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04090041 ' CITY OF CUPERTINO. _ �s �c7^s� ''p g7�*yds` �j�7 "�' BUILDING DIVISION - PERMIT `NjW01\;LIA"'v A�'al*�0MUM66N., ' BUILDING ADDRESS: A PERFECT CLIMATE PERMIT"04090041 OWNER'S NAME: PERMITLSSUEDATR MARIA CHAU E: SANffARYNO. CONTROL NO. 408 861- ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ?Cp LICENSED CONTRACTOR'S DECLARATION O O 1 hereby slfam Nes 1 Bre licensed under previsions of Chapwr 9(commencing Job Descrlptl NNALED nz1 with Section 70W)of Divisio Sof dor Business and Profossions Coda,and my licenso is <; mfollfo ;o;off , �'� 3 _P, EPLACE FURNACE & ADD A/C j z License CI Lk.X ;� Date conwacmLA OCT iz 2004 RCHIECrs DECTION, a I un&maml my plans shall M cud as public records 0`u BUILDING 3 G Licensed Pmlcainnel p ^ 5 5 OWNER-BUILDER DECLARATION '\tl,V aI I hcrehy affirm that I am axempt from the Cnnlncute.License Law for the a o following reason.(Section 7031.5,Business and Pmfesiva Code:Any city or county $ which requires a permit In Consumer.altar,improve,demolish,or repair any mucous t-zeprior In its issuance.also requlru the applicant for such permitm file a signed statement the he is licensed pursuanuo the pmvisiom of the Co.,wcturs License Law(Chapter 9 Sq.Ft.Floor Area Valuation ad (commencing with Section 7(1001ofoivision 3 of the Business and Professions Code)or Nat he is exempt therelmm and Ne mals for Ne alleged Cameroon.Any viahfion of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 MXM5DlAer 0 0 Occupancy Type not.. than five hundred dollars(S500), P Y YP ❑I,a owner of the pmpeny,or my employee whh wages m Noir sole compensation, will dathewank.ande: he Corrosion's License den not (See ADW,Baines and ery wh obu builds The Conthemon,License law dam not apply w an owner or - Required Inspections property who bu ilds or f m pmvu thereon,and who dao tach work himselr ed through his Own employees,pmvi&dthat provemimprovementsarene year fooraQered far We.IL however.Neave he arimprovementiehal within one Wild or completion.the owners builder orifi have the burden of proving WI he did not Mlld ar improve for purpose of cath.). ❑1.as owner of she property,am utlusively contracting with licensed Contractors to construct the project(Sec.70dd,Business and Pmfesioa Gude:)The Conaamuses Li- Oman law dols not apply w an owner of property who holds or improve thereon,and who contracts for such projects with acan mun(s)licensed pursuant in the Contractors License Law. ❑1 am exempt under Sec. .B&P C for this recon Owner Dec WORKER'S COMPENSATION DECLARATION I hereby upon under Penalty of perjury arc of the following declarations: have and will maintain aCenificate of Consent to self-insure for WaimeaCompen- tian,a pnavidcd for by Section 3700 of the labor Code.for the performance of the work far which this permit is issued. �Tijave and will maintain Worker's Compensation Insurance,a required by Section 33700 of the Labor Code.for the performance of the work for which this permit is issued. My Workers amps oda au rice snow and Policy n Mom: �{2. Cartl 3\\PPQqIIry Na.: % . CERTIFlCATE0FEATIOWNNFR0M RK - COMPENSAT111IIIBBBOBBMMMMNM''"{((((NSURANCE (This section need not Mcemplewd if she Introit Is foronehundred dollars(510() or loss.) 1 certify that in the performance of the work for which this permit is Wood I shall not employ any person in any homer an as to become subject to tM Workers'Compensation Lows of California.Dow Applicant NOTICE TO APPLICANT:IL after making Nu Ccni0caw of Exemption,you should Mcome subject to ncc Worker's Compensation previsions of the Labor Code,you must .J O faMwith comply with such provisions or this permit shat]M doomed ownkod. ,zr tiCONSTRUCTION LENDING AGENCY [—t I hereby affirm that thea is a coawctinn lending agency for the performance of 0.a 7 the work for which this permit is issued(Sec.3D97,Civ.C.) aQ Lender's Name z Lender's Address V Q I certify that I have read this application and slow that the above information is tL E' correct.1 agree in comply with all city and county ordinances and soon laws relating in V building Construction,and hereby amhodre repnesenlotivu of this city in enter upon the [I] above-mentioned property for inspection purposes. Lis, !1 (We)agree to an,indicatory and stop hrtmlass the City of CuPCr im,against �t 14 liabilities,judgments,casts and expenses which may in any way&Come against mid City C) in consequence of the granting of this permit k ,_ APPLICANT'S AN AND WILL COMPL WW NONPOJ��O Issued by: 60 Date AP RCE REG A 0 NON-PO 2 Re-roofs gig A en antraim, Da HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or town building Occupant tow or handle hawsolous material as dc0ned by the Cupenino Municipal Code,Chapter 9.12.and the Health and Safety Code,see es zss3z(an All roofs shall be inspected prior to an roofing material bei' ❑see P P Y g g installed. Will the applicant lecture building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove is havandous air contaminants a defined by The Bay Ama Air Quality Management all new materials for inspection. olicl7 ❑Yes 1 have mad the harardous materialsou uirements under Chmicrd.95 of the Califon nix Hcalth&StfeiyCo ,Sccdaa23505.25533and2553d.lun&rawnd Nazi[Oc building dons not cumnntly have a went Nat o is my m win my w aml,dor occupant of the quire Lvwichmust In met p'o two or aCCnificate0 C ropy Signature of Applicant Date r ormtharized agent D le All roof coverings to be Class"B"or better CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: nancyc COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35610034 . 00 DATE ISSUED. . . . . . . : 09/09/2004 RECEIPT 4. . . . . . . . . : 26971 REFERENCE ID # . . . : 04090041 SITE ADDRESS . . . . . : 8056 PARK VILLA CL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . : . . . : MARIA CHAU ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4008 RECEIVED FROM . . . . : A PERFECT CLIMATE CONTRACTOR . . . . . . . : SMITH, BYRON E LIC # 21144 COMPANY . . . . . . . . . . : A PERFECT CLIMATE ADDRESS 10570 S DEANZA BLVD CITY/STATE/ZIP : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 861-9545 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 7, 000 . 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 ----------------- ------------ ------------------ CHECK 176 .44 021218 TOTAL RECEIPT 176 . 44 VOICE ID' DESCRIPTION, VOICE ID DESCRIPTION O1 ROUGH PLUMBING 303 ROUGH MECHANICAL 04 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL S CITY OF CUPERTINO 41ogxx� J' FLIF�NACE/AC _UPERkTINO PERMIT APPLICATION FORM APN # /3 ,5(o _ — n Date: - Building Address: Owner's Name: C Phone #: �g-Z52- 5/0 Contractor: C C l Phone:�! S License Contact: Phone: rCupertino Business License #: Building Permit Info: V I 1 Bldg ❑ Elect Plumb ❑ Mech 9' Job Description: G Residential ©/ I Commercial ❑ For Residential Installations: Attic ❑ lst floor ❑ 2"d floor ❑ Adhere to min setback requirement❑ or Commercial Installations: eplacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: J ,z Type of Construction: Occupancy group: Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement ❑ fplyi�ab)e if A Fee ID Fee Description Fee Grou BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfn MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL 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 _ Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPERTINO Building Department JOB ADDRESSS PERMIT # Q OWNER'S NAME: PHONE # GENERAL CONTRACTOR I am not using any subcontractors: �6 Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical ZJ r 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 F Owner/Contractor Signature at