06120117 CITY OF CUPERTINO - .:�$ +`
BUILDING DIVISION PERMIT C�NTRACTORINFORMATION
BUILDING ADDRESS: PERMIT NO.
ERSNAME: r r T n
OWNE DATE
THOMAS TANG 1965 KYLE PARK COURT 12/21/2006
E:
SANITARY NO. CONTROL NO.
(408) 286-8931
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG � ELECT PLUMB MECH
cj LICENSED CONTRACTOR'S DECLARATION
w I bemby affirm that I am licensed under pmvisians of Chapur 9(commencing Job Description
'i5
So Co.
ftheBusincasmdlimitasiovCod�admylicenseu ADD A/C
in full fortt and eflee 1133
�Zi Liccnw 1-1 LW.g - '
r Da¢ Comastar
R N CTS DECLARATION
i�i 1 undersand my plans still he uvA as public mcords
jyU
'LLH Licensed PNfe531an8I
0.11ammonaptOWNER-BUILDER DECLARATION
)2 0 1 herebyac alum.n 1 am acmpt from the Contractor's k:MY C Law for the
fallowing reason.(Satin.703 I.S.Business anal Pnf,de oli Code:My city.f county
which its requires a permit re,.mown,altarplic Improve,demolish,fi repair any structure
Prior uits issuance.also mquiry the applicant for such pcnnitw file asignd slaum.nt
; o that he is licensed porsuantw lad provisions;of tic C.ntrecmr's Lianw law(Chapter Sq.FL Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Profesiov Code)or $5000
s $ Nat he is ewmp,therefnfm and dee basis for the alleged exemption Any violation of
Section 7031.5 by any applicant fm a Permit subjects the applicant he a civil penalty of 3 5 912 0 0 2 5�'I Number Occupancy Type
not mom Nan live huadmd dallaus 0MO).
0 1,as owner of the property,or my employees with wage as their Sale compewtlan.
will an we work.and the stannum u ml m¢nded orner
aed fnarde(Sec.7044,Basins,And aired Inspections
and Professions Cade:The Cantre Mme,License Law doOut apply u an e ns owner of q P
property who builds or i mpmves dee men,and who doessuch work h'w,..tf or nnfugh his
own employees,provided that such impnfvemmu ase nos imanded nronered formals.IL
however.the building or improvement is veld within one year of completion.the owner.
builder will have esu burden of prating that le did an,Wild Or Improve fan purpose of
ASIC.).
0 1.as owner of the propert,am aclusively contracting ankh liccved mnuutars in
...most Ne project(Sec.7004,Business and Profusions Code:)The COMMIoh U.
Cove law it.not apply in an owner of property who WiWs or improves deereon,And,
who contracts for such inflects widea emtractar(s)licensed pursuant Or the,Comrwtats
Lice.law.
0 1 am exempt undo Sec ,B&P C for this won
Owner DaW
WORKER'S COMPENSATIONDECI RATION
I hereby afBrtn under pevlly of perjury mar,of the fallowing declaraionc
ha and will maintain aCeNOeaW o(Cntuenua self-ivumfmWarkcYsC.mpen-
an,as provided for Stttian 3700 of tk labra Cade.far Ne pertormarae of du
which this Permit u issued. ,
h r and will maintain Workers Component Insurance,as required by Section
C On labor Code,for Ne corminmecof the work for which uia Permit u issued.
Y W.rt��-�a)C?om}pcpw' a and Polity ) Ecr ase:
Cartier.lJ t I�L li L N M, m Policy No,:
CERTIFICATE of"EMPTION FROM WORKERS'COMPENSATION INSURANCE
(Thu sectim decd not b.compleud if ase permit is forme hundrtddenars(5100)
ar le5s.)
1 CCMfv act In nc Performance of the work for which this Permit u issued,)aball an,
employ any pawn in my mmnerSa AS to become subject to due Workers'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL after making this Ccnifau,of Damler. ,you should
became subject in the Wommrs Compensation provisions of ase lalur Code.you mo
�0 f.Mnf
with comply with such pvisioas mumi
ss Pcft shall boo
.deemed rked.
'Z� CONSTRUCTION LENDING AGENCY
[-� I hereby a?ren Out then its construction Wading agency for ase performance of
IY 7 tic work for which esu pemtit is iuucd(Sec.3097,Ci,C.)
W Q Lender's Name
= z Lcaders Addw .
U 0 1 cmify that 1 have rad this applica;on and RAW esu the above infotmatiun IS
It, F come(.I agree to comply win all city and county ondinmues and 9]W laws relating to
L.1 building Construction.and herebyautborirz representative of nim city m enter up)n the
0. ahu.cmcmioged mproperty for inspection purpowhich ms.
(We)agree to save,indemnify and keep harmless be City of Cupertino agamat
H N liab"Man judgmcna,Costs and of da' it. may in my way accrte agaiast ala city
U Z 'tAnPPLLICA nce.f D HANlingDS thu0 WILL COMPLY WITH ALL NON-POINT /' / 41
Issued by: Date t/
SOURC G NS.
''/ 0 Re-roofs
Sign oma Da
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will ase CupintmfMunime,buildings.Chartxomor handle h calor and SWrul
As defined by ase Cupertino Municipal Code.Chapur 9.12,and ase Health and Safety
Code,Scccdon 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Yu
Will ase Applicant 'K.0
m amoccupant devices npant use ego;pro , .i. which If a roof is installed without first obtaining an inspection,I agree to remove
Dark hanoMm. it conaminanu u defined by the Bay Arca A.,Quality Management all new materials for inspection.
District?
0y.
1 have mal rte IuaardrfusmaWrials requiremenuunder Chap¢r6.95 oftic Glifor
nice Health&Safety Code.Scaov 25505,35577 mJ 25574.1 undersand uazifthe Wilding
docs not curt ave a¢Wane m rcapovihilitY m ramify dt�oceupant of tite
myuimrden must be pri. u i Co of t Ccrtiftcau of Occupancy.
Signature of Applicant Date
ownma a >. D,W All roof coverings to be Class"B"or better
'1 Community Development
10300 Torre Avenue
'%✓' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
#UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
20 71 S ' v. 0 co 19,L)1 <-4—
OWNER'S NAME: r�ir-K PHONE # Sl� - 9P3 S
GENERAL CONTRACTO : a O L FAX #
I am not using any subcontractors: ,Z G
ignature Date
Please check applicable subcontractors and complete the following ' ormation:
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
l � O
Owner/Contr for Signature Date
CITY OF CUPERTINO
• 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35912002 . 00
DATE ISSUED. . . . . . . : 12/21/2006
RECEIPT # . . . . . . . . . : BS000000052
REFERENCE ID # . . . : 06120117
SITE ADDRESS . . . . . : 20771 SCOFIELD DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER THOMAS TANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . .
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : TRILLO, STEVE LIC # 4269
COMPANY . . . . . . . . . . : STANFORD PLUMBING HEATING &AIR
ADDRESS 1965 KYLE PARK COURT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 286-8931
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
----------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1. 00 34 . 86 0 . 00 34 . 86 0 . 00
BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 .26 0 . 00
BREMFURN NO UNIT 1 . 00 14 . 31 0 . 00 14 .31 0 . 00
BREMRECEPT NO. OUTLETS 1 . 00 1 .20 0 . 00 1.20 0 . 00
BSEISMICRE VALUATION 5, 000 . 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
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 .37 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 176 . 24 0 . 00 176 .24 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 176 . 24 8347
---------------
TOTAL RECEIPT 176.24
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
•
CITY OF CUPERTINO D 11
FURNACE/AC ocnla
CUPERTINO PERMIT APPLICATION FORINT
N # �7"1' I (�off-J Date:
Building Address:
Owner's Name: Phone#;
Contract r: Phone: License#:
oar vi I o v "�"Y13�
Contact: Phone: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect lr Plumb Com— Mech 11 �
Job Description: Add 4—IC
Residential Commercial ❑
For Residential Installations:
Attic ❑ l' floor ❑ 2"d floor❑
Adhere to min set back requirement❑
or Commercial Installations:
eplacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Cons tion: v Occupancy oup:
Strapped ❑ On Platform B— Bonded ff 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
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