08010004 (2) CITY OF CUPERTINO �a� ah +ya ^` '�• n �' '- ' '
BUILIOING DIVISION PERMIT A+OL\ llA].( Avu� �A *`" t F
u'�sL.�. ��. P@�syn TEs
BUILDING D ESS: v - c PERMIT NO.
REDONDO CT QUAN' S ELECTRICAL 08010004
OWNER'S NAME: PERMIT ISSUE DATE
HARRY VANDEVORT 10628 RANDY LN 01/02/2008
HONE SANITARY NO. CONTROL NO.
(408) 366-1823
CHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
o C LICENSED CONTRACT'OR'S DECLARATION
rdbF 1 hereby&from that 1 am limoad under provisions of Chapter 9(commencing Job Description
with Section 7")of Division 3 of the Butdrom and Pmfeulunr Cobs.rnd my license is CHNG FURNACE & ADD A/C @ SAME LOCTN
n❑y in full force and effect.
9 gJ Z License Class Lim.N
p Dam Contractor
ee �7y ARCHITECTS DECLARATION
tl U 1 undn
eund my plana shall ho useu
d public recounts .
5 Licensed Professional
OWNER-BUILDER DECLARATION
1 horthy olnrm Nal I am exempt from tiro Conuaaofs License Law for the
following mason.(Section 7(31.3,Business and Professions Cade:Any city or county
which inquire a permit to eonstmet,alter.improve,demol'uh,or repair my sNmum
Z y prior m its issuance.also mquims the applicant for such permit to file a signed su ament
'yx<
that he is licensed pursuant to the provishm.of the Coruscate.Lhomm IA.(CMpor 9 Sq.Ft. Floor Area Valuation
I-g (commencing with Section 7000)of Division 3 or the Business and Prefassmons Code)or $4300
- that he is exempt tMmfrom and the but,fa the alleged exemption.Any violation of
Section 7031.3 by aro'applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type
not mart than five hundred dollen(5500). 35621010:`fit
01,.sawn&ofdiepmpeny,sermyemployeewi0wg utheirsolecompmadnn,
will Pr Newmk.rode: he Comment',
License
owdo does
napply 7t an ownness Required Inspections
and PmRulau Cade:The C s domino k License Law rims cot apply lf an owner of q P
own emy who builds or improwa thereon,and who does such work Mmseif ser through his
awn employee,provided that each improvements wit art not ear of c aro@rcd Farads.if.
however,the building arimpmwment is aid within one Wild of completion,the awury
Wilder will Mw the burden of proving that he did tot Wild or improve for purpose of
❑1,as owner of Ne property am exclusively combing with licensed conwcmes to
contract Ne project(Sec.7094,Business and Prefewstou Code:)The Conuacmrs Li.
cense law does not apply to an owner of property who Wilde or Improv,Neeson,and
who contents for such projects with a comm ourfs)licensed pursuant to the Contractors
License Law.
❑tom m//em/j�1tL under see /yJ/4&P C fm Nis tenon
owner('tZ(MM V Z Le .
WO ER's COMPENSATION DECLARATION
I hemby a0hm under penalty of perjury am of the Following declarations:
I have and will maintain a Certificate of Conant se air-moor fm WorlCoupon-
oon,,as provided for by Secdon 37&0 of the labor Code,fa the performance of du
rk for which this permit is issued.
I have and will maintain Workers Compensation Imuranm,u acquired by Section
3700 of the labor Code,fa the performance of the work for which this permit is Issued.
My Workers Compensation Insurance coria and Polity numb...:
Cartier. Policy No.;
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE -..
mus mlan need not b completed if the permit is forme hundred dollen($100)
or less)
I certify that In the performance of the work for which this Permit is issued,l shall not
employ any nin my manners at become sex je a the Workeri Com en on
Laws of Cali i te
APPIi.s.
NOTICE TO APPLIC :11fS,making his CcNRcate of gimarption.Im simuld
become subject to the Workers Compensation provisions of the labor Cnde.you run
7.' faMwith comply with such provisions or this permit shall be deemed rommed.
OCONSTRUCTION LENDING AGENCY
[-h I mmby M.Nat there I..consumed..lending agency for the performance of
0.i> the work for which this permit B Issued(Sec.3097,Civ.C.) '
W�a Lender's Name ,
O z Lenders Address
V O 1 comfy that I have read this application and sum that the show:information u
Ty H contact,I ague to comply with all city and county ondinanms and amu laws relating to
O V building construction.and hereby authorise mprexnutives of this city to tomoupon the
W alpve-mendonod property fm lupecoon Purposes
gy (We)agree to save.imcmniry,and keep hoarier&the City of Cupemino against
ti f/1 liabilhim,judganum,case and expenses which may In any way acerae againatsamd City
t.1 7 in consequence of the Standing of this Farrah.
r7 Issued by: Date
APPL CANT UNDERSTANDS A D WILL COMPLY WITH ALL NON-POINT
SO BREGULATIO
U Re-roofs
Signature aft IfmMComraaor am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupantsmnt or handle hasardous material
ex defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and safety
code,same.25532(a)7
❑Yue, ®KNa All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or dcvicm which If a roof is installed without first obtaining an inspection(I agree to remove
it haxdd..air contaminants o defined by the Bay Arta Air Quality Management all new materials for inspection.
.vitt?
❑Yue &(No
I have read the huarMws materiabmquimn¢nu underCbpser 6.95 of Ne Oehler.
nia HcalN&Safety Code,kedam25505,25533and25534.Tmdemandthairdte Wilding
dam not cunt y hew a¢nut.Nu h u my reponsihiliry m notily time axupant nr d.
require whichmus,bm nr ar.c r &ramp Signature of Applicant Date
/ � ' All roof coverings to be Class"B"or better
Owner or amhons ageni D
agwr CITY OF CUPERTINO
FURNACE/AC
cl or
CUPEQ INO PERMIT APPLICATION FORM
APN# Date:
Building Address:
Il ), 41 i?eoegoo coap- r Cof&-zr,,jo C11 9Sz/V
Owner's Name: Phone #:
fl��nRY 6 V0AT s—/ 7
Contractor: Phone#:
y�urt-N'`S t=cCc't2iGAZ eo .
Fax#:
Contractor License #: Cupertino Business License#:
2- Geo G333Z
Contact: Phone #:
Fax #:
Building Permit Info:
Elect Er Plumb ❑ Mech Z
Residential Commercial
Job Description:
ChLpnCC �u2i/ACC- � /I-()D I /Af A/C flkML Lo CAT,vn/
For Residential Installations:
Attic ❑ I"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 Re wired ❑
Cost of Project: Type of Construction (Usage Class):
A41360 C;-4u
Strapped ❑ On Platform ❑ Bonded P New Location ❑ Replacement
Valuation:
Green Building: Must attach Green Building Check list to this application
CITY OF CUPERTINO
FURNACE/AC
CUPEf�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1MCRAA Commercial-Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by this _
code.
1MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1MCSUSHTR Commercial InstalI/Relocate ea M
suspended heater,recessed wall litr, or
floor mounted unit heater.
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed & not incl in an appliance
permit.
1BSEISMICO Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1MRAPPVNT Residential for the install/relocate/ or M
replacement of ea appliance vent
install ¬ incl in an applpen-nit.
CITY OF CUPERTINO
, gFURNACE/AC
•CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1PGASRES Residential for ea gas piping system of P
1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
/ 1BSEISMICR Residential Seismic B
1MECPLNCK Mechanical Plan Check M
1MFR=<100 Furnace Syst <=100k BTU install or M
relocate ea forced-air/gravity type
/ furnace/burner, incl ducts/vents
attached to such appliance up to and
• include 100,000 Btu/h
1MFRN>100 Fumace Syst> 100k BTU install or M
relocate ea forced-air/gravity type
fumace/bumer, incl ducts/vents
attached to such appliance over
100,000 Btu/h
1EPERMITFEE Electric Permit Fee , E
II 1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
•
CITY OF CUPERTINO
FURNACE/AC
CUPEfi;TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Grou
AIR FURN/AC
CONDITIONING
1BCAIRIIAN Commercial A/C Units <= IOk CFM B
1MCRAA Commercial Mech Repair/alt/add M
1BSEISMIC0 Seismic Commercial B
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet. Comm/Resid
1BREMAIRHAN Residential A/C units <= l0k CPM B
IMRRAA Residential Mech Repair/alt/add M
1BSEISMICR Seismic Residential B
1EPERMITFEE Electric Permit E
1MPERMITFEE Mechanical Permit M
1PPERMITFEE Plumbing Permit P
1TRAVD0C Travel Documentation B
IBUSLIC Business License B
•
CITY OF CUPERTINO
• 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35621010 . 00
DATE ISSUED. . . . . . . : 01/02/2008
RECEIPT # . . . . . . . . . : BS000003593 '
REFERENCE ID # . . . : 08010004
SITE ADDRESS . . . . . : 11249 REDONDO CT
SUBDIVISION . . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HARRY VANDEVORT
ADDRESS . . . . . . . . . . : 11249 REDONDO CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : DAVID D CHENG
CONTRACTOR . . . . . . . : HIEN Q TRUONG LIC # 23332
COMPANY . . . . . . . . . . : QUAN'S ELECTRICAL
ADDRESS . . . . . . . . . . : 10628 RANDY LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 366-1823
• FEE ID UNIT---- QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------- ---------- ---------- ---------- ---------- --- ---
1BSEISMICR VALUATION 4, 300. 00 0 .50 0. 00 0. 50 0. 00
IEPERMITFE FLAT RATE 1. 00 40.:79 0. 00 40.79 0. 00
1MFR=<100 UNITS 1. 00 122 . 38" 0. 00 122 . 38 0. 00
1MPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00
1PPERMITFE FLAT RATE. 1. 00 40 .79 0 . 00 40.79 0. 00
ITRAVDOC FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 286 .04 0 . 00 286 . 04 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 286 . 04 VISA
---------------
TOTAL RECEIPT 286 . 04
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
113 SLAB 301 ROUGH PLUMBING
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 506 GAS TEST
507 FINAL PLUMBING 508 FINAL MECHANICAL
Community Development
" 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
CUPEkTINO
®
Building Department
JOB ADDRESS: PERMIT #
11 -2-Y-? /ZC-DoN)o (fou/-T, Gu/Jc-Rj ,Jv C/¢ 6Owe/ L'1
OWNER'S NAME: 4#rzn vow oC- 7 PHONE # >' /7 o f/ I-
GENERAL CONTRACTOR: a4,40'J EcC-eMWl L FAX #
I am not using any subcontractors:
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
ankSheet Metal
Sheet Rock
Tile
•
Owner/Contractor Signature Date