06090125 CITY OF CUPERTINO r iii«a�w 1 :"= o '"" �'' ' -
BUILUINGDlVrstON PERMIT ��L1NpTRAC'T-ORI�NFORMATI0IV _.
BUILDING ADDRESS: A PERFECT CLIMATE PERMIT N0.06090125
809 ROSE BLOSSOM
OWNER'S NAME: PERMIT ISSUE DATE
JEAN SUN 10570 S DE
E:
SANITARY NO. CONTROL NO.
(408) 86119545
ARCHITEC 'ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
(� 0 (� 0
o0 LICENSED CONTRACTOR'S DECLARATION Job Description
U FI trembly affirm that 1 am licxvcd under provisions of Chapmr 9(commencing
with Section 7")af Division Sof the Business and Professions Code.and my licensee
.may in full fora and effect.Cva `I 'a31 S� � ADD A/C
t adz License Cl Lk.d
;F0 Date ^ Consracmr pE ^PG'F •ka'L
ARCHITECTS DECLARATION
i 1 malcistand my plans shall he used u public rands
iiU
.O t•, Licensed Professional
OWNER-BUILDER DECLARATION
3 I hereby affirm Nal l am exempt from the Conuanors License Law for dhe
:pc following mason.(Sccdun 7001.5,Business and Professiom Code:My city or county
m whish requiress permit in constmcL alas.impmoo.demulah,or repair any structure $4511
!iy prior m its issuance.aim rcquima the applieantfor such permit to fileasigned sammem
m d
< that he is licensed pursuam m provisions of the Conuacturi Licenm law(Chapter 9 Sq.Ft. Floor Area Valuation
is
N (commencing with Secdon 7000)of Division 3 of the Business and Prafcisinns Code)or
that M is exempt therefrom sad the hese for the alleged exemption.My violation of
Section 7031.5 by any applicatR far a permit subjects the applicant o a civil Penalty of r Occupancy Type
our mom Nan five hundred dollar(5500}
❑1,u ownv o!da proputy,m my wployces with wags ss the"v sok compemadon,
will de dini and the sWCWR is not intended Or Offered format(Sec.7044.BesIOCV Required Inspections
and Pmleviam Cade:The Conuxcmrs License Law does not apply m M owner of q P
oviertywho buildsarimprowchhop.andwho.tsmetsuota omuded mselfer Wmuate his
awnemployees.provided prvemimpmwmmts arenot erMdmolfertd Ter sale IL
however.the building or me of proving
is hale within one year of completion,proor the osis of
builder will have the huAen of proving Nat bo did not build er improve far puryase of
Colo.).
❑Las owner of the property.am exclusivelyand
connecting with licensed mouacma U.
eme,La the es project(Sec.7D44,Buiannoy ocs aced y who oro Code:)The Cmuanars Li
fume law dote wispily a an owner of property Mm builds m unpmves therson,and.
who contracts fm such projects with aconuumRs)Licensed pursuantmtM Conuutors
License01..Law.
❑I oro esempt under Sec ,B k P C for this mum
Owner Date
WORKER'S COMPENSATION DECLARATION
I bemons,by air=under penalty of pi oof the folkswing declamuam:
1 him and will maintain a Certifimm of Consent to self-insure for workers Compen-
den.as provided for by Section 3700 of the Laker Cade.for the per forms a of the
wart for which this permit is iuuct.
1 have and will million Workers Compemnion Insurance,u required by Section
700 of the labor Cade.far Ne do..of the wart for which des permit a ivued.
My Workers C/y/t/W/�u-a�1go_� rata agicr aha Policy number are:
Cagier. 1 /N e Policy No.: 116 $ -/
CERTIFICATE OF EXEMMON FROM WORKERS'
COMPENSATION INSURANCE
lilies mesion need net bo complied if the permit is for one hundred dollars({100)
or kis)
I cmify that in the perfions a of the work for which this permit a issued.l shall rat
employ any permit in any mannerm a m hemme subject to the Workca'Compenadon
Laws of California.Data
Applicant
NGnCE TO APPLICANT:If,aper making this Certificate of Eamption.you should
become subject W the Workers Compensation provisions of the,Labor Cade.you mm
.J O forthwith comply with such provisions or Na mail all he deemed reveled.
CONSfRUCnON LENDING AGENCY
tom+ Ihereh anion that there is a conswcdan lending a
F Y { gcmy for the performance of
CL the wish for which the permit is issued(Sec.3097,Civ.G)
Q Lenders Name
D
� z Lender's aaama
U O 1 certify that I have read this application and sure one the above infor adua Is
ty F corms I agree m comply with all city and county ordinances and sham laws relating m
DU building Conswetion.and bemby,authorire reprmemmives of this city m enter upon the
CL mem-menduned property for impcNT
o t punms.
(We)agree to ave,indemnify and kelp harmless the City of Cupulate against
F'rA liabilities,judgments,Casa and expenses which may in any way accme against and City
U Z in consequence of the Shooting of this permit.
APPLICANT NATION. NDS AND WILLY WITH ALL NON POINT
SOUR R�u6AnoNs.S/TK// Issued by: Date ��r'
!S 0 ��s+*�� 9✓SCJ Re-roofs
Siga do re Of Applian/Conuxtor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupantnore orhandle harmonious mnerial
as depacd by the Cupertino Municipal Cade.Chapter 9.13,and the Health and Safety
Cook.smuan 35532(a)?
[3 You mina All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I
Will the applicant or future building occupant use equi Qor devils which g Pe agree to remove
emit haxardnm air cmtaminants u dcpned by ft Bay Area Ail
r Quu ality Managcmem all new materials for inspection.
DisVict?
❑Yes PNu
1 hate mad the couscous mamsialsmquirentents under Chapter6.95 of the Califon.
nice HcalN sofaycodc,Sauwa35505,25533u 25534.1undcnwd Naifd Wilding
does notsly hoc a a:nan4 darn a my nsibility m notify the occupant of on,
onto nta yb inmet ' rro aracertir teofr-IWy Signature of Applicant Date
a�v
Owner or authcmcdagent `� DS All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 3 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35903005 . 00
DATE ISSUED. . . . . . . : 09/15/2006
RECEIPT # . . . . . . . . . : 36060
REFERENCE ID # . . . : 06090125
SITE ADDRESS . . . . . : 809 ROSE BLOSSOM DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JEAN SUN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
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) 86119545
EE 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 4 , 511 . 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
-------------- - - - - ----------- - = - --------------
CHECK 501 . 00 025457
TOTAL RECEIPT 501 . 00
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
4JUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
go Se (Aa mV)< l2S _
OWNER'S NAME: Sect n S PHONE # G I - c}S
GENERAL CONTRACTOR J?ew -, �j�FAX # I - 9 5-Y (�
I am not using any subcontractors: 1 �-(iN'� SA2002� 9 -15-406
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
OUPEkTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
09 rose oSSo vr.
Owner's Name: Phone #:
Scar, �► 3 (�(7 .
Contractor: (� I Phone: e 9 License# 7 a 31S p
2rk ecus r �.�-t�1mrn•t 2 6' � • y O
Contact: I/) f Phone: D / U� Cupertino Business License#:
✓�.� VYl '7 I I , O l� r/
Building Permit Info:
Bldg ❑ Elect D' Plumb C9-- Mech P '`
Job Description: Ad ol 41C
4-0 �JO i'✓1 L
Residential Commercial ❑
For Residential Installations:
Attic ❑ I" floor ❑ 2"d floor❑
Adhere to min set back requirement
4PFor Commercial Installations:
Replacement same weight ❑ Additional weight (structuralEl calcs)
Structural Calculations required for new installation El
New installation Planning Approval Required ❑
Cost of Project: Type of Construction: Occupancy grou
5/D. SO \Z7
Strapped On Platform Bonded Sq.Ft. Floor Area:
New Location Replacement E-1
Qty. if
Applicable Fee ID Fee Descri tion . 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
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