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05070027 CITY OF CUPERTINO BUILDING DIVISION PERMIT CO NTRAOTOR;INFORMATIONT BUILDING ADDRESS: A PERFECT CLIMATE PERMIT"905070027 OWNER'S NAME: PERMIT ISSUE DATE JIN LIM ONE: SANITARY NO. CONTROL NO. 408 861-9545 ARCHITECT/ENGINEER; BUILDING PERMIT INFO ' BLDG ELECT PLUMB MECH 0 e,0, LICENSED CONTRd Orders DECLARATION on thereby )of Our Iamfde,Ba Order previsions of Chapter myhot..is Job DesCrlptlOn �UF owith Section]gID7 of Division 3 of the Businessan0 Profcuiuns Code.end my license is ttuBB� u . ff imm�toraeand - INSTALL A/C j ? Ln. ass Lk.DECLARATION Da¢ Cornets, ' ARCH A,h,li be, DELLA ATIO /y � C-I 1 undersand my plans shell W stud as public records p 77 G Lacnud Professional 5 OWNER-BUILDER DECLARATION �n +� 1 thereby alarm on 1 am cacmpt from tlr Conuumfs :Any c Law for Inc K p yo whichfollowing reason.(Section 7031.5.Business andProfessions ve de io li Code:Any oily or county K m 4. which mgYllea a perrllll 10 LOn51NLt.OIMx ImpmVC,d[m11111M1,or repair My SINLIYm 'tib prior m its issuance,also requires she apPlicanl for such permit file a signed statement s Nat W is licensed puant rato the pmnm visoas of the Comra 's License Law(charter 9 Sq. Ft. Floor Area Ore H//-Valuation xr-� (Commencing with Section 7000)of Division 3 of NC Business and Professions Code)OF I��'' 1l that he is exempt therefrom and die basis for the alleged exemption.Any violation of Q Section 7031.5 by any applicant for a PermitSmjeets the applicant IF,a civil penalty of 3 6d@2IIt&d)e10 0 Occupancy Type not more Nan firs hundred dollars($500). ❑I,As ower of the property,or my employees with wages as their sole compensation, will do thc work and the stmaum is not intended oroRcred for ale(Sea 7014.Business and Professions Cade:The Contractnra Liana Law docs wt apply m an Owner of Required Inspections propmy who builds orimpraves thereon,and who daessuch work himsclfor through his own employ=.provided that such improvements are not intended or offered for ale.If. however,Ne Wilding or improvement u sold within arc year of cam,l.doA.the owners Wilder will have one When of proving that he did not Wild or improve,for purpose of ale.). ❑1.as owner Of the property,am exclusively convecting with licensed conuamars to Construct the project(Sec.7044.Business and Pmfessiom Cocky The Consacter's U cense law dam not apply in an owner of property who Wilds or improves Nercon,ane who convects for such projects with a eamactoKs)licensed pursuant to the,Comactor's License Law. ❑1 Cafe exempt under Sec. .B&P C for this moon 137W wner Data WORKER'S COMPENSATION DECLARATION 1 hereby aRires under Penalty of perjury one of the following declarations: I have and will maintain a Certificate of Conacm to self-inSum for Worker's Compcn- ion,u provided for by Section 37M of Ute Inter Code,for the Performance of the rk for which this permit is issued. ' 1 have and will maintain Workers Compensation Insuramz,a required by Section of the labor Code,for the performance of the work for which this permit is issued. y War CmnemItion Inarantt Cartier end Policy no W rrier. CL(fy4lyl Policy No.: Rig CERTIFICATE OF EXEMPTION MOM WORKERS' COMPENSATION INSURANCE (Thu soman need not becompleted if the Permit Is formic hundred dollars(SIM) or less.) I rom fy that in the icrIumance of the work for which this permit is issued.I shall not rmpioy any person in any manner an As m become subject o on,Workeri Compcnation Laws of California.Date Applicant NMCE TO APPLICANT:If.after making this Ccrificau of Exemption,you should become abject to Ne Worker's Compensation previsions of IW Labor Code,you most .JO foMwith comply with such Pmvishma or Nis perona.hall W dccmd m cvokW. Z" CONSTRUCTION LENDING AGENCY [~i sN- I hereby aRfm Nat there is a construction Lending agency ler the Performance of CIW work for which this Permit is issued(Sec.3047,Civ.C.) LU Q lender's Name = z lender's Address U C I certify Nat 1 have road this application and sate that the above information is D. r- correct 1 agree to comply with all city and county ordinances and sure laws ralming to ' C U Wilding cooscuction,and Wmhy authorise representatives of this city to color upon Ne, Y'Wahove-meationce property for inspection purposes. Ow (We,)agree to ave,indcmni ry and keep nannlcss the City of Cupertino against H N liabilities,judgments,costs and experts which may in any way accrue against aid City U Z in eomequencc of Ne granting of this Permit. r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 50 E EGU ATiONS.� / ✓.sVf Re-roofs Signature of Applicant/ Cut - Dau HAZARDOUS MATERIA S SCLOSURE Type of Roof Will Ne applicant OF forum Wilding ecu titer,or handle hazardous material as defined by the Cupenino Municipal Code.Chapter 9.11,and the Health and Safety ode.Section 25512(e)? ❑Yes All roofs shall be inspected prior to any roofing material being installed. Will the aPplicont or Enolding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it harardom air eanmminEN.1tonals defined by the Bay Area Air Quality Management all new materials for inspection. cabin? ❑Yes 1 have mad Ne haaNr requirements under Chapter 6.95 of Ne Calder- MaHeath&SafctyCnde.Smuars25M5.25533 am125534.1 undersand thatifthe Wilding dors not currently have a tenant Nat it u my rtsparsibiln ufy Ne,aecupen,of the recti a nicnm�yy�ss��Wmetd/y,Eian nnvg, rtk sergkfen t Signature of Applicant Dale s� �d. P Owner or authorircJ agcm All roof coverings to be Class"B"or better Date, IF Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 �UPERTINO Building De artment JOB ADDESS: PERMIT # /ON9 1. 6100- a 95ai4 1So-7 O v 2.-? OWNER'S NAME: VI t PHONE GENERAL CONTRACTOR: / // FAXX # I am not using any subcontractors: i/ ane,C.c I--Y- a& Signature YDate Please check applicable subcontractors and complete the followmi 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 FURNACE/AC OF UPEkTINO PERMIT APPLICATION FORM APN # Date: 10 b24 B •��A dress: a / Owet's Name: U Phone #: cl 1l1KP tractor: hone: License #: c - 4s S has i SV Co tact: / hone: Cupertino.Business License #: �L dV -aQ�, W6�) cJJ � Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential A Commercial ❑ For Residential Installations: Attic ❑ 1" floor ❑ 2nd floor F-1Adhere to min set back requirement❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction: Occupancy group: la 7 02) Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfrn 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 Z BUILDING 0