06120121 `CITY OF CUPERTINO �•r,
BUILDING DIVISION PERMITC0NTR ,-i oR INFORMATION
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: r r Tr,,
YVONNE CHEN 1965 KYLE PARK COURT 12/21/2006
IV NE: SANITARY NO. CONTROL NO.
(408) 286-8931
ARCHffEC(ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
loo
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm Nal I am 0¢aed under provisions of Chapter 9(commencing
i
bir Section 7(X%))of Division 3 ofthe Business and Professiona Code,and my licenou:is REMOVE AND REPLACE FURNACE
in full force and eff - ��-
� i Liccta
se Cl Ce.S
r oDa¢ Contramr
' oe R CCS DECLARATION
i 1 understand my plans shall he used a public mcnrds
iyV
'py Licensed Professional
OWNER-BUILDER DECLARATION
<f I hereby a(Tum on I a1.cBust from the Contra Co IJccnu Law for the
C o following mason.(Sealers m3 su Business and ow,de oro Cade:Any tiny or county
%$v. which mquirns a perm,re consumer.the alcor,improve,demolish,or repair any swmom
�i-cpoor R)its issuancealeu mquira Novisiosoffar men permiuoflcasLaw(Chkmcm -
NanhcislicenscdpnrasanuoNcpmdsionsofthc[anuxmr'a lusrns law lCbpnm9 Sq. Ft.Floor Area 1900 Valuation
e (commencing with Section 7")of Division 3 of the Business and Professions Code)or
Our he is aeoapl therefrom and the basic for We alleged exemption.Any violation of
Section 7031.5 by any'appikon,for a permit subjects We applicant to a civil penalty of �,p�7 Number Occupancy Type
rot...Nan five hurMmd dollars($5W). 3 4 217 04 6 .W PlV'
❑Lo he woraf the therme,or myemntendedwith wagesvuei(Sec.eompeasauras
said do Ncwonal andh, ac Con unoUnmi cense oRemdforsakpply in a4,B.of Required Inspections
pompand erry wh ons Cadc:The Conuacmrs License law don rot apply if r t awnv of q P
own em who Wildsvided Oat suchiimrovounand hodassuchendedwork imselrorNmugh his
own ver.We
building
or i Nan such improvements are not intended mpictioroffered for sale.owner.
however.iU building or improvement u sold within one yea of completion.Ne seof
Wilder
said lure We burden of proving Nal he did ms Wild m improve for puryaa of
Cl
0 1,as comar of the property am re clasivcly canuacling with licensed Contramars no
mnstrom the project(See.7061.Business and Professions Code:)The Cmuano's U.
co ac Law dors not apply in an owner a property who builds or improves thereon,and.
who contracts for such pmjeca with a conuacmr(s)licensed pursuant to the Contractors
License Law.
0 lamexear"WiderSee .Bk PCfor Nisreaan
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 herby affm utWcr pensity of perjury arat o(Ne fallowing dmlamuons:
(ham and will maintaineCertificate of CameralmCrah.for forWarkcdceofth-
sham,r which
this
for by Section J]W of We Labor Code.for We performance of tar:
work far which Nis permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as visioned by Section
37W of We Labor Code.for We performance of the work for which this permit is issued.
My Wa oAmpenruiuon Iw�ra�rrtt rartirr�arW Polity number arc:
Came c
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
This section rated not he completed if the Noun,is fmonc hundred dollen(SIM)
less.)
I certify Wt in We Nifionsmove of Ne work for which this Permit is Lssmd.I shall Trot
employ any Noon in any manner m as b become subject o NC Workcn''Compensadon
Laws of California.Dau
Applicant
NOTICE To APPLICANT:If,after making this Ccnir:cam of Exemption,you should
become subject or to Workers Compensation provisions of the Labor Code,you most
.J O forthwith comply with such provisions in Nu permit shall he deemed rtwked.
Z rjy CONSTRUCTION LENDING AGENCY
'Ca I hereby affrm Nat Were is a construction lending agency for the performance of
'y.
We.,it for which this permit u emitted IS..3097,Civ.C.)
6W. Lender's Nam.
z lenders Address v
U Q 1 cenify Nat 1 hast mad this application and sum the We above information u -
IL P correct.I agree no comply with all city and county ordinances and state laws mla0ng to
.JU building Constriction,and heroby authons mpocientativeS or this city to enter upon the
lfl above mentioned pmpcny for inspection purposes.
H c. (We).,me ro save,indcmni fy and keep hamlcss the City of Cr,nfino against
cn liabilitins,judgments.coxa and expenses which may in any way accrue against said City
t-7 z rAnPPLslrCquNncrc a rami
TANDS Ars D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG NA %
Re-roofs
Signaurc of AppliaHAZ0, DOU - Date
xAznRoous Wilding MATERIALS DISCLOSURE Type of Roof
Will ticoCupamor(Muni buildingocmpaRaortor handle Health and
a defined by 25 Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section zss3z(a)+ All roofs shall be inspected prior to any roofing material being installed.
40 Yes o
Will the applicant orf tum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
coal,haxardnus air contaminants as defored by the Bay Area Air Quality Management all new materials for inspection.
District?
0y. N
I have mal We haardi rialxmquimmcnu under Chapmr6.9S ofthe Calif.,
isliusldrk SafctyCa Scetlera 05.15533 and 25534.I undersand thaifthc building
docs not current my ai n u my res rahllity m noury tat occupant ar tat
mquircoacnuw E.' Ipaorlomou nfacmtificamora. "my. SignatureofApplicant Date
Owner orauthont alascnt � `� All roof coverings to be Class "B"or better
CITY OF CUPERTINO
• 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34217046 . 00
DATE ISSUED. . . . . . . : 12/21/2006
RECEIPT # . . . . . . . . . : BS000000053
REFERENCE ID # . : 06120121
SITE ADDRESS . . . . . : 10723 SANTA LUCIA RD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : YVONNE CHEN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3939
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : TRILLO, STEVE LIC # 4269
COMPANY . . . . . . . . . . : STANFORD PLUMBING HEATING &AIR
ADDRESS 1965 KYLE PARK COURT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 286-8931
•
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
BREMFURN NO UNIT 1 . 00 14 . 31 0 . 00 14 . 31 0 . 00
BSEISMICRE VALUATION 1, 900 . 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 164 . 78 0 .00 164 . 78 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 164 . 78 8347
---------------
TOTAL RECEIPT 164 .78
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
Community Development
10300 Torre Avenue
r ).✓ Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
4WUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
Ib�z r� 0Cc lZc� Ocv\aoka �
OWNER'S NAME: PHONE # 9 4 --'1
GENERAL CONTRACTOR (L 114 C FAX #
I am not using any subcontractors:
Signature ate
Please check applicable subcontractors and complete the following ' ormation:
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
He
• -2 v
Owner/Contra ignature Date
CITY OF CUPERTINO
FURNACE/AC 0(01 a of 0
CUP kTINO PERMIT APPLICATION FORM
APN # Date:
Building Address: j a
Owner's Name: ! Phone :
ClLo ttyUyw -
Contracto Phone: License#
�3�1 - oSl
Contact: S � I Phone: Cupertino Business License#:
Building Permit Info: L/
Bldg El Elect ff Plumb E�` Mech 'f�—
Job Description: k—
Residential 11q
Commercial ❑
For Residential Installations:
Attic ❑ 151 floor ❑ 2"d floor❑
Adhere to min set back requirement❑
For Commercial Installations:
eplacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Gotr on: Occupa`nccyy group:
I �
Strapped ❑ On Platform @ Bonded 0 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 cfin 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
AIL BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING