05070167 CITY OF CUPERTINO x tial '^�'* "� n '
BUILDING DIVISION PERMIT COI I -- I 'OR INJOQRMATION '
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BUILDING ADDRESS: A PERFECT CLIMATE PERMrrNO.05070167
99t;29 poppy ng
NEWS NAME: PERMIT ISSUE DAIS
RON W
C
NE: SANITARY NO. ONTROL NO.
408 861-9545
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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300 LICENSED CONTRACTOR'S DECLARATION Job
1 hereby amm,Nat 1 am IicemN under Provitiats of Chapter 9(cemmencingtestNAUU
with Batson 7011U)of pivWon laf the Budrca and PrO(caioa Code,ad my Ikense 4
imm'm�prn�eese cao31ST' INSTALL A/C
3gz o. L I s �y
ARCHI'TECT'S D RAT N '1\lQ_ ZOOJ
LKonsed Professional I4a shall nrN BUILDING OWNER-exempBUILDER
und ft ATION BUILDING
2 M O I hereby.Rion the 11. exempt tram d r Comracrors License Law for Ne
EMO O following mason.(Section 700 construct,sines and ve.denni Calc:Any city m comity
5$ which mquima•,.also re resthellq impmw,demolish,orrepaira signed structure ement
_zry^
prior mits issuance.also requires applicant for ContrannitmMusse Law(Chapter
<
thathelicensedPSeaanitoNcofDialoaofNeConuinessaUwnofeado Code)or Sq.Ft.Floor Area Valuation
eRg (ham els axe pttheral 70M)ofDivision oftheeged Business endon.Any
Code)or
Q�., Nat be la exempt tMrefrom and the buts for Ne alleged exception.Any violation of
Section 7031.5 by airy applicant for a pem It subjects the applicant an a civil penalty of 3AP&24A6er00 Occupancy Type
not mom than five hundred dollen(5500).
❑Lu owner Ofthe property,or my employers with wages as their axle compensation,
will do the work,and theswclum is not Intended Oroffered fonaie(Sec.7044,Business Required Inspections
and Professions Code:The Conmcar's License LAw does not apply to in Owner of q P
property who build,or improves Nercon,and who does such work himself or through his
own employees,provided that uch lmpmwments are not intended or offered for ale.If,
however,the building or Improvement Is aid within one you of completion.the owner
builder will have slue burden of proving that M did Out Wild or Improve for purpose of
ale.).
❑1,a owner of rte property am mu lMd ly conuacdng with licensed conmcmn in -
construct Ne project(Sec.7094,Business and Professions Code:)The Contractors U.
cense Law does not apply m an owner of property who Wilds or improve thereon,and,
who coronets for such projects with a cotuactods)licensed pursuant in the Consumes
License Law. _
❑I em exempt under Sec. - .B&P C for this mann
ter — - Dam
WORKER'S COMPENSATION DECLARATION - '" -- - -
1 hereby alarm under penalty of perjury one of he following declantiom -
❑I haw and will maintain a CeNncam of Consent to elf-InsumforWorkeraCompen-
ame.as provided for by Section 3700 of the ober Code,for no performance of rte
work for which this permit is issued.
❑1 have and will maintain Workers Compensation IaWaom.as inquired by Section
3700 of the ober Code.for the per(ormana or the work for which this pumit is issued.
My Workers nCom^pe�nati^o�n�Inanrme carrier and Polly number art: p
Cartier. I I�J Polity No.'�51 t4(1J2
CERTIFICATE OF E%EM MON FROM WORKERS'
COMPENSATION INSURANCE
(fhb section need notheeompleted lithe permit is farome hundred dollus(5100)
or lav)
1 certify that in the performance of the work for which this permit is WrOod,I shall nm
employ any person In any manner an a to become abject to the Workers'Compeaadan
Laws of Califomla.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become Subject in the Worker's Compensation provisions of the(Aber Code.you muss
.,O fmNwith comply win such provisions or this permit shall w doomed revoked.
Z CONSTRUCTION LENDING AGENCY
[—t Thereby affirm Lost Nem Is a construction lending agency for the performance,of
IYa> the work for which this permit is Wood(Sec.3097,Civ.C.) '
QLenders Name
.7 z Lender's Address
U Q I certify that 1 have mad this application and sate that the be.Information is
correct.I agree to comply with all city and county ordinances and sum laws relating to
Q lrJ' building construction.and hereby authorlm representatives of this city to cncr upon Nc
L57 about-mendoned Property for ImPeNon Pugmas
a (We)egret to ave,indemnify and keep harmless the City of Cupertino against
Ilabllides,judgments,eau and expenses which may In ay way accme against said City
U 7 in consequence of the gaming of this Permit.
rte• APPL ANT UNDERSTANDS AND WILL CO LY TH ALL NON-POINT Issued by: Date
SOU p REGULATIONS, 9 A
_ lel&n(I,(- /- Re-roofs
Signature of ApplinnUConusctor Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding Occupant Brom or handl haArdous material
as defined by Ne Cupertino Municipal Code,Chapter 9.13,and Ne HesIN and Safety
.section 255324)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant o uwm Wilding=opem use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit lux"noa sir conuXN..
dc0ncd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes T haw roW rtehaeda.. nu under Chap1r6.95 of rte Glifor.
nb Halth&Safety C.k.Secdau35505, 33 25534.IundenteMnaifOa Wilding
doesnol curmmly haw a tenal.Nat It my res aibility m notify Ne accupat of the
m�q��``nu which mug be incl p�eiom l�ssu�ce fa Grtifka of Occup Signature of Applicant Date
a kj / All roof coverings to be Class"B"or better
Owner tar amhodrted agent Dom
CITY OF CUPERTINO
3 of 4 PERMIT RECEIPT OPERATOR: euem
COPY # 3'
Sec: Twp: Rug: Sub: Blk: Lot:
APN . . . . . . . . : 34212004.00
DATE ISSUED. . . . . . . : 07/26/2005
RECEIPT #. . . . . . . . . : 30520
REFERENCE ID # . . . : 05070167
SITE ADDRESS . . . . . : 22529 POPPY DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RON WONG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0802
RECEIVED FROM . . . . : A PERFECT CLIMATE
CONTRACTOR . . . . . . . : SMITH, BYRON E LIC # 21144
COMPANY . . . . . . . . . . : A PERFECT CLIMATE
ADDRESS . . . . . . . . . . : 10570 S DEANZA BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
• TELEPHONE . . . . . . . . : (408) 861-9545
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 4, 066.00 115.56 0.00 115.56 0.00
BREMAIRHAN NO.UNITS 1.00 10.26 0.00 10.26 0.00
BENERGY PERMIT FEE 115.56 55.47 0.00 55.47 0.00
BREMFURN NO UNIT 1.00 14.31 0.00 14.31 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
BSEISMICRE VALUATION 4, 066.00 0.50 0.00 0.50 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 311.21 0.00 311.21 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
•
Community Development
10300 Torre Avenue
OCIFCupertino CA 95014
Telephone(408)777-3228
�DC�TIAIO Fax(408)777-3333
rC 1 '�1 Building De artment
JOB ADDRESPERMIT#
OP.529 S�tvoq- i pS 0? � / 6 ?
OWNER'S NAME: PHONE oZS -
GENERAL CONTRACTOR: CU Q,c FAX#
Q
I am not using any subcontractors: �&jd(Le,
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
FURNACE/AC
•UPERTINO PERMIT APPLICATION FORM 567��10
APN # 3W2 I tZ Date•
-r3-as
Building Addres
aa�
O er's Name- hone #:
c 05 - 78 A
a tor: Phone: ticense #:
-72-31 S
�ntact: Phone: Cupertino Busme s.License#:
WIKC4 l$
Building Permit Info:
Bldg ❑ Elect K Plumb ❑ Mech
Job Description: C�
Residential Commercial ❑
For Re idential Installations:
tttic LJ I"floor E:12nd 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: Type of Construction: Occupancy group:
D1i?G� Lv
Strapped ❑ On Platform El Bonded ❑ Sq.Ft. Floor Area:
New Location zr Replacement ❑
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of 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
EPERMTTFEE Elec Permit Issuance ELECTRICAL
MPERMTTFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING