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04040072 (2) CITY OF CU1aEWI'INO BUILDING DIVISION PERMIT ICON,"TRACTOR INFO�MATI�N BU I LDING ADDRESS: A PERFECT CLIMATE PERMIT NO04040072 10130 N BLANEY AV OWNER'S NAME: PERMIT I55UE DATE SIOE T. TJHAN 10570 S DEANZA BLVD 04/ 3Z2004 ONE: SANITARY NO. CONTROL NO. (408) 861-9545 ARCI IITECTIENGINCER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 woo LICENSED CONTRACT'OR'S DECLARATION j.r 4heireyyy affirm that I am licensed unucfpmvonone or Chapter 9(commencing Job Descriptiof�� with Scfljop/(g1117 nrDivision Jof the in dPrufcssione Cndc dmy liccnec is � to ml aw Is R CE FURNACE & ADD A/C ads`sLLYV L"Anu Class Lica pro Date Contra Cr t t ARC ITELTSDE . 1 N MAY 1r 2004 5s 11 I undersand my plans shall he used as meurea soN Licensed Pndcssicnal BUILDING L1 OWNER-BUILDER DECLARATION a S 1 henchy alarm that I am exempt from the Contractor's License Law I'ur the 00 fallowing reason.(Section 7031.5.Business and Professions Code:Any city or county i m which requires a permit to construct,alter,improve,demolish,or mpmr any structure $20300 at ¢i prlorwits issuance,also requires the applicant for such permit to File a signed statement =r< that he isliicensedpursuammthe previsions ofthe Contractors License aw(Chapter 9 Sq.Ft. Floor Area Valuation `y (commencing with Section 7(ki of Division 3 of the Business and Professions Cede)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant l9 a civil penalty of 3 10&Sf1q(b;aGr00 Occupancy Type not more than Eve hundred dollar,(IrKXd. P Y YP ❑I.As owner of the property,or my employees with wages u their sole compensation, will do Ne work,and Be structure is not intended or offered for sale(Sea 70PI.Business And Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections property who builds or improves Ncrcon.and who does such work himselfor"rough his own cmploycc,provided tlrauueh impmvemcnts are not intended.,offered for sale.If. however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving Nat he did not build or improve for purpose of ale]. ❑1.az owner of the property,am"elusively commning with licensed contractors to Construct the project(Sec.7044,Business and Professions Cotler)The Contractor's Li terse law does not apply to an owner or property who Wilds or improves thereon,and, who CoMmCa for such projects with a contractor(&)licensed pursuant to the Contractor's Licence Law. ElI am exempt under Sec. B k P C for this reason 131" ner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Cenifiemc of Consent to self-insure for Worker's Compen- im,As provided for by Section 37W of the labor Cede,for the performance of the h for which this permit is issued. 1 have and will maintain Workers Compensation Insurance,az required by Section s of Ne Tabor Code,far the perfrmance of the work for which Itis permit is issued. y Wurkeispnm enation lnsunna caricr and Policy number R I Policy ANCE CERT ICATEOFEXE Pn[1L�ROM ORKW ERS' COMPENSATI I RANCE GTuaection need not W completed Rthe permit is for one hundred dollars($1001 or less.) 1 certify Nat in the performance of the work for which this permit is issued.1 shall nut employ any person in any manner W az on become aubjecuo the Workers''Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If.after making this CeNBeale of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you muse .,O forthwith comply with such provisions or this permit shall W deemed revoked. Z N CONSTRUCTION LENDING AGENCY I hereby affirm that there is Construction lending agency l'or the performance of a the work for which his permit is issued(Sec.3(197,Civ.C.) W A Lender's Name Lenders Address V Q I ecnee that 1 have read thirty and coup and sum that and shove ws rmaliun is W H building I agree m comply with all city and county ordinances and Cott laws relating a QU buildingconstruction.pronly and herfor by mrienonpurposescmalivesufthiscity to enter upon the have-mentioned judgctl pmpcny for inspersion purposes. Fr„ y (We)agree to save,indemnify and keep harmless the City of Cupertino against Z in ofthcdosuang expenses whichm in any way ettmc againstsaid City U rZ in eonuyucnec of the granting of this permit '-" APPLICANT U DERSTANDS AND WI MPLY WITH ALL NON-POINT ssued by: Date SOUR REGI A IONS- t-'I—`-3,O kC 0 Re-roofs Sign Of ApplicanUCmtTAm(r ale HAZARDOUS MATERIALS DISCLOSUR Type of Roof Will the applicant Or future building occupant store or handle havarduus material az defined by the Cupenino Municipal Code.Chapter 9.12,and the Health and Sarny Cc ode. r-1 lYea z'571ea)'.' All roofs shall be inspected prior to an roofing material being❑Yea �1 P P Y g g installed. 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 tit hasardous air contaminants as def by the Bay Arca Air Quality Management all new materials for inspection. District' ❑Yes I have read th<ha>aNtms materials rcyvimmcn¢untkr Chapmr QYS of the Califnr j7 Tia Heal"Safcty Code,Seeuor 35515,15533 and 4.l undersand dtmifthe building rrllyf{[J.GIs'' Jtas n"I curtently have a mnank thin it is my re dity venodly the rscupant of the rewimmcnlawnihmua,he met pdort .. nos ccnific¢pr0.cup tgnature of Applicant Dale N owns or autlu i Agent D 3 All roof coverings to be Class "B"or better Community Development 10300 Torre Avenue to' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEkTINO Building Department JOB A RESS: RMIT# t 2 30 Ij � �a ev�vZ � OWNER'SN S+© `� T V.a _ PHONE 6: t GENERAL CONTRACTOR FAX # I am not using any subcontractors: 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 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 Contractor Signa Date CITY OF CUPERTINO x ru- FURNACE/AC v `' Z UPEI�TINO PERMIT APPLICATION FORM APN # .3 ((J' 7i l - 073 Date: BuildingAddre�Q �0t3 �� IN XI� E ���JJl)2 G A- �' Owner's Name: Phone #: S 1 vc" ,nl C¢S0) Contractor: Phone: License #: Co tact: Phone: Cu ertino Business License #: Building Permit Info: Bldg ❑' Elect IX lamb ❑ Mec 0---- Job escription: �- v ��� �w ADD > LG ✓Lv ,c ca_ 1 -w 1 � Residential .01 Commercial For Residential Installations: Attic ❑ 1" floor ❑ 2"d floor❑ Ajh�dhere to min set back requirement❑ or 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 �J- 1D 30o • 'D Z) Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Flo rArea: New Location ❑ Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of 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 EPEPM4 FEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee 74BUILDING U LIC Busi ess Licens BUILDING —�1 �G L �-RC-M UC ;div VV — � �ti Z9-161