06080207 CITY N CUPERTINO : .vl'. '(<=
BUILDING DIVISION PERMIT >CUITRI�.CTQR INFURNI�TI .N
BUILDING ADDRESS: QUANtS ELECTRICAL PERMIT N0.06080207
1122 MILKY WY
OWNER'S NAME: PERMITLSSUE DATE
JASON CHEN 10628 RANDY LN OR /9.4/2006
NE: SANITARY NO. CONTROL NO.
(408) 366-1823
ARCHITECT/ENGINEER: BURRING PERMIT INFO
BLDG O PLUMB O
loA,
LICENSED CONTRACTOR'S DECLARATION IObDeSCrI Description
�a I hereby affirm that 1 am licensed under provisions of Chapter 9(mmmcming P
with Section 700(y)olDivision 3 of the Business aM pmfessions Cade,and my license is
qF Z iDniamm Co.And ff —
L ADD A/C TO EXISTING . FURNACE
LeeLic.a !0o�
Conucmr
q I ARCHrrECrS DECLARATION
< 1 unticrsmnd my plans.hall Po used An public records
I U
•era Lir.'Cmed Mr...]
S Oat I am aUIL.DEfr DECLARATION
I hereby.from that 11. exempt from NI Contractors License Law far Nc
1 o o (allowing mason.(Section 7o incomes,BmiOce roti Fhvfmions Cade:Any city monuaty
1$,n which requires a permh m piresdo,AAbout.pplicant
improver.s pcmit i fi repair any aVuerum $2800
-Z} dust YIIIWnM.alm legalx.NC app?%ml far6neh pefmllm file aslgned.lalClnml
0 thOheislicensedpurOanlmtheprovisionsofNeCmtmon'sL3mnoeLaw(Chip=9 Sq.Ft. Floor Area Valuation
S (commencing with Section 700M of Division 3 of the,Business and Professions Quit)or
—
that M b exempt tumorous and the buts for she alleged exemption.Any violation of
Smdm 7031.3 by any applicant for a permit Objema the northeast to A civil Pmtalty of r Occupancy Type
not mare Nan Ow hundred dellus(1500).
C I,O owner often property,m my eropioyces with anger As their role compensation,
wiltdo thework and Neawcwm is not inhended her artved forOle(Sse.1014.Busimas
and Profession Cade:The Contraawfs red who law doss rot apply ll an owms is Require resp i)('IIS
Own enYwhabuiWaaimpmlathermn,antlwho smart,intended
hwmkhinuelfm through hf,
own a ern th ea,pmNded Nmumh improvements ax rot ie r ofd m nfliciendledon,for Own If, / (/
bull&' the building hoimprovementlamid within one yar of mproefor the owned
builder will have dhe burden of proving Nn M did rot bulb m improve far purpose of
Owl.
❑L as owner of a property.,B stop.And contracting with OmnmA mnaxmn U. `C
construct the project(Sec.Adan.wner of and rrowho Wild.
CadeI The Cmasemn. d
cense Law doer not apply m an owner of property who build.ms improves thereon,and.
who a nfor such Droketa with a tonuacmr(s)Ikrnxd purawm N
nt e Goml(aclOr.
Lwense Lov.
law.
❑Toro<umpt undo See .BBPCfor this mason
wnsr Dam
WORKER'S COMPENSATION DECLARATION
1 thereby atrium under penally of perjury,arc of the folhnving dcclarmiorm
C I have and will maintain a Cenifscae,of Consent It self-Insure for Workers Compen.
sation,as provided for by Section 3100 of the labor Cade.for the performance of Ne
wart for which this Permit is issued.
C 1 have and will maintain Worker'.Compensation Insurance,O required by Section
3700 of the labor Cade.for the performance of the work fnrwhich this permit b Issued.
My Workees rampcuatn humarlm artier and Policy number Are:
Grtier. TPolity No.:
•RTI•COTE�Op EX�EMP170N FROM WORKERS'
COMPENSATION INSURANCE -
(Thit.emlm used rot he completed if tis permit is fmave hunthuddo0ars(1100)
or less)
1 cenify that In the performam..I tlm work for which NB permh is bound.1 shall not
employ any Perron In my momrso a to become subject m NC Wafkeri Compensation
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT:If.After making this Cenincam of Exemption,you should
become subject to the Worker',Compensation provisions of the Labor Code.you most
.J,z forthwith comply with such provisions or Nle permit Nall he deemed mmkcd.
ZO CONSTRUCTION LENDING AGENCY
1-i 1 hereby Arm that Nem is a construction lending agency for use perfoonmm:e of
Gi
the work for which this permit Is named(Sec 3097,Civ.C.)
QLender's Name
.7 z Lender'+Address
U C I cmify that I have mad this application and state that Ne ahave information u
U. F cormct.I agree to comply with all city and county ordinances and Subic laws relating to
OV building construction, ai hemby auNorix representatives of this city to enter norm the
W above-memiuncd property for inspection innit.A.
CH' gyp (We)agree to Ove,indemnify and keep harmless the City of Cupertino against
m Iiabiiitia,judgments,cord and expenses which may in any way accmc agaiM mid City
U Z in consequence of the granting of Ni.pmmlt.
'••' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �-2 t't'-EX
SOURCEREGLOTIONS.
�lI Q 3/640104 Re-roofs
Signature of ApplicnaComrsctor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant stoat or handle hOallom material
O defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code,Section 25532(x? All roofs shall be inspected prior to any roofing material being installed.
Oyer, I6No
Will the applicant her future building Occupant use equipment her devices which If a roof is installed without first obtaining an inspection,I agree[o remove
cath huurdnua air cmumiranu O denied by Ne Bay AMA All Quality Management all new materials for inspection.
District?
CYv Lyr+u
I have mad the harAnkno materials requirements under Chapter 6.95 of the Califor.
n1aHOlth@SafetyCo&,Smdans25505.25533md25534.1undcr dNuifthc building
does not currently how A tenant,that it h my resp mwhillLy in notify the occupant of the
mruimmcnuwhwhmlWbcmctpdormimanceofaCrmficamor Signa tureofApplicant Date
Owner her authorized agent 4C All roof coverings to be Class nBn or better
CITY OF CUPERTINO
gem 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36220002 . 00
DATE ISSUED. . . . . .. : 08/24/2006
RECEIPT # . . . . . . . . . : 35763
REFERENCE ID # . . . : 06080207
SITE ADDRESS . . . . . : 1122 MILKY WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JASON CHEN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : QUANS ELECTRICAL
CONTRACTOR . . . . . . . : HIEN Q TRUONG LIC # 23332
COMPANY . . . . . . . . . . : QUAN' S ELECTRICAL
ADDRESS . . . . . . . . . . : 10628 RANDY LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
. TELEPHONE . . . . . . . . : (408) 366-1823
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- --- - ------ --------- - ---------- ---------- ----------
BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BSEISMICRE VALUATION 2 , 800 . 00 0 . 50 0 . 00 0 . 50 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 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 161 . 93 0 . 00 161 . 93 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
-------------- --- ---- -------- ------------------
OTHER 161 . 93 VISA
TOTAL RECEIPT 161 . 93
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ------------`--------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OCUPE(�TINO
Building Department
JOB ADDRESS: PERMIT #
a -2 wC6b�a2o
OWNER'S NAME: I CAZC13 PHONE # - ,-L
GENERAL CONTRACTOR / A FAX #
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
Owner/Contractor Signature Date
CITY OF CUPERTINO
fi FURNACE/AC
•CUPEkTINO PERMIT APPLICATION FORM
APN # �90 Date:
lY d
Building Address:
`�z 11i
Owner's Name: Phone#:
Contracto • Phone: License#:
Contact: p Phone: Cupertino Business License#:
GtQl? 10
Building Permit Info: / n/
BldgEl Elect EY Plumb El Mech (7'
Job Description: o61, C _
� (7�Q1Slr'n. N��
Residential Commercial ❑
For Residential Installations:
Attic E31 s` floor ll 2"d floor❑
Adhere to min set back requirement L/d'
4jFor Commercial Installations:
Replacement same weight ❑ Additional weight (structuralEl calcs)
Structural Calculations required for new installation El
New installation Planning Approval Required ❑
Cost of Project: c� per, oo Type of Construction: Occupancy group:
Strapped On Platform Bonded Sq.Ft. Floor Area:
New Location Replacement
❑
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm 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
1 MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING