06060201 CITY OF CUPERTINO let""'" ' '� ""��'"'� `''�` •""°°'� ''`
DVILDIN,C DIVISION
PERMIT C,OI�iTRA `l;,QR NP'OIZNIATI,ON
BUILDING ADDRESS: STANFORD PLUMBING HEATING EkIKV'06060201
21064 MARCY
ER'S NAME: PERMIT ISSUE DATE
DANIEL CHOW 1965 KYLE P
PHONE: SANITARY NO. CONTROL NO.
(408) 286-8931
ARCHTfECTBNGINEER: BUILDING PERMITPLUMB
BLDG ELECT PLUMB MECH
Sop LICENSED CONTRACTOR'S DECLARATION Job DOSCrIpUOn
rd�+ I hereby&(firm that I am licensed under provisions of Chapter 9(commencing
IW Section 7000)of Division 3 afthe Business and Prtressians Cods,and license is
+� mmnmrcoWerr a0 / R & R 2 FURNACES/ ADD 2 A/C 3 TON UNITS.
2 Lken CI Lk,g
�8' Dam Con"I'm WILL MEET SETBACK REQUIREMENTS.
ARCI,l DECLARATION
DI
I understand my plans shall Ito used u public meads
len Licensed Professional
5� OWNER-BUILDER DECLARATION 4NALE®
I botchy affam Wm 1 am exempt from the Contractees License Law for We
E O O following mason.(Section 7031.3,Business and Professiuns Cade:My city or county
1§9 which requires a Permit to consuuc6 alcor,improve,demolish,or repair my swemm
—Z�, pricer lo its iuuama.Asti requires the applkanl for such Permit te Dk a signed statement o�8 0 0
< that W is licensed radiation m the provialans of use,Cmuracmri Lice.Law(Chapter 9 Sq.Ft. Floor Area 288klila[
XWR to mmeMn{with ScWm7ODa)of Divsion3attie Bust) WAafcasioa Codc)ur
{I .• that he Is eu nit therefrom and the bull for We Alleged exemption.My violation of
Section 70313 by any applicant for a permit abjecu the applicant in a civil penalty of APN Number Type
not mart than rim hundred dols.(5300). 32654030 . 00
Q I,as owner of Ila Properly,or my employees,with wages u them sole coespentation,
willdothcwork,andthes umsmtinmndedoranemdforsak(Sue.7044,Butinas Required Inspections
W Portions code:The committees Le Law doa seer apply m an Owner of 9 P
property who builds a improvns Ihermn,and who does such work himulf or though his
awn employe&,provided that svemimprovemmu tie mt year
ofe maQerd for ale owner.
bidder We buil thebrimprommmtshathwithin ane year or rnmpledon,for theoseof
builder will hew the burden of psaving the he did not Nim a improve for Purpose of
ale.).
❑1,as ower of the property,am exclusively contracting with licensed conuectars in
common the Project(Sec.70ad,Business and Professions Cade:)The Commissar's LI-
cella Law does not apply m an owner of property who Wilds or improves themm.W
who conmacaa(m such p o)eeu with aconmuands)licensed pursuant an the Cannanore,
Lice.taw.
❑I amexemptunder See ,Bl PCforlhismsen
rDau
WORKER'S COMPENSATION—DECLARATION
I hereby affam under penalty or perjury and or the following dcolandom:
❑I ham and will maintains Coniriauaf Cament to alf-ssun for Workees Compen.
satire,as provided fa by Section 37M of use labor Code,for the performance of the
work for which this permits issued.
and will maintain Worker's Compensation Warrants,u expand by Section
ofthsComputation
o pthe performamer and work number
aNis permit is issud.
y Worker's ompeaaOan�I-Tmunncea�rtier W Polley number am:
Gorier. T(2 I/-Y Policy No.:L?(00"�G _
CER77FlCATE OF P.K PtION FROM WORKERS'
COMPENSATION INSURANCE
(This session sued not be campleud If tie permit is foram hundred dollen($100)
or less)
I certify that In We performance of the work far which this permit is issued,I shall nm
employ any person in any manrcrso as in became subject in the Worker'Compensation
Laws of Califomla.Data
Applicant
NOTICE TO APPLICANP.IC after making ads Certificate or Exemption,you Amid `
become&.him to the Warkees Compensation plov+alou of the Labor Code,you must
.J 0 forthwith comply with such provisiom or Ws permit shall W diad mmkcd.
CONSTRUCTION LENDING AGENCY
t•n Ihereby affirm than them is A construction sling agency fm tie performance of _
qi the work fa which this permit Is issued(Sue.3097,Cs.C.)
t✓J Lassoes Nurse
z Landee.Md.
U Q I testify that I ham rad this application W mu that the above Information is
L1.P conte.I agree in comply with all city and county ordinances and suss laws relaing.o
O V building construction,and hereby authorize ropresumunives of this city to enter upon the
LU ahove-mentioned property(or inspection purposes.
gy (Wc)agree to an,indemnify W kap homeless,be City of Cupertino against
V) Iiabilitionjudgmenu,caau and wrens&which may in any way SCOUs.t1de.said City J �s
UZ inconugnencearthe{rsnungofthspmml.'
^+
sou7eAPPLICANT UNDERSTANDS AND WILL C MP WI ALL NON-POINT Issued by; Date
sou7e /,,
673Ab Re-roofs
Signalike ornvpl+HAZ\RDOUS MATERIALS DISCLURE — Type of Roof
WIII the applicant or fugue Wilding orcupanluare or handle hrsadam material
as defined by the Cupertino Municipal Carlo.Chapter 9.13.W the HesIW and Safety
.Section 25532(87 All roofs shall be inspected prior to any roofing material being installed.
❑Yes /la a If a roof is installed without first obtaining an inspection,I agree to remove
WIII us applicant or ams a building by the
tau equipment Qu m devices which
Dill huardnus air cmuminanu u defimd by the Bry Ams Air Quality Managcmem all new materials for inspection.
Distrust
❑Ya o
I have mal Ne herard,msmateriab regWro m as under Chopper 6.93 of ttheCaliber-
ns Hand"Safety Cade.Soctiau 33505.35533 W 23334.1 turnaround Wulf use Wilding
data m.curreally hevea tion dist I.s my nesp teri III acct pant of th
rata' watch mfrsalso ertine.te Signature of Applicant Date
Owner or mWariudagcm DA All roof coverings to be Class nBn or better
. CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32654030 . 00
DATE ISSUED. . . . . . . : 06/23/2006
RECEIPT # . . . . . . . . . : 34996
REFERENCE ID # . . . 06060201
SITE ADDRESS . . . . . : 21064 MARCY CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : DANIEL CHOW
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . :
RECEIVED FROM . . . . : ATLAS HEAT & AIR
CONTRACTOR . . . . . . . : TRILLO, STEVE LIC # 4269
COMPANY . . . . . . . . . . : STANFORD PLUMBING HEATING &AIR
ADDRESS . . . . . . . . . . : 1965 KYLE PARK COURT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
• TELEPHONE . . . . . . . . : (408) 286-8931
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
----- ----- ------------- ---------- ---------- ---------- ---------- ----------
BREMAIRHAN NO.UNITS 2 . 00 20 . 52 0 . 00 20 . 52 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 2 . 00 2 . 40 0 . 00 2 . 40 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 7, 000 . 00 0 . 70 0 . 00 0 . 70 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 187 . 90 0 . 00 187 . 90 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 187 . 90 7806
TOTAL RECEIPT 187 . 90
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
Community Development
10300 Torre Avenue
! is Cupertino CA 95014
Telephone(408)777-3228
DCITY OF
C��IA to Fax(408)777-3333
fC /�I Building Department
JOB ADDRESS: , � PERM #X6,0 2Q
OWNER'S NAME: 2L PHONE # a8(o c?C/ZS)
GENERAL CONTRACTOR / e -,t FAX # -5 (:2-
I
oZ
I am not using any subcontractors: �a d
Signature e
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
SumCITY OF CUPERTINO
FURNACE /AC
OCUPER,TINO PERMIT APPLICATION FORM
APN# .� a 5y — 03 0 Date:
Building Address:
1 o c,z uI �Y O J-
Owner's Name: I IPhone #:
�4 -3 to -
Contractor: License#:
A i- 4- , 088137
Contact: Phone#:
pqr\ (Y1cx-r i r,e z CQ 89 :3
Applicant/Contractor:
Building Permit Info:
Bldgect Plumb Mech
Job Description:
Residential: + 2 q ZCCL Commerc;al: v, yeva
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation: o0
Type of ConstructionOccup cy Group:
Qty. if
A licable Fee ID Fee Description Fee Group
BENERGY Energy BUILIDNG
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
2 BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
• BUSLIC Business License BUILIDNG