05010002 CITY OFCUPERTINO - •°^'^ '**� + � V: � tai; i�<
BUILDING DIVISION PERMIT CC1IvTRCT,o I1VFUUN
BUILDING ADDRESS: A PERFECT CLIMATE PeRMIT N005010002
10108 RANDY LN
OWNER'S NAME: PERMITL95UE DATE
FRANK LIANG 10570 S DEANZA 131-VI) 01 1011200c;
NE: SANITARY NO. CONTROL NO.
(408) 861-9545
ARCHD`ECf/ENGINEER: _ - BUILDING PERMLTINFO
BLDG ELECT PLUMB MECH
p � I�
X100 LICENSED CONTRACTOR'S DECLARATION - Job Description
^
y� F 1�cuby))f lma shat I Am licensed undcrpp66iiisions of Chapmr 9(commcw]as t _
with Scnibt jtkl0)of DlO'.0oftiw Buri auluwC and my license is
:^ infullfom defren. FURNACE REPLACEMENT
S 3 Llccn I Lk:g - .. .t
Dam Cuntncmr ..
ar.h. CI'S DE' ;k.TI
IundeMenam nsahellkuudaspubl cods
3 w Licensed Pmfesaional _
O OWNER-BUILDER DECLARATION
ComrION
r a g; 1 mean.(firm the 1 1. exempt from the Canuumh License Law for the
i O O following resann.permit
t Ronsu Business and sae.de ioli Code:My city or County
tM
u�$ which require•permit to cnMrve, aimcant frove,deameritt, fi repair any auunum
Fiy
prior miuivuawaalso aralacquires tie applicant farauch Permit Lief)asi{wdmaumem ,•.-.
g < thatkulicensed parwwmlkpmvisiow ofam CanuinasandxnseLAW(Clade)w Sq.Ft.Floor Area _ _ Valuation ,
g $ (cot he Is {wt Scnfan70ndClsDrvmonl them Buainwand Professions Cnde)w
Thu k u cacmpl Memfrwn and Ue basis for the alleged eumpMte.MY vialetico of - -
Section 1071.5 by any applicant fur a permit subjecu the aPpllant to•Civil penalty a( aj0 0 . .. Occupancy Type
Act am that Ove hundred dollars(55007.
❑L As owner afthe property or my employee with wages as Neo tale compensation.
Milan the work.And the avuuum iratlmmdedora@red far,ak(See.7044,Business Required Inspections -
and Professions Code:The o Coruscate,License Lew daflat apply m An owwr Of q P
property who Wild,or improves marcon,and whod=such work himsnrwthmu{h his - -ow.employ=.provided that such Improvements atenormarted aroQerad!weak.If. -
hmever,thebuildin{arimpmwmentiswldwis nowyMofcompkdon.theowwr• _ -
builder will have the bund n of proving that he did not build or Improve fur purpose of
251.1.
❑I,As owner of the property em exclusively contracting with licensed conuumrs m -
construct the project(See.7014,Business and Profeadans Code:)The CaneacmM1 Ll. .
cause Law does not Apply to an owner of property who build,or Impmw daemon.suds ,
who contracts for such projects;with a connatr(q licensed pursuant in the Committees -- -
License Law. •
❑I am exempt under Seo. - .B B P C far this Lawn
Owner Gets-
0
ets _
WORKER'S COMPENSATION DECLARATION
Iheuby affirm under pvaltY o(pesjury ace or the followln{deelwions: _ - • -__._.
IM.A.d Milmainuin.Ce riimmofcansentwulf.imumfmwoeaesCompere - -
suion,v provided for by Suedon 7700 of me,Labor Cade,far tins perform ace Of the .. -
workforwhichthispermitisimed. - -
❑1 haw and will maintain Workees Compensation Imwan¢,v required by Seedon -
J100of the Labor Crum.far Me performarmse of the work for which this permit is Issued. - .-
My War a Campensation I sur n e ams and Polity number eam:�'f -
Carver. WORKERS* 43
WORKERS
TION AN WORKERS'
COMPEN ATION INSURANCE
(Thla Auction need nut encampment lfthe permit mforonc hundred dollen($1(11)
w ICU.)
1 certify that in Ne performance of the work for which this permit 4 issued,l shall not -
employanypersoninanymaneersuuibecomesubjectto,he Workcrs'Compemation - ..
Laws of Callforala.Dam - -
Applicant
NOTICE TO APPLICANT.If.after making this CeniOam of Exemption.You should
become subject in the Worker's Compensation previsions of the Labor Coda you mum
�O foMwiO comply with such proviaians or this Permit shall en deemed revoked.
ZLyth.. CONSTRUC ION LENDING AGENCY
(r I hereby affirm Mut then it.construction lending.geny,for the performance of
fYe 7 Ne work for which this permit is isswd(See.3091,Ci,C.)
L0 Iendfles Nunc
=z Lamwe,Addres
U G 1 cedly that 1 haw read Ws Application and sum that the above Information is
Ly U mttett 1 agree m comply with all city and cutely ordinamsa and sate laws MIAMS to
0 rUbuildingconcoction,and hereby aumoriu repreumutivss of this city in Awa upon the
W show-mentioned property for inspection purposes.
(We)agree to an,indemnify and keep harmless the City of Cupertino against
cow req Ilshilida.jud enu,cwu anafthir&=.
m may in any way vow again said City •/.
in consegwn of a{rv,ing L ' L COMPLY WITH LL NON-POINT Issued by: Date
'SOOR ItR U A ONS.
3 105 Re-roofs
Signature fApp RcaAvc.nuac.r -'1 Dam of Roof
HAZARDOUS MATE IAM DISCLOSURE Type
Will the applicant or furore building carnal slam orhaodm haerdaw Material
v definedby thc Cupertlao on 1 al Code,Chapmr 9.13,and the Health and Safety
Algeria.Sedan 25573(.77 All roofs shall be inspected prior to any roofing material being installed.
❑Ya o
Wi71 she applicvt o mum building ocoupem use eyuipment or devl=which If a roof is installed without first obtaining an inspection,I agree to remove
In mit hvardnus air comm' ane acr=d by the Bay Area Air Quality Management all new materials for inspection.
District? CZ
OW, �1i1
Thew read huaNnusmemria arequimmenu unacr Chapter 6.95 of the Califon
nu NA
C , 57Wilding
Does b •manic the u resparulhility m wdfy the upant of theh enmc, r waMeanCeNfm.maiD� p - Signature of Applicant Date
owwr ar nathaA7ed agent \ Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
m/d u..�( k& no 4 950/ 050 DD�Z
OWNER'S N r PHONE #
GENERAL CONTRACTOR 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 eh� 7oZ3 50�
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
G, e ice,1&7164
Owner/Contractor SVgnature Date
fl J CITY OF CUPERTINO
FURNACE/AC
UPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Addre s: /
Owner's Name: Phone#:
f-r W) s2 t —
actor: Phone: License#:
#o a?G l - 5 7.23
Contak , Phone: Cupertino Business License#:
�G
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech
Job Description:
Residential C mmercial ❑
For Residential Installations:
Attic ❑ 151 floor ❑ 2nd floor❑
,dinikdhere to nun set back requirement❑
or Commercial Installations:
eplacement same weight E3 Additional weight (structural calcs) 0
Structural Calculations required for new installation
New installation Planning Approval Required ❑
Cost of Project- �� Type of Construction: Occupancy group:
Strapped El On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty-
c bl Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfin 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 BUILDING
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