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06060122 (2) CITY OF CUPERTINO BCILDINO DIVISION PERMIT �'CONTRACTQR INFORMATION i BUILDING ADDRESS: A `ECT ULIMP.TE PERMITND.06060122 21638 ROSARIO AV OWNER'S NAME: PERMIT ISSUE DATE YEN YAO _ 10570 S DEANZA BLVD 06/15/2006 NE: SANITARY NO. CONTROL NO. (408) 86119545 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG E1ECrPLUMB MECH Inc, LICENSED CONTRACTOR'S DECLARATION m I hereby affirm that 1 am licensed under previsions of Chapter 9(Commencing Job Description with suction 7W0)of Di mini Sof NC Basin.aM Profesdons Code^ndm liceveu m« to 25-1 a?) v y INSTALL FURNACE & A/C ��? Lice 1. Lie # d o Date ARCHMECI'sContractor CLARATON IIEEIy��ys fff� tttt]]]] �t PPP-��� wI McrsunJ my plans shall h used u public records FI NAL I3 H Licensed Pmfcssional ffggll 111t�ff Iti��a OWNER-BUILDER DECLARATION a� 1 hemhy alrirm Nm 1 am exempt from the Contractor's License Law for,W JUL 5 p o fallowing mason.(Section 7031.5,Business and Pmfmumin Code:Any city or county J — n/ np I_V which rcduiru a permit m tonsured,alter.improve,demolish,or mpoir any structure 2��6 $9874 prior On its issuance,also teyuau theapplicant far such Permit to file a signed statement EEO that he is licensed pursuant to the provisions of taeComracter'sLee.Law(Chapter9 Sq.Ft. Floor Area I luation R (commencing with Section 7000)of Division 3 of the Business and Prefessimm Code)an Q Nat he u exempt dominant and the baso for the alleged exemption.Any violation of P nphill , Suction 7031.5 by any applicant for a permit subjecu the applicant in a civil family of —'" u u U 'Obbuoincy Type not mart than fnw hundred dollars(MI ❑Lumamaof the the "Cum, Cis employes withfere�ssrevsole campeuatian, will d.Prthework oil the awctmeisnmintendede offered awdoas hot a(Sec.7014.Business and property W code:rn Ommescion's License law dam wort apply te rt owner of Required Inspections pmpcnywhobuildsoriceprovesth unproandwho dosstachwork himxiredthrough his own cmr.theuip Ing or i that such imprercmenu are not unusual of maRenW for owner. haw rcr,thebuildingorimprovementissold within ane Wild of improve the owner, Wilder will marc the burden of proving Net k did not Wild mr'unpmse fm Ouryuc of ale.). 0 I,an manor of the Property i m exclusively contracting with licensed contractors in construct the pmlem(Sec.7014,Business and Professions Code:)rn Comrmteri Li. cruse Law does not apply m an owner of property who Wilds or improves daemon,and, who contracts for such projects with a contractor(s)licensed pursuant in the Conuamorx License Law. O lamucmptundersce. .BSPCforthisresson Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirms under penalty,of perjury one of the following declarations: I have and will maintain a Cetifiem of Conant to self-inure for Workers Compen. sation,as provided for by Section 37W of the labor Code,for Ne performance of the work for which this perm"t is issued. 0 1 have and will maintain Workers Compensation Insurance,as required by Section 37Wof the Labor Code.for the Performance of rte work fm which this Permit u issued. My Worker ttlaupn Insunna artPolicy and Policy number are:A,t 1 l�a7 Cartier. ✓ Policy No.g#-r�5YW �,;W CERTIFICATE OF EXEmmoN FROM wo"ERS' COMPENSATION INSURANCE fruits it.need not h completed if tle Permit is rare.hunNcd dollar(sl W) or less.) 1 artifY thm in the PCrfarman.af,h work fm which Nis permit u issued.l shall nm employ any person in any manners 1110 become subject to de Wartans Comperetion laws of California.Dare Applicant NOTICE TO APPLICANT:If,after making Nu CcniOak or Exemption,you should become subject in,W Workers Compumation previsions of th labor Code,you rota .JO forthwith comply with such provisions or this permit shall h damcdtrntked. zr. CONSBUCT"ON LENDING AGENCY Ihcrebyaffrmthetthem ua Connmetinn lending agency for the Xecommm of C the work for which this pcmit is issued(Sec.3097,Civ,C.) 6W. Q lender's Name .7 z Lenders Addmu U Q 1 Comely Nat 1 have reed this application and sue Nat the about information a I,F correct.I agree to comply with all city and county ordinances and auto laws relating to 0 U building conswction,and hereby audhorim rep mmowii. of this city in crmr upon the r fW m alwvetmcmidncd property for inspection purposes. 0. (We)agree save,indemnify and keep harmess lthe City of Cupcmno against+h liabiliuut .judgmen .eosuandexpensoswhichmayinanywaYaamcagainstsaidCity U z APPLICANTe oN a RSfAN 0 Ars pc WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCER ULA S _ Re-roofs �1� Signature o! ¢ UCanvaem Date HAZATR U MATERIALS DISCLOSURE Type of Roof Will the applicant m forum W"ding oecupant store or handle htecom us maedal u 1,14md by the CuPerhad Municipal Cade.Chapter 9.12,and the Halth and Safety Code.section 25532(,)7 ❑Yes Na All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,I Will th applicant or future building occupant tax equipment or devices which g agree to remove P Condit W e,ardnus air conumina;u IdcOned by the Bay AmAir Quality Management all new materials for inspection. OYcs ❑No 1 hsse read the aaraNrusmncrials myuircmenu underChp cr 6.95 of the Califon ria Halts of I,Code,Sc aons25505,25533and25534.1und.m taatifdte Wilding does;not m Y marc a coon tha it is my responsibility 10 noufy,h occupant aide require easwne Wot prio miaxumaafaccrdreaeorge pan Signature of Applicant Date owner m ired agent /y Date1 All roof coverings to be Class"B"or better x, Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO n 6 0/ zo Building De artmento6 o 60 JOB ADDRESS: PERMIT # O O,12 /OS?o -5• C)E &i 2,4 6,1 V,:>, 06 0 d© / 2 Z OWNER'S NAME: PHONE # - X& GENERAL CONTRACTOR: FAX # I am not using any subcontractors: ignature;7- 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 CITY OF CUPERTINO om 3 of 4 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN 35619013 . 00 DATE ISSUED. . . . . . . : 06/15/2006 RECEIPT # . . . . . . . . . : 34862 REFERENCE ID # . . . : 06060122 SITE ADDRESS . . . . . : 21638 ROSARIO AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : YEN YAO ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , 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) 86119545 WEE 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 10, 000 . 00 1 . 00 0 . 00 1 . 00 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 . 74 0 . 00 176 . 74 0 . 00 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 CUPERTINO („ 01 22- FURNACE/AC `e CUPEkTINO PERMIT APPLICATION FORM APN # Date: bl3 Building Address: 02��P3 Q ��C4� 44,ve CLI . Owner's Name: CJ Phono 4�: y� �- ass-1/a9 Contractor: one: to/- QSyS License*: der yah - P Contact: Phone: Ctiipeftino Business License#: Building,Pewit Info: Bldg ❑ Flect Plumb ❑ Mech 17 Job Description: ,G,An G —, e Q A/ Residential Commercial ❑ Foridential tions: Attic 11 floor 6 ' Zod floor❑ Adhere to min set back requirement L5 For Commercial Installations: Replacement stupe weight ❑ Additional weight• (structural talcs)❑Structural Calculations required for new installation New installation Planning Approval RSguired ❑ Cost of Project: c�j p7./ � Type of Construction: Occupancy group: strapped On Platform Lei Bonded Sq.Ft. Yloor Area: New Location ❑� Replacement ❑ Qty. if A licable Fee DX Fee Descrivfion Fee Grow BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C: Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMRF.C:FPT _12Mq, Switch&Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING Ir BSEISMICOM Seismic Commercial BUTLIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMTI'FEE Meeb Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING • 13USLIC Business License BUII..T)TNG