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06020006oc z. V UC UC Ou. F C C OF CUPERTINO -.,gip BUILDING DIVISION 40 .4 ��I.4 de .J -d;tea.aks ,..;R.MATPERMIT Bu1LDINGADDRESS: SUPREME AIR SYSTEMS PERMIT NO. 06020006 21885 WOODBURY DR R'S NAME: PERMIT ISSUBOATS CHUI KWONG 80 GILMAN AVE 1 02/01/2006 NE: SANITARY NO. CONTROL N0. (408)376-0406 ARCHTTEC (ENGINEER: BUILDING PERMIT INFO BLDG PLUMB MECH O O LICENSED CONTRACTOR'S DECLARATION Job Description P I hereby affirm that I am licensed under provialtms of Chapter 9 (commencing wideSoeil 7000)ufDi" 3oftho BusinmsaMProfusiom Cadc.&Wmylicame6 in funroCCnlxIuua{{adaffect. � ��p< RADIANT HYDRONIC HEATING UNDER TILE Dem:c"1�-Contrractor TANKLESS BOILER TO FOLLOW MANUFACTURE SPECS. ARCHITECTS DECLARATION StiS42N 1 understand my plans shall W used as public records ' Licensed Professional OWNER -BUILDER DECLARATION 1 bamby oM m that 1 am uempt from the Conuamors License law far the fallowing reason, (Section 703 1.3, Busimmsind professions Code: Any city or county which mqulres a permit to construct, slur. improve. demolish, at repair any suucwm prior At its issuance, also mqulres the applicant for such permit to file a signed suumcnt Contncter's Licenb Law 9 Sq. Ft. Floor Area Valu 31608 that W is licensed pursuant to the provisions of dee (Chapter (commencing with Section 7010) of Division 3 of dee Business and Profession Cade) or that he is exempt therefrom and the basis fm the alleged urmption. My violation of mber Occupancy Type Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty ofAr out mart than live hundred dollars ($300). 3 2 6 4 5 4 8. 0 0 ❑ 1, an Owner of the property, or my employees with wagu u their sole compensation. Required Inspections P wig do tib work and thesuunute I. net hastened or offered for uk(Sac. 7044, Business ladoes apply le an of Cuseme, Licensew m tetawns Of slid Propose. Code: Theon q propenY who bWid s or ins pasta thercon, and who does such soot Mmself or through his Own employees, provided that such improvements Are me intended mo@red for sale if. however, the building or Improvement Is sold within one year of completion, the owner. builder will have the burden of paving mal W did not Wild or improve far purpose of Oak.). ❑ 1, As rens of the properly, am eaclusively contracting with licensed conuachers m comtmm IN: pmjecs (See. 7044. Business and Professions Code:) The Contractees U. came taw does not apply in an owner of property who builds or improves thereon. and, who canttactsfor such projects with a contractor(s)licensed Punu nt ro the Conuaaten's License Law. ❑ Ion uemptundm Set .BBPCfmthlamason Data WORKERS COMPENSATION DECLARATION 1 hereby afRtm under penalty of perjury am of the following declarations: ❑ 1 have and will maintain aCcalftcobof Convent maelf-insom fo WmearACampen- na0on, an provided for by Section 3100 of the Labor Code. for am performance of iW .it for which this permit in I..& ❑ 1 have and will maintain Worker's Compensation Insomnia u required by Section 37M arthe labor Code, for the performance of the work for which this permit Is issued. My Wo er's Campemmon llnurame no Or aM Polity number am: 1 •SV G PoB'la.:293870Z6 3 ' Came - P CE IPTCATE OF EX ION PROM WORKERS COMPENSATION INSURANCE (Thin somm =it notbecompleted Kline permit lsforone hundreddollsss(SI0(1) to kse) 1 certify that In the pciformanro of the work for which this permit Is Issued. I shall not employ any person In any manner an as in became subject to the Workers' Compensadon Laws of California. Dab Applicant NOTICE TO APPLICANT: IL arm, making this Centimes of Esempdon, yen should become subject te the Worker's Compensation provisions of the Labor Coda, you mass forthwith comply with such previsions in this pem it shall W deemed revoked. 1 , . CONSTRUCTION LENDING AGENCY 1 Wreby alarm But them Is a conswatinn kMin{ agarwy for the performance of ' the wait for which this permit 6 issued (See 3097. Civ, C.) Iande/s Nurse lenders Mdrtu 1 I cmlfy that I haw: mad this pplicNon and state Our the above Information is ' corteck i gree to camp'y w' city and <oumy aNinances and sub laws rtla0ng b building construction, and teb audeodcerepresenW Of this city to clear upon the aW.-mentitrtedpropeftY ori c0onpurbones. (We) agree b Uvelindeldnify and kap harmleas the City of Copemno against j lubithics.jud u m ode pensu which may in anyway scene against said City In conscal o o e ng of this Permit. i APPLIC PS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOUR RFA IONS. I'(A- Re -roofs Type of Roof SigauumofnppliuMCanuanm Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future Wilding eccupant stare or handle hazardous material defined by Cupenbo Municipal Code. Chapter 9.11. and the Health and Safety .1 s men us31(a)7 roofs shall be inspected prior to any roofing material being installed. YenAll If a roof is installed without first obtaining an inspection, I agree to remove Will the appiushatof future Wilding occupant use equipment or devices which emit W1401.1cs it coruan Main an defined the Bay Area Air Quality Management all new materials for inspection. District? ❑Yu IM No IhavereWtha a d smabri Is qu' mewunderL'hepterG93ofOttCalifor- niaHmlNkSefcly atins1350,75377 uul ZSSN.IuMommtd thnifthe Wilding docs trot cormntly av a bra n4 that h my mspnmihility b nify dee =ce pmt of the rtquimmcnuw •h R metpdarlu mAAcO0fa CmiBeabal OO1F1 �t Signature Of Applicant Dale All roof coverings to be Class "B" or better Owner or awhamcd agent Dab 0 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Elk: Lot: APN ........: 32645048.00 DATE ISSUED.......: 02/01/2006 RECEIPT #.........: 33038 REFERENCE ID # ... 06020006 SITE ADDRESS .....: 21885 WOODBURY DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: kiersaw COPY # : 3 OWNER ............: CHUI KWONG ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-1147 RECEIVED FROM ....: SUPREME AIR SYSTEMS CONTRACTOR .......: ALLEN SENNERT LIC # 21614 COMPANY ..........: SUPREME AIR SYSTEMS ADDRESS ..........: 80 GILMAN AVE, #1 CITY/STATE/ZIP ...: CAMPBELL, CA 95008 TELEPHONE ........: (408)376-0406 ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC __________ __________ NEW BAL _____ _____________ __________ BPWHEATER PER HEATER 1.00 __________ __________ 10.79 0.00 10.79 0.00 BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BREMHEAT NO OF HEATERS 1.00 7.02 0.00 7.02 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 BSEISMICRE VALUATION 16,088.00 1.70 0.00 1.70 __________ ---------- 0.00 TOTAL PERMIT __________ __________ 92.74 0.00 92.74 0.00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ____________ CHECK 92.74 __________________ 2176 TOTAL RECEIPT 92.74 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CUPEIZTINO CITY OF CUPERTINO PERMIT APPLICATION FORM bcooa cx�ao ��'��"J' Date: 2— 7N# Bt�)In�s ess- Mailing Address (if different from building address): ner's Name: —Zi W �� 6 lPhone #: .- ; - \ Contractor: License #: --� Aa Contact:' Phone: Cupertino Business License#: ��('� Fax: Building Permit Info. � 1� ,��j� j� 1�"� �� UC117Z �� "Cly+ tkleJS � -k-0 o.� t-� cnvfcc�ka.� Sin �e,i Bldg ❑ Elect ❑ Plumb -B' Mech ❑ Job Description:/ Residential Ili Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Proiect: / Occupancy GrouD: Type of Constructio Please check this box if the project is a second -story addition: o'ect Size: Standard f K Laze ❑ Major ❑ MECHANICAL uant ity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BB.QILER3. Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1,751x1 Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Corm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <=1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 010 CUPETINO CITY OF CUPERTINO PERMIT APPLICATION FORM uantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMTTIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIAQE Impaction Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHIC P12n Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE, Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BRENLkMIAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY .. Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Re] oFumace> IOKbtu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMHVHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO PERMIT APPLICATION FORM • 3of3 Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUIIAING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temp6rary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING • 3of3