06030047 CITY OF CUPERTINO "*
BUILDING DIVISION PERMIT CONTRACTORFINFORMATION
BUILDING ADDRESS: A PERFECT CLIMATE PERMIT NO.06030047
921 S STEL
OWNER'S NAME: i PERMIT ISSUE DATE
JAMES KAN 10570 S DEANZA B 03/10/2006
NE: SANITARY NO. CONTROL NO.
(408) 861-9545
ARCHAIC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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, LICENSED CONTRACTOR'S DECLARATION' Job Descrl L�
i< 1 hereby affirm that 1 am licensed under previsions of Chapter 9(commencing
with Section 7")of Division 3 of the Business and Professions Code.and my license is
LED
in fall force and Or .. t7 f FURNACE REPLACEMENT. & A/C
q z Licence. Lk.a ,
Date
contractor _ MAR off; 2006
RCHTTECIS tor F?'L
a1 understand my plans shall be used u public recnms
3 Q
Licensed ProfessionalM ■ ■'Ly y�
OWNER-BUILDER DECLARATION V N■®�■
NG
E<Y 1 naso .(Sect on 1 em exempt from the Cantons Co License Law for the
O a following career a (Schon 703 LS,Business and dm.0 Code:Any city or county
s which its iln a permit re cheat t,alter.improve.demolish. fi repair any stfu atm $10424
E a pnformiw issuance,ales requires thovisio aus,sof farthe sucCohpctor's Dance,Law Chasulumem
<
Beat Wislicensed pursuanlreNCprovili.naafNCG.aIavCl.fWce�law([Npter9 Sq. Ft. Floor Area Valuation
y�$ (commencing with Section70DD)of Division 3 of NC Business and Profusions Cock)or
Jut he is exempt thcmfrom and dam bazis for the alleged exemption.Any violation of
Section 7031.5 by airy applicant for a pe.I,subjects the applicant to a civil penalty of
......dun five hundred dollars 0150B). F Occupancy Type
0 1.as owner of the property or my employes with wages as dch sets compensation,
will do the wort.and Ne suucture is not Intended oroRered foraak(Sec.7044,Business
and Prefecdou Code:The Contractor's License Law does ml apply d an owner of Required Inspections
property who builds or improves Nelson,andwho doessuch work himselfor dough his
own employees,provided Balaton Improvements tie not intended croRered for sale.If,
haweven the building or improvement is sold within one year of completion.the moor.
Wildcr will have the W Icn of paving Nat be did nol build of improve for purpose of
sale.).
❑1.as owner of the property,am exclusively conunc,mg with licensed mnuacdrs to
Construct the pojcct(Sec.7044,Business and Professions Code:)The Contractor's Li. .
cense law does not apply to an owner of property who Wilds or improve Hereon.and.
who contracts for such projects with a co moscoar(s)licensed pursuant to the Contractors
License La .
OIs....pt under Sea ,B&P C for this nation
Owns Data
WORKERS COMPENSATION DECLARATION
41 I hereby&Birn under penalty of perjury,am of Ne following declarations:
Lj I hsve and will maintain a Certificate of Covent to self-har m far Workers Compcn-
.can,u provided fm by Seed..3700 of the LSWr Code,for the pffomtance of the
work for which this permit is issued.
❑1 have and will maintain Workefs Compensation Iwrance,ss required by Section
37W of the labor Code,for the performance of He work for which this permit is issued.
My Wa , a Co p sena lours.«carrier and Polity nu Ito art:
Cartier. Policy Nod L�➢(ryj���+
CERTI CATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thusec.im mrd not wcomplcted If NS Permit is fore.hundred dollara(SI00)
or less.)
I certify that in the prformaneu of the work for which this Permit is issued,I shall nut
employ any person in any mmncru u to become subject d the Warleers'CompcnsaJon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of Ne Iabm Code.you mon
.J O forthwith comply with such Provisinna m this Permit shall W deemed invoked.
z Vy CONSTRUCTION LENDING AGENCY
(~ l hereby affirm but Ncrc its construction lending agency forthe performance of
W> the walk for which this pennfl'u issued(Sec.3197,Cie C.)
A Loral Name
Z)z Iandefs Address
U C) I certify Nat I have mad this application abo sou that Ne shove information is
W F corrctT.l agree to comply with all city and county ordinances and awls laws misting to
pU building construction,and hereby auddrim represcntetivcs of Nis city to enter upon He
r[!1 above-pandoned property for inspection purposes.
F6. (We)agree to save,indemnify and keep harmless the City of Cupertino against
'lA liabilities.judgments,cocas ande.p;nus which may in any way acerae against said City
U,r in c.megm.e of the gaveling of this permit
^ APPLICANT UNDER 4D 4D WILL COMPLY WITH AL/1//,�N/O/N/�P)OINf Issued by: Date
SCE iaۤUI}9'CIQNS. VLA I`1(V fCJ
sngnuumo ApplicanUC.nwactor � Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or to,=Wilding.cupm,short of handle huardous material
u defined by the Cupertino Municipal Cods.Chapter 9.12.and the Heslth and safety
cess,semanns3xa)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yca
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air contaminants as defied by the Bay Am Air Quality Management all new materials for inspection.
Dbtrict7
❑Yca C]N.,
1 have real Ne hamm�asmamaxis requirementsundclChepmr 6.95 of the Califor-
nia He."&SafelyCode.Sections 25505,35533 and 26534.1 undenlsnd Nm if dtc building
Jars not c fly ha a ant Nat it' my map.os hili.y w notify Nc.cup of the
2�tlCq�q iim, ts hirnm (mnici.fr/'l)iss scearcam or asoma�(/n)� (� Signature of Applicant Date
kll — of 1pl�y'�a
Owmroriathodudegeat D,te All roof coverings to be Class "B"or better
Community Development
r ^F, 10300 Torre Avenue
L+"' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
*UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
1
OWNER'S NAME: Ly -e 5 PHONE #
GENERAL CONTRACTOR: r c t FAX #
I am not using any subcontractors: I—�—� -
Signature Date
Please check applicable subcontractors and complete the following information
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Am 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
1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35906019.00
DATE ISSUED. . . . . . . : 03/10/2006
RECEIPT #. . . . . . . . . : 33513
REFERENCE ID # . . . : 06030047
SITE ADDRESS . . . . . : 921 S STELLING RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JAMES KAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4203
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) 861-9545
*E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
______ _____________ __________ __________ __________ __________
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
BENERGY PERMIT FEE 1.00 34 .86 0.00 34.86 0.00
BSEISMICRE VALUATION 11, 000.00 1.10 0.00 1.10 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 175.64 0.00 175.64 0.00
METHOD OF PAYMENT AMOUNT NUMBER
__________________
CHECK 175.64 024464
TOTAL RECEIPT 175.64
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
' CITY OF CUPERTINO Ute '
FURNACE/AC
RT
OCUPEINO PERMIT APPLICATION FORM
APN # `35 G a / Date: / o
Building Address: / 1p
Owner's Nam : Phone#:
Contractor:—, Phone: , License#: � -31T'
� 0
Contact: Phone: Cupertino Business License#:
Building Permit Info: —/
Bldg ❑ Elect E Plumb--ig;,--�' Mech t✓JJ
Job Description: j C
Residential ax Commercial ❑
For Residential InsttqW
itions:
Attic ❑ 151 floor ^a 2"d floor❑
Adhere to min set back requirement El
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 Construction: Occupancy group:
(b . CO
Strapped ❑ On Platform ❑ 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 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