04040082 I CITY OR CUPERI-INO
BUILDING DIVISION PERMIT CONI RACTOIZ INFORMATION �,
nun.Dwc An°arss: SAN JOSE AIR CONDITIONING- PERMIT N°04040082
111012 -,WF.P.T OAK RT
NF,R'S NAME: PERMIT ISSUE DATE
O W
YUNG SHAW 880 N. 8TH Q4/14/2004
ONE: SANITARY NO. CONTROL NO.
(408) 286-2047
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
X00 LICENSED CONIAACode,PDECLARAT]ON
up 1 herchy affirm that I um licensed under provisions of Chapter 9(commencing lob Description
�W wi toll Section and
atnfDivision3of the Ousinesson rufessiena Cnde,and mylicenm is
Lii.amanrleanderlet. ccs REPLACE A/C
Y Date ARCHITECTStractor DECL A 01
[ t13y 1 understand my plans shall M used as public records v/
gats
g'
j Licensed Pmlessinnal Y
OWNER-BUILDER DECLARATION
sF 1 hereby affirm that 11. exempt from the Contractors ;Any c Law for the
O O
following moss(Section AIDS,Business and ve dcaom Code;Any city nr eouary
Sm� which requires a permit ac construct,aper,improve,demolish,or repair anystruclum
—ZN that heor itsissuance,pursuant
nt in the
dm applicant the for such rcrmiuuice file
rom Law slammcm
££S82725
< (comma cingwitPurstion700)nfDivinmefoftheStsiness Lianulsion,C(Chapter9 Sq.Ft. Floor Area .. Valuation
Yk'n (commencing with Section 7gl(pnf Division Jnf the Business and Pnafcuinns Cnde)or
i m3$ Nat he Is exempt thcmfMM and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit&object,the apPdicam to a civil penalty of 32kP9IJilfr6eer00 Occupancy Type
normo.than five hundred calls.($500).
P Y YP
❑I,as owner of the property,or my employees with wages As their sole compensation,
will do the work,and Ne structure is not intended or offered for sale(Sec.7044,Business
said Professions Code:The Contractor's Liaruc Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employes,provided that such improvements arc not intended or offered for sale.If.
however.lie building or imp awarenl is sold within one year of completion,the owner.
builder will have the burden of pmving Nat he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed convectors to
Construct the project(Sce.71144,Business and Professions Codm)The Contractor's Li.
cense Law docs not apply to an owner of property win Builds or improves themon,and
who contracts for such pmjcca with a contractor(&)licensed pursuant o the Conuactoes
License Law
❑I am exempt under Sec. B k P C for this reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury Arte of the following declaratinm:
1 nave and will maintain a Certificate,of Consent to self-insure for Workei sCompen-
aation,m provided for by Section 37W of the Labor Code,for she performance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,As squired by Section
of the Labor Code,for the performance of the work for which this Permit is issued.
My Wn R Co pemalion Insurance cart r and Policy number a
Carrier. Policy R RKERS ^
CERTIFICATED SATION'ION RANGE RKERS'
COMP SATION INSURANCE ,
(This section need not be completed Brie Permit is for one hundred dollars($10.7)
or less.)
I certify that in the performance of the work for which this Permit is issued.I shall not
employ any perann in any manner so u to become subject to the Workcri ComPcmatinn
Laws or California.Date _
Applicant
NOTICE TO APPLICANT:II after making this Certificate of Esemption,you should
become subject to the Workers Com pe ration provisions of the Lahr Code,you must
.Jz fonhwi th comply with such provisions or this Permit shall Ito deemed mvmkcd.
'ZO CON STRUC`MON LENDING AGENCY
[-+ I hereby affirm that there is a construction lending agency for the parrurmance,of
a ? the work for which this permit is issued(Sec.3097,ON.C.) ^
UQ Lenders Name, V
z Lender's Address
VJ Q 1 certify this 1 have ithJ this application and sure that the salve information Adding is
C (~ coned.1 agree to c comply with all city and county matins of and sum laws relating to
C7 V building ationaclion,and hereby wthorimrepresematiwa of this city menter upon the
[1] shove-mentioned Properly for inspectionkeeppurposes.
(We)agree to cast,indemnify and keep may
in an the City of Cupertino against /
y fiabilinconsopu nceofthe grandand expertise which may in any way accrue against said City
C.I Zhis Penn it,
APPLIICCANTeUNDERSTANDS ng of tAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO CE REGULATIONS. ,.S
v Re-roofs
ignmurc of APPlicaHpAZARDOUS MATERIALS DISCLOSURE m Type of Roof
Will Ne applicant or future building Occupant store or handle hamduua material
As defined by the Cupertino Mum ipal Cede.Chapmr 9.13,and the Health and Safety
We.Section ns3z(aY' � � All roofs shall be inspected prior to an roofing material being CYea [pJNa P P Y g g installed.
Will the applicant or future building Occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
pit harardnua air conmmimma as dedaml by the Bay Arca Air Quality Management all new materials for inspection.
it,
❑secs a
I have real the Ismail.mamrials requirements under Chspmf 6.95 or the Califnr. 1 O
nixs nothSently Cndc,Sccdoes3at it is 573aW355J4.1 to nodlande neaur building
re
docs not currently haw a Conant,rhos is is my respumibility m nodl'yy the occupant of the
up namemc which At etriurIoissuvmcofaCmAC,uCof Oce pane
r-1.
il Signature Of Applicant Dale
Owner p ant dy aEen D to All roof coverings to be Class"B" or better
v
aC10F
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRE I Ir
PER #Oak
v (7 Z�—
OWNER'S NAMEPHO p
GENERAL CONTRACTOR FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
f Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
C o
e //Contractor Signature ate
f
C TI' OF CUPERTINO
FU CF,/--AC
PEkTINO Pik H1 T PPLICATIONORM
Date: /
APN # � 3 Zoo � .1 O !o Q.
Buildi ;ddvr 1 s • CD^
Phone
Owner's N : W �Jf� #: �� -G
L.
Contractor• f Phone: . r Licensee Gr)o
Contact: 1 Phone: �¢ Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech so
Job Description: ^ z
ResidentiA),ID Commercial ❑
For Residential Installations:
Attic ❑ 151 floor ❑ 2nd floor❑
dhere to min set back requirement❑
or Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations. equired for new installation
New installation Plannin roval Required ❑ 1
Cost of Protect: � Type of Constru ion Occ pancy oup:
S apped ❑ Com, latfbrm 11 Bonded ❑ Sq.Ft. or Area:
New Location / Replacement ❑
Qt .-if
A i h le Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAH AN A/C Units<= 10, 000 cfim 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
BUSLIC Business Licen BUILDING