08090126 CITY ON CUPERTINOr -�n.,+rg6,.uaS"� �° `*
BUILDING DIVISION PERMIT CONTRACTOR INFORMATIOM"
BU PERMIT
DR CONDITIONED AIR P 08090126
NER'S NAME: 77 PERMIT ISSUE DATE
RICHARD YUAN 1701 LITTLE ORCHARD ST' 09/19/2008
PHONE: SANITARY NO, CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
REMOVE & REPLACE FURNACE BLDG ELECT mums MECH
UOO LICENSED CONTRACTOR'S DECLARATION O O O O
jtad� 1 bereby affim that I oA licensed under prevision of Chapter 9(commencing Job Description
Z with Secdon 7M)of Division 3 of the Believes and Prafeaslom Code.and my licensee
^< in full farce and affect yy5/6Z
j i License Lie g — -
ep r/ ' AR call Wuse DECLARATION
Y ulSlS U 1 undnvand my piano dull be used u public records
J
g C Licensed Pvfessioal
.� 3 OWNER-BUILDER m the Com ION
n o I hereby afNm then I am.Bumps from the Cations Co License law for IW
p O following reasaa(Smote lllll.S.Business and m.diumd .or Any city at county
$
which tia its a permit re eonswel,alar.im for
ecmiraitt li repel,any urocmm
_iy primbicecensed pursuant
thovisiosofwatum far ouch p«mr'toicomm aw(Chned temcm
E CdutWom,ugwitpurvanttONcpmvumns3 the oftComrinctutldcenselaw(Code)m Sq.Ft.Floor Area Valuation
(conoto8 that he W exempt Section 1 and of ands n l of the B ed cos Deco Proort.Any
Cade)of
Nal h u exempt therefrom me the Ensu for the alleged exempJon Any violaUan of
Section 103M by am,applicant for a permit subjects the applicant to a chill penalty of APN Number Occupancy Type
tet more this firm hundred dean,(531101.
0 1,u owner of the property.«my employes with wages u their sole compensadon,
will eo Nework,and NestrunumuwtuteneedoroRered forsale(Sec.]044,13usinus ns Required Inspections
and Prefestioa Cade:The Contractor,U.Law don,not apply to an owner of q P
propenywW Wads«implore thmaan,and who does suchw«k himxlfmthrough his
oweemployes,provided that inch impmsemenw ve not handed moRered fordo U.
Wwem.the Wilding or imp omnent is sold within one year of mmplemn.Ne owner-
Wilder will have the,burden of proving that W did not Wild or Impress for purpose of
aide.).
0 1,as owmm a the propen,not exelnsimly cmu,n rig with licensed mnuaemrs in
comrsot the project(Sens 1014.Bomea and PmfeaUov Cede:)TW Cmuactots U- .
cove law does not apply to an owner M property who Wilds or improm Nemon,and
who contracts for ouch projects with a comeamot(a)licensed pursuant to the Communes
License Law.
Iameaemptunder See ,B&PCfmdsx.
nor Date
WORKER'S COMPENSATION DECLARATION
I Wmby Nim under penalty of perjury one or Na fallowing detaradom:
❑Ihoneand will maintain aCuJBomof Ca emHomlf--ivum f«WorkaYn Compen- '
cation.as provided for by Section 3100 of the ISWr Code,for that performance of the
wart for which his permit is issued.
0 1 have and will maintain Wmkuh Compensation Insurance,as required by Section
37W.fNe labor Cade.for the performareceofthe work for which Out permit is issued. '
MY Worker.Comps"..huutartoc carries and policy number are: AlCarrier. �t MVEi/ Policy No.:z7000186YS-- O
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
Into section need not W completed if the permit is f«om hundred down(SI00)
or lost)
I certify Not in the performance of the work for which Nis perdt is Wood.l.ha11 Out
employ my person in my manrerso as an biome subject to the Wor Compevadon
Laws of California.Dao
Appliant
NOTICE TO APPLICANT:If,after meting the Cenificam of Exemption,you chord
become subject to we Workers Compcnsalion provisims of the,Labor code you mus
.J 0 forthwith comply with such provisions m Nu permit Nall W deemed i mked.
Z '7 CONMUCTION LENDING AGENCY
1 bomb affirm Our Nem u a construction kndin a
I"" Y g .)eery for the performance of
[Yi
the wmh for which Nu pemtil'u issued(Sec.3097,Civ.C.)
OW. Q Lenders Name
Z) z I<Mers Address
U O 1 only Nat I haw read thin application and sum the the above iNmnatim u
gy ^. comm 1 agree to comply with all city and county ordinances and Bum laws mladng to
l)CrJ' building covuuction,and hereby auNariae minduenmtim of this city to enter upon Ne
Fr+aaWw-mendotmd property for inspection puryma.
(We)agree to eve,indemnify and kap harmless the City of Cupertino against
fIl liabilidesjudgmcnu.cmu and cxpmuu which may to any way.agaivtdd city
U 2 m consequence of Nc granting of Nu permit.
^ APPLICANT UNDERSTAND AND WILL COMPyY• ITH ALL N -POINT Issued by:
SOURCE REGU�TIO�a e% Date —/��.�K.
Stgnuurt Applian ntractor�!/—�L C Re-roofs `
HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
Will Ne applicant or ruutre building otecupantamm«handle hexndma motorial
Med by the Cupertino Municipal Cade,Chapter 9.13.and me Health and Safety
.Scetion 8532(.)?
pyre JQNo All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building oc Upanl tax cquipmem or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
emit haxvdom air continuance as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0Yns 5WO
N
I haw reade hnardousmamriau requirtmmce under Clap e,6.95ofJo Califon
nia Health&Safety Code,Sections 8503,8533 and 8534.1 understand Netifcom Wilding
does n«cunen ly haw•teen,coot it is my map asubility at notify On occupant of the
nequircmence which muss W met prim an re f.ccrdfreamorompamy. Signature of Applicant Date
Owmr rr,rmarivtee,grn, to All roof coverings to be Class')?."or better
• CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36928014 . 00
DATE ISSUED. . . . . . . : 09/19/2008
RECEIPT # . . . . . . . . . : BS000006132
REFERENCE ID # . . . : 08090126
SITE ADDRESS . . . . . : 20199 SUISUN DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER RICHARD YUAN
ADDRESS . . . . . . . . . . : 20199 SUISON DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4427
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
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
IBSEISMICR VALUATION 2, 850 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0. 00
1MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1MRRAA UNITS 1. 00 61 . 19 0 . 00 61 . 19 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 224 . 85 0 . 00 224 . 85 0 . 00
METHOD OF. PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 224. 85 visa
---------------
TOTAL RECEIPT 224 . 85
VOICE ID DESCRIPTION VOICE ID DESCRIPTION .
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
..a.1, Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UP kTINO
Building Department
JOB ADDRESS: PERW&Fe2 Z�
O('t`( o ✓ C r7i,4 950y v
OWNER'S NAME: kZa+ c cn PHONE # ( — ('
GENERAL CONTRACTOR: Ctvad 'f Oa t e FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
bd SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
• Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
t/ Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
• Tile
Owner Contrac or Signature Date
I
CITY OF CUPERTINO
FURNACE/AC
CITY F
CUPERTINO . PERMIT APPLICATION FORM
APN# o '2( p
co q 2� � ILS� Date:
Building Address:
I T
ACX RV%A-vno C-0 °ISoI c�
Owner's Name: Phone#:
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Contractor: Phone#:
CYos) Zq�• 2.ZZo
ccwkiA\Cance n%c YA S do c . Fax #: c�tois� zr�i• 1,2Lti
Contractor License#: Cupertino Business License#:
iduSlbZ
Contact: Phone#:
'�af+trr� SArv�E F\9
Fax #: `A fypUE
Building Permit Info:
Elec Plumb ❑i Mech
Job Description:
q-e Yv ocP, ce .
Residential Commercial
pF;orCon
dential Installations:
1St floor [� 2°d floor ❑
minimum setback re uirement ❑
mercial Installations:
ent same weight ❑ Additional weight (structural calcs)tructural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction (usage Class):
2t8S0 . o v
Strapped On Platform Bonded New Location
Replacement
aluation:
Green Building: Must attach Green Building Check list to this application
Z9-_
CITY OF CUPERTINO
FURNACE/AC
CUPEIINO FEE SCHEDULE
AIR CONDITIONER:
Qty. if
Applicable Fee ID Fee Description Fee Grou Permit Type
BCAIRHAN Commercial A/C Units<= I Ok CFM B FURN/AC
MCRAA Commercial Mech Repair/alt/add M
SEISMICOM Seismic Commercial B
BREMAIRHAN Residential A/C units<= 10k CFM B
/ MRRAA Residential Mech Repair/alt/add M
BSEISMICRE Seismic Residential B
/ EPERMITFEE Electric Permit E
I MPERMITFEE Mechanical Permit M
PPERMITFEE Plumbing Permit P
BREMRECEPT Electric Receptacles E
PGASCOM New Gas Piping System Commercial P
1-4 Outlets
PGASRES New Gas Piping System Residential P
1-4 Outlets
BPGAS Gas Piping System 5+Per Outlet P
/ TRAVDOC Travel Documentation B
BUSLIC Business License B