 100k BTU M
MRAIRI AN Comm/Res< 100k BTU M
EPERMITFEE Electric Permit Fee E
MPERMITFEE - Mechanical Permit Fee M
BREMRECEPT Electric Receptacles E
PGASRES New Gas Piping System 1-4 Outlets P
Residential
BPGAS Gas Piping System 5+Per Outlet P
/ TRAVDOC i Travel Documentation B
BUSLIC Business License B
CITY OF CUPERTINO
• 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36935023 . 00
DATE ISSUED. . . . . . . : 01/03/2008
RECEIPT # . . . . . . . . . : BS000003606
REFERENCE ID # . . . : 08010016
SITE ADDRESS . . . . . : 10777 FARALLONE DR
SUBDIVISION . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JIE ZHANG
ADDRESS . . . . . . . . . . : 10777 FARALLONE DR -
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : CONDITIONED AIR
CONTRACTOR . . . . . . . : RICHARD READ LIC # 22334
COMPANY . . . . . . . . . . : CONDITIONED AIR
ADDRESS 1701 LITTLE ORCHARD ST
CITY/STATE/ZIP . . . : SAN JOSE; CA 95125
TELEPHONE . . . . . . . . : (408) 291-2220
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ------- -------
1BSEISMICR VALUATION 6, 750. 00 0.70 0. 00 0 .70 0. 00
1EPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00
1MPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00
1MRRAA UNITS 1 . 00 61.19 0. 00 61 .19 0. 00
1TRAVDOC FLAT RATE 1. 00 40.79 0. 00 40 .79 0 . 00
---------- ---------- ------ ---------
TOTAL PERMIT 184 .26 0. 00 184 .26 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 184 .26 VISA
---------------
TOTAL RECEIPT 184 .26
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
113
-- -------- ---
113 SLAB 301 ROUGH PLUMBING
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 506 GAS TEST
507 FINAL PLUMBING 508 FINAL MECHANICAL
•