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07060031 [13UIILTIffyl OF CUPERTINO BULDING DIVISION PERMIT C1kTR�CQR� + RMTI�N. PERMIT NO. QI�p�2ES$ OLUMBUS AV CONDITIONED AIR07060031 4 /1 ` PERMIT ISSUE DATE OWNER'S NAME: WOO WILLIAM AND YAN 1701 LIr'TLE ORCHARD ST 06/05/2007 SANITARY NO. CONTROL NO. ,NE: (408) 29'--2220 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG EO PLUMB ME�CH p p LICENSED CONTRACTOR'S DECLARATION Job Description m P I hereby affirm that I am licensed under provisions of Chapter 9(commencing U with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE FURNACE, ADD A/C t in full force and effect License Class fL'c S- • p Dalc_� Contractor F v� ARCHITECT'S DECLARATI i a.a < I understand my plans shall be used as public records >aU U.in Licensed Professional < OWNER-BUILDER DECLARATION ja 1 hereby affirm that I am exempt from the Contractor's License Law for the :00 following reason.(Section 7031.5,Business and Professions Code:Any city or county $ which requires a permit to construct,alter,improve,demolish,or repair any structure "H prior to its issuance,also requires the applicant for such permit to file a signed statement ;q Ft.Floor Area Valuation ►a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $8000 t=- (commencing with Section 7000)of Division 3 of Ole Business and Professiens Cade)or a that he is exempt therefrom and the basis for the alleged exemption.Any violation of 7�Number Occupancy Type Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 3620401L .t�CJ' not more than five hundred dollars(5500). 0 I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered forsale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Conuwwes Li- cense Law docs not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the contractor's License Law. 0 1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affinn under penalty of perjury one of the following declarations: 0 1 have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: t��p�t�q Cartier "SA Policy No.:'73.V3 L Q CERTI A OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need trot be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY [�ce) I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) W A Lendcrs Name z Lender's Address U 0 1 certify that I have read this application and state that the above information is CL correct.I agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorive representatives of this city to enter upon the above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City o[Cupertino against E" to liabilities,judgments,costs and expenses which may in any way accrue against said City U z in consequence of the granting of this permit. Date C/ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATI S. �J 9o, C-S-Ca Re-roofs e Date Sig of ApplicanU onuacto Type Of I:OOf HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. 0Yes If a roof s installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes d4No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the Date requirements which must be met prior to isyanYof a Certificate of Oc Signaturc of Applicant �- All roof coverings to be Class"B"or better O r authorized agent Date CITY OF --UPERTINO 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36204011. 00 DATE ISSUED. . . . . . . : 06/05/2007 RECEIPT #. . . . . . . . . BS000001549 REFERENCE ID # . . . : 07060031 SITE ADDRESS 21471 COLUMBUS AV SUBDIVISION CITY CUPERTINO IMPACT AREA . . . . . . . OWNER WOC WILLIAM AND YAN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4972 RECEIVED FROM . . . . : RICHARD READ CONTRACTOR RICHARD READ LIC # 22334 COMPANY CONDITIONED AIR ADDRESS 1701 LITTLE ORCHARD ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE (4C8) 291-2220 FEE ID UNIT QUANTITY PMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 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 BREMRECEPT NO. OUTLETS 1 .00 1.20 0 .00 1 .20 0. 00 BSEISMICRE VALUATION 8, 000 .00 0 . 80 0 .00 0 . 80 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 176 . 54 0 . 00 176 .54 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 176 .54 VISA --------------- TOTAL RECEIPT 176 .54 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF CUPERTINO FUR,NACE/AC rc OF UPEF�TT INO PERMIT APPLICATION FORM APN# Date: Building ddress: Owner's Name: Pone#' r,�i ) -,% 1 �ntractor: � /�;9 Phone: � - � Lice se#: _ c"IA1, kJ i.cru,_ < 1 G_ tact:a Phone: r, Cupertino Business License#: It / Gn Building Pe' it Info:`_) Bldg Elect A�11Plumb �� Mech 1J� Job Descriptio4: , , on Residential Commercial ❑ For Residential Installations: Attic ❑ 1'floor M 2nd floor❑ Adhere to min set back requirementc� ,or Commercial Installations: rceplacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation New installation Planning App royal Required ❑ Co of Project: T e o Construction: Occupancy group: �-�� Strapped ❑ On Platform 11----Bon ded Sq.Ft. Floor Area: New Location R lacement Qty. if Applicab e Fee ID Fee Description Fee Group BENERGY Riergy BUILDING j BREMFURN Fl unace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAMHAN A/C Units<= 10, 000 cfin MECHANICAL BREMRECEPT Rec tl, Switch&Outlets ELECTRICAL BSEISMICRE S_,ismic Fee Res BUILDING BSEISMICOM S,-ismic Commercial BUILIDNG EPERMITFEE Elec.Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE P'umbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK P.an Check Fee BUILDING BPGAS Cas Pipin System Fee PLUMBING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue ='r , `��, Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF ,UPEIZTINO Buildin :]7 rtment JOB ADD E S: MIT # 2016 d o 2 / Yi Atc OWNER'S NAME: (� PHONE #' GENERAL CONTRACTOR % �. till I am not using any subcontractors: =f- - ate Signature Please check applicable subcontractors and complete the followinginformation: SUBCONTRACTOR BUSI14ESS 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