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06060030CITY OF CUPERTINO U 3 C �i y � $ _ Ofo Z F-' U W W f/) 'z ^' ;,w"w�ie s'I ,!NEORMATI0IV "WILDING DIVISION PERMIT �..�ONTRACTOI BUILDING ADDRESS: CONDITIONED AIR PERMIT ND. 06060030 22625 SALEM AV OWNER'S NAME: .f PERMIT MME DATE Akk CHAO ROBERT 1701 LITTLE ORCHARD �T 06/05/2006 E: SANITARY NO. CONTROL NO. (408)291-2220 ARCHITECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions or Chapter 9 (commencing will$Codon7=)of DMY on3ofthe BushellN NofcWomC' ,andmyIIcc=is in full force Lj45i6ra ADD A/C an, Lieeme Claw �g Deck /_ anZ CantDEC fcvvt:-\:c p��.+ SJ ARCHITECTS DECLARATION ppp �� JJJ 1 utMeraeand my plain shall be used u public record `1 c ®8 2006 Licensed Pmfcsdanel OWNER -BUILDER DECLARATION 1 hraso .(Tion I am exempt from the CmnmactCo License Law for the jell L ¢ssoa (Section ]W 1.5. Business and Rofcoium Cade: Any city or county on which re issu petrol' cnnsrthe mmr, improve, nae swmum which - t 3 9 0 0 its n rectums h pem it t a sig ed priorm iso issuance.alson,te theapplicantfor suchpeons'mces Law (Chapter that he is liccmcd purwan'to the pmvisiam of the Conkxwh lJecnw law (Chapter9 Sq. Ft. Floor Area L�� (�� ll� On (commencing with Section 7000)ofDivuion3ofthe Business and PmfeuiansCoae)or u 1) 11 that he u exempt ificadrom and Ile basis for the alleged exemption. Any violation of r Occupancy Type Section 7031.5 by any applicant far a Permit subjects the applicant to a civil penalty of, not more Nan five hundred doll. (S5W). Q I, as owner of the property or my employees with wages as their Sok, compensation, Required Inspections will do the wart. and die invnurt u to untended or offered forsale (Sec. 7064, Business and Professiam Cade: The Com actors LiRne Law ducal Ml apply W N OMNI of propcnywhohuildviimprawch doessuchwork himselforthrough hu ceproandwho awncm mc@red for sa1u1f, ear mid within of completion. isle building or improvement ahold she iproNded prsuchentisthe ose year a( eaprove did Wilderhowever. n I. of Wilder will have time Wrdm of proving that k did nom build or improve far purpow of can 1.1i Wlltr Or tht pruperlY• am aeluSlVelY cOnlllCling with IlRnied COOV9CIOIa w construct the pmjea (Sec. 7066. Business and professions Code:) The Conassames U- ccnm Law docs not apply m an owner of property who builds or im nowm Iberton, and who consaes for such pmjecs with a com anor(s) licensed pursuant an tlk contracmes ' Licence law. ❑ 1 am eacmpt under Sea . B d: P C for this ressan Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby of iren undr penally of perjury, one of don fallowing declaadom: , I hsve and will maintain a Certificate of Consent w self -insure for Worker'sCrimper- sedan. as provided fur by Sayan 3700 of the Labor Code. for due Performance or dm work for which this permit is Issued. 1 have and will com uin Workces Compensation ImuranR. as reyuirtd by Scsvom 37Wof the labor Code, for the performance ofshe weak for which this permit u issued ' My Worker's Compensation Insurance artier and Policy number are: carder: k)p60- , �vs t l? h PolicyNm.: o icorilgiciQs-nG aER —lb c OF IXEnm()NFROM WORKERS' COMPENSATION INSURANCE mlis section mind not be completed if toe permit is forms, hundred dollars ($100) or Icra) I sonify that in the performance at the work for which this Permit is issued. 1 Nall net employ any pawn in any manner w u m become subject to the Worlan' Compemadon Laws of califmmia. Dale Applicant NOTICE TO APPLICANT. IC after making this Ccnilicas of Exemption, you should become subject W me Worker's Compmation pmvisions of due Labor Code you muss thWuh comply wild such pmvisiam or this permit shall be deemed raked. CONSTRUCTION LENDING AGENCY 1 Itemby a1Brm this ft. is a cmnarucdma lending agency, for due Ikofmm. of dte work for which this pesmis u sound (Sec. 309'7, Civ. C.) Lender's Nene 1<nder's Address I certify that 1 hale read this application and soon that the abuse infunnadon u corkn.l agree m comply with all city and county ordinances and sus laws relating to buildi ng convection, and hereby authorim m:prescoutives of this city to enter upon Nc abuvememianed property for insPeetion pumosex. (We) agrte to save, indemnify and keep harmless the City of CupeNno against inof the =find of this PeWht. mey In ally Way lt[NC iglinStwld Glly of the graining of this Permit. A APPLICANT APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON i5 Issued by: �/ -POINT SMREGULATIONS. `^C/ KJN/ Date J Re -roofs Type of Roof of _ Jos to Si mu of Appli&m1Contract37 Date HAZARDOUSMATFRIALSDISCLOSURE Will do appliam orfukro building onepactioure or handle harudom material as deft od by the Cupertino Municipal Code. Chapter 9.13. and the Health and Safety Cw,,Secdan35533(a)7 ❑Ye No All roofs shall be inspected prior to any roofing material being installed. Will future If a roof is installed without first obtaining an inspection, I g � agree to remove ft applicant or Wilding occupant vu equipment, or devices which .mit huramous air noncoms... as dfuncd by the Bay Area All Quality Management all new materials for inspection. District'? ❑Yes }Liu I have mad the ha]allovs materials rtyvire rcom under Chapkr 6.95 orthc Califor- ria Health k Safcsy Cade, Sodom 25505.35571 and 35534.1 undersand dlmirNc building does not curmmly haw a tenamL We it is my responsibility to notify the meupwm of drc Xenia mussheme, priorwissu an eeniftmateoraapanyy.O Signature Of Applicant Date �C �S[ All roof coverings to be Class "B" or better 0 Dam" lie CITY OF #UPEkTINO E 11 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # 1 22l DGZ� OWNER'S NAME: IPHONE# GENERAL CONTRACTOR: p _ I FAX # 9q I I am not using any subcontractors: �. G /5 /o 0 Signatu e Date Please check applicable subcontractors and complete the following information: Owner/Contractor Signature S 45 /oC- Date 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/ Sep' Tank eet Metal Sheet Rock Tile Owner/Contractor Signature S 45 /oC- Date om 1 of 1 CITY OF CUPERTINO Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34212064.00 DATE ISSUED.......: 06/05/2006 RECEIPT #.........: 34682 REFERENCE ID # ...: 06060030 SITE ADDRESS .....: 22625 SALEM AV SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: amyw COPY # : 2 • OWNER ............: CHAO ROBERT ADDRESS ..........: CITY/STATE/ZIP ...: , RECEIVED FROM ....: CONDITIONED AIR CONTRACTOR .......: RICHARD READ LIC # 22334 COMPANY ..........: CONDITIONED AIR ADDRESS ..........: 1701 LITTLE ORCHARD ST CITY/STATE/ZIP ...: SAN JOSE, CA 95125 TELEPHONE ........: (408)291-2220 �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 3,900.00 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 • «UPERTINO O�eO CITY OF CUPERTINO (�W3 0 FURNACE/AC PERMIT APPLICATION FORM APN # 3 y g 1 6 6 Energy Date: 6•os•o6 Building Address: Furnace 6� CL \'-,sio CYl 9,0014 Owner's Name: MECHANICAL Phone #: A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Contractor: Phone: ELECTRICAL License #: Corgi .r `(a SS 1 3920 BUILDING BSEISMICOM Contact: Phone: BUILIDNG Cupertino Business License #: r SMm >_ ELECTRICAL MPERMITFEE Building Permit Info: MECHANICAL Bldg ❑ Elect\1LIl Plumb 10— Mech Job Description: BPERMFEE 2� -\-A 1 0 - BUILDING Residential Commercial ❑ Plan Check Fee For Residential Installations: BPGAS Attic ❑ 1" floor ❑ 2nd floor ❑ I PLUMBING Adhere to min set back requiremerZE�� Business License Por 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: goo 3 oa Strapped On Platform Bonded a Sq.Ft. Floor Area: New Location Replacement ElL Qty. if Applicable Fee ID Fee Descrintion Fee Gmun 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 I PLUMBING BUSLIC Business License BUILDING