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06060217 ctB�LD cDIVIISSIONNO PERMIT 'oNTRACT()R IiVFORMAT N� s BUILDING ADDRESS: AT'XPERFECT CLIMATE PEaMITNO'06060217 1 ; 229 STLUFFER IA 9R'S NAME: PERMIT ISSUE DATE WILLIAM LO 10570 S DE PHONE: SANITARY NO. CONTROL NO. (408) 861195 45 ARCHI ECOENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH app LICENSED CONTRACTOR'S DECLARATION lob Description e wm C 1 hereby grim that 1 am Housing under Provisions of Chapter 9(commencing P .zo, with Smtion7W0)of Divispa 3 of the Business and Professions Code.and my license is n in full fora and Offer— �q= License Class Lm.s ?�� �S� REPLACE FURNACE- 1ppj7��j7� ` t- Dam jj6 CTSDECL II ("�. '( l,1 FF ARCNI7E(co DECLARATION N{�yll'll tt IlrLff`J`Jppp))) W I understand my plans shall he used.public records JULetc I' LiccnmJ Profcssionsl 1U c0� OWNER-BUILDER DECLARATION Com eh 7� C U6 I hereby alum Not I am exempt from No COntrxmrs License Law for the Z O o following moon.(Secdon 703 L5,Business and Profesuaas Code:My city or county I S K which myuims a permit m construct.cher.Impmw,demolish.ver repair my ummun, nth5(]5 prior mita issuance,also".i.Nc appliust far.,h pemit m file a signed statement -�< that he is liccnmd pursuant to the provisions of the Conuacter's Licene,Law(Chapter 9 Sq.Ft. Floor Ar Valuation E (commencing with Section 70)(0 of Division 3 of the Business and Professions Code)in that he Is exempt thetcfrom and the basis for the alleged e u mpdan My violation of Secdon 7031.5 by any applicant for a pemit subjects the applicant or a civil penally of r Occupancy Type not mom Nan fin hundred dollar(5500). ❑1,as owner of the property,or my employees with wages as their mlc compensation, will do the wode and the mounum u.dintrded of offered for sake(Sm.7044,Business Required Inspections and Professions Cede Committees Liww dos Out m e ns ase Lav, apply .owner of q P property,who builds or impro sNemon,and who dmasuch work hiwelforNmugh his own employees,provided that such improvements meet intended aroffered forsxle.If. however,the building or improvement is mid within one year of completion,Ne owner- buildar will have the turdm of proving that he did and build Or improve far purpose of sok.). ❑1.as crone,of Ne property am exclusively embracing with licensed combacmm m construct the project(Sea 7044,Business and Pro(essons Cade:)M Conmcmr's U. cease law does oat apply to an ow.r of property,who Wilds or hop.Nemo.and, who contracts fm such Projects wish a contranof(s)lianzd pursuant m the Conmerimes License law. ' ❑l am exempt under Sm .B&PC for this reams Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty,of perjury arc of the fallowing declarations ❑I have and will maintain a Certificate cr(Consent to self insure for Workers Compen- sation,as provided for by Section 3700 of the labor Code,for Ne performmem of the wart for which Nis permit is inputs. ❑1 ban and will maintain Workces Compensation Insurance,u required by Section 37M of the labor Code•for the performance oldie work for which this Permit is issued. ' My e a Wallace,ers C n i.... rrior and Policy number are: Carlow. NQS Policy No.: &p -rrSye"13 0 $UO CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This sector need not be completed if Ne Fern is fora.hundred dollen(SIM) Ica) I century that in Ne performance of the work for which this permit Is Wood.l s,sl ant employ any person in any mannerm as in become subject in Ne Workers'Compensation Laws of Califomia.Date Applicant NOTICE TO APPLICANT.If,ager making Nis Certificate of Exemption,you should became subject in thc Workers Compensation provisions of the Isbo,Codc you muss .J O forthwith comply with such provisions or this Permit shall be damcd masked. 'Z� CONSTRUCTION LENDING AGENCY [-+ I hcmby alRm Nat Nem lsa eonamcdnn lending agenry for the,perforans of lX Ne work for which thia permit u ismed(Sec.3097,Civ.C.) (y Leadcrp Namc a, . z Lenders Address U0 I certify Nat I haw mad this application and Stam Nat the stun Wonsan..u ly F correct-I agree to empty with all city and county ordinances and rota laws relating to 0U Wilding,construction,and hereby aomorim mpresentatins of this city to enter upon de r W above-mentioned property for inspection purposes. F 6. (We)agree tp save,indemnify and kap harmless Nc City of Cupertino against , RI liabilities,judgments,costs and caperuca which may in any way acme against said City / V Z APPL CANT Umee N the gaining Of thiJ imerit. STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date O 2 SOURCE RE LAT: NS. n„ Re-roofs SigavumofA ontrxmr f D. AZAROOUSMATER:ALSDISCLOSURE Type of Roof Will theapplicant of room building mcupantuomwhMlehav usmac A defined by Ne Cupertino Municipal Code.Chmmr 9.12,and the Hca10 and Safety .Seeuon 25532(a)7 All roofs shall be inspected nor to an roofing material being❑m m P P � Y g g installed. Will thO applicant or future building Occupant use equipment Of devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hO.1dnus it contaminants as defined by the Bay Ama Air Quality Management all new materials for inspection. Domet7 C]Yes u I have mad Ne hvsrdws materials mquircmenu under Chapxrti.95 afdm Califon his Health&Safety Co k.Secdotu 25M5.25533 and 25534.1 understand dm iftM Wilding does net cuncntly ham a tenant.that It is my mspara bility in notify the Occupant of da reyu�e wnhyyeemetpmrto iso.of.CesuraxmpfaeypaxyG1Signature of Applicant Date rOTr Ikoulimcccdd atop! (��jD, All roof coverings to be Class"B"or better • CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT OPERATOR: suem COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36609050.00 DATE ISSUED. . . . . . . : 06/26/2006 RECEIPT #. . . . . . . . . : 35015 REFERENCE ID # . . . : 06060217 SITE ADDRESS . . . . . : 11229 STAUFFER LA SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WILLIAM LO ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014 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 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL __________ _____________ __________ __________ __________ ___--___-- BREMAIRHAN NO.UNITS 2.00 20.52 0.00 20.52 0.00 BREMFURN NO UNIT 1.00 14 .31 0.00 14.31 0.00 BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BREMRECEPT NO. OUTLETS 2.00 2.40 0.00 2.40 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 BSEISMICRE VALUATION 61505.00 0.70 0.00 0.70 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 187.90 0.00 187.90 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ _____________----_ CHECK 187.90 024910 TOTAL RECEIPT 187.90 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL • - Community Development f' Cupertino CA 95014 Telephone(408) 777-3228 fCITY OF Fax(408)777-3333 m TINO Building De artment JOB ADDRESS: LW PERMIT # OWNER'S NAME: W /i4w IPHONE # GENERAL CONTRACTOR: PelAer ¢ C 'm e- FAX # I am not using any subcontractors: "Signature Da e Please check applicable subcontractors and complete the following information: 66 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 er/Con ctor Signature Date CITY OF CUPERTINO © ' FURNACE/AC CUP kTINO PERMIT APPLICATION FORM D�b�6�i7 APN # Date: ala Q Building Address: as Owner's Name: _ Phone #: a, 1- 0 3-8 a8 Contractor:p rI G7L Cl.m�1Phone: c —�S S License#:7a3 /Sg Contact: �CP'hone: O Cupertino B siness License#: iii Building Permit Info: _/ Bldg El Elect l� Plumb L'J Mech L1 Job Description: G .0 c ate0 a a� Residential Commercial ❑ For Residential Inst ations: ttic ❑ 1S1 floor V 2nd floor❑ dhere 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 Cgpstruction: Occupancy5oup: Strapped .0' On Platform LeJ Bonded 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 fl, 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