06010041 CITY OF CUPERTINO p�,��
BUILDING DIVISION PERMIT ICO s �%LQRxltl l`1'VAVw1� 0 ; ,
:`a`a ,«:,Is,�rs . . ??tom« s,� �, ..tn� ,�,•
' BUILDING ADDRESS: A PERFECT CLIMATE """ND-06010041
,, 10179 CASS PL
OWNER'S NAME: PERMIT ISSUE DATE
Ad 1h WEIGUN YANG 10570 S DEANZA BLVD 01/09/2006
NE: SANITARY NO. CONTROL NO.
(408) 861-9545
ARCHITECTIENGINBER: BUILDING PERMIT INFO
BLDG ELECT tu 0 PLO 0
30MECH
G LICENSED CONIRACIOR'SDECLARATION IobDescri non
Lys 1 hereby&BI m that 1 am licensed under provisions of Chapter 9(commencing p
with Section 7")afD10,10n 3 Orlin Business Pmfeasinna Code.and my Ikea's la
in in
Licen torn antle k, a REPLACE FURNACE
0'z Licca CI a" Lic.w
Da¢ Canuanror
ARCH be oS DECI.a ATION
1 understand my pans dull he used As public records J/
Sud Licensed Pmfcuianal
^
OWNER-BUILDER fo DECLARATION
4 I I hereby.(Sc that 1 1. exempt rrom the tensions Code:s A nso ty o for the
p o which ru rosaon.(Scotia IIBstr Bmalaar and in.dem li h,oAny city ler county (ems
$t4i prior requires n Permit m m=itt.alter,bnpmw,demolish,t,m repair any suucwu $3421
_Zt?0 pdormitsisswnce,alsunt to Bas lhovisios Or fa Cmaretere miecuse A-(cha mem
< mathnislicenwJpSectiotmNepmvivlonafthcComslactu ndProfswsCods)r9 Sq.Ft. Floor Area Valuation
Pa y (cum a Is exe pt therefrom
70n d or Division r of the egad eoantl on.Any
Cmk)or
lt, That he a exempt Nem(ram antl the bus fart the Bayed exemption.Any viols0on of
Section 7031.5 by any applicant for a permit subjects the applicant toa civil penalty of r Occupancy Type
not mom than gw hundred dollars(5500).
❑I.as mner of the property,or my employees wish wall As their Arm compensation,
will do Ilan work and the muuurt is not lnmMed or.ff.md for We(Sat.70th,Business
W ProfeWou Cade:Th.Contncmrs License Law don trot apply m an Owlet of Required Inspections
property who builds car i mptows Ihemon,and who does such weak himsel f a through his
Own employee,pmvidcd that such Improvements are notimended motioned fatale.IL
however,the building ler improvement is Bald within oro you of compledon,the owner.
builder will haw the burden of proving Nu M did not build or Improve for purpose of
sale.).
❑1.As owner of the property,am exclusively contracting with licensed camnsc on In
cantmct the project(Sec.7004.Business and Profession Code:)The Contractors U.
cause Law does not apply to an owner of property.who builds at improv theuon,and
who constants for such projects with a con owev(s)licenced pursuant to the Contractors
License Law.
❑I ane exempt under Sea ,B k P C for this resin
Owner Dam
WORKERS COMPENSATION DECLARATION
I hereby Apron matter peWty,of perjury Oro of the fallowing dalmatian:
Its.and will maintain a Cerdfcste of Consent o alhinum for Wohm'sCompen-
_g0on,an provided for by Section 3700 of the Labor Code.for this performance of the
work for which this Permit is issued.
[],M`w and will maintain Workers Compensation Inurune,As required by SeNon
3700 of the labor Code,for the peRormance of the work fa which that permits load.
My Workers am sa an manna carver and Polity iu�mp�nt(�m:
Cartier. Paliry Na.: h�
CERTIFICATEOF"K YIIUNFROMWORKERS'
COMPENSATION INSURANCE
(Thsucgn and notbeeampleteJ If the permit Is foraahunthW dollen(SIM)
a Ws)
1 certify that in the performance of the work for which this i mmlt is issued,I shall not
employ any person in any manner an As m become subject to the Worker'Compensation
Laws of California.Dau
Appllenl
NOTICE TO APPLICANT.IL after making this cerdi cam of Exemption,you should
become subject m the Workers Compcnation previsions of the Labor Code,you mut
,JO faMwish comply with such previdmu or Nu permit mall hd rowk
e dccmced.
'Z .
,v rCONSTRUCTION LENDING AGENCY
[••t I hereby affirm mat inert is a construction lending agency for the performance of
!Yi the warts for which this permit Is inwd(Sat.3097.Civ.C.)
0 Lcndces Name
Q z hinders Add.
[)Q 1 mgree out 1 Nw rand shitty and ours and oma this the above Information s
0 U wrung I agree ro comply with y city and county ntainanaf and eau sows r upon
n
Q V building and hereby Authorize rpoeunmtiws of this city mentor upon Ne
D7 ah0vc-(We)a agree
property for inspection indemnify
aIUNP ha. /
(We)ague to an,indemnify nal keep hvmlw we City O Cupertino id City 10/
O 6/
faA liabilities,ouence of nts.
tratsng of this esmit. may in Any way ears against Said City / 7
fJ7 A consequence of the UNDERSTANDS
shit permit.
'7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
` SOURCE REGULATIONS.
Re-roofs
Signature of Applican✓Contruror Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant marc ler handle haysmaus maim d
As dented by the Cupertino Municipal Code.Chapter 9.17.and the Health and Safety
Id.=
de,Section 75537()7 All roofs shall be inspected prior to any roofing material being installed.
Oyu VO
Will the applicant or future building occupant are equipment m devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
It havatdous air conmminants u J need by the Bay Area Air Quality Management all new materials for inspection.
Ionia?
❑Yca
IhawmW Codc.Sdnsmuedasu33%xd mm�derdsortnG95Orthe Glbuilding
Flral1ba mad
hwardomnawrials nathi meats 4.Uuulcrnud dutifth Cubing
not cutmntI haw a unset that It s my.1"malbillly m aufy dte occupant of the
u enmwH m home 'ler Innnaaa rkmcorOccop Signature of Applicant Date
Own nauthOrind. net Dam All roof coverings to be Class"B"or better
Community Development
4. 10300 Torre Avenue
aClOF
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
�
OWNER'S NAME: PHONE # 3 — 19
GENERAL CONTRACTOR FAX # — -q
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 Metal
Sheet Rock
,Tile-
i.;1-7
Owner/Contractor Signature Date
CITY OF CUPERTINO 6 o d
FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
Owner's Name: Phone #:
r V19 3b6,-aal9
Contractor: License #:
7 31 S8
Contact: Cupertino B Isiness License #:
Building Permit Info:
Bldg, ❑ Elect ❑ Plumb ❑ Mech LSI
Job Description:
Residential Commercial ❑
For Residential Ins lations:
Attic ,2;'� 1 s` floor 2 I floor❑
Adhere 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: I Type of Construct' Occupancy cup:
l rvla L
Strapped ❑ On Platform ❑ n/Bonde ❑ Sq.Ft. Floor ea:
New Location ❑ Replacement
City. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
/ BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL
BREMAlRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
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 LicenseBUILDING