06050186 (2) CITY OF12UPERTINO '" ' f
BUILDING DIVISION PER UT
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BUILDING ADDRESS: A PERFECT CLIMATE PERMITNO.06050186
2186b EATON PL
OWNER'S NAME: PERMITISSUEDATE
ANTHONY LAI & VIVIAN KOT 10570 S DEANZA BLVD 05/22/2006
`
ONE: SANITARY NO. CONTROL NO.
(408) . 861-9545
ARCHITECT/ENGINEER: BUILDING FERMTT INFO
BLDG ELECT PLUMB MECH
ion LICENSED CONRACIOR'S DECLARATION - lob Description
E I hereby affirm that I am IRreneed under provisions of Chapter 9(ameraming p
with Suedoe 7011(1)OfDivison 3 afthe Ruches and Profundum Code.and MY Iiceene is
+� in full forte am effect. REPLACE AIR CONDITIONER & FURNACE
?MZ y Llcerra Clw Lic.R
+`p Dou Contractor
uFJ5�7W
ADECLARATION
I understand my plane shall N used
as public records
yd
s
Licensed ercley llo
OWNER-BUILDER DECLARATION
aI lereny.frim that 11. exempt Imre the COnuamrs License Taw far tee /
o O which ire mason.permit
a 7U31A Business and P e,dicami Cale:Any city or county //
$ which requires n pemir m carms the alter.imPmse,demdlN,an repair MY tuumure 6(] []
,ism
prior miu iuuanco,suis mqulrw lM applicant forsuch Termites Ole uipned su¢mem
pp < thelimi.1meRMprmalwduprovisions ofthe Cmorncur'sUnceaLaw(Chip.9 Sq.Ft. Floor Area � Valuation
J�F0 (commencing with Section 700M of Division 3 of the Business and Professions Code)or
r that W is mares themfmre and the basis far Ne aicged MMIW .Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant an a civil penalty of r Occupancy Type
ms mom than five hundred dollen
❑I.ssawmrofthepmpny,ormyemploycnwithmguudelrmle=Mmaum,
willda the wort and the someone Is notintended"offered fertile(Sm.7044,Business
and Profession;Code:The Contravenes Licence law don ml Apply 10 an owncr of Required Inspections
property who Wilds c r improses theme.and who does such work hnnself or through his
awn employace.pm idcd duel each Improvements tee natimended aro@red forule If.
however.the building orlmprowmat Is sold within am year orcompledon,the owner-
Wilder will neve the b adere of proving that he did not build or improve for pNuo of
tele.).
1:as Owner of the property,am mmussively connecting with licensed com a ren be
mwuuct the pmjea(Sec.7044.Bwiness and Professions Code:)The Commences U.
anise taw aon not apply a an owner of property who builds or improvea therear,and
Who conuuv far such poleeu with a conuumrp)licensed increases be the Contrast's
License Law.
❑I at cmnp mdm Sia�'1. B&PCF rthumaam
Owner /`r��V Wa Data �- t)
WORKERSCOM ENSATIONDECLARATION
1 hereby ailbm under penalty of prjury one of the fallowing dedmadons
IhaveandwlllmalnulnaCudncamof Cowensaelf.iemmtar Wo e,Compn-
sadon,as provided for by Secum 3700 of de labor Cade.for du performance of the
work for which this Permit is issued.
❑1 have and will maintain Worker's Compwaumn Impurities,u required by Section
3700 of the Labor Code,far um performance of de ware,for which this permit is issued.
My Worker,Cmnpmadon Insurance carrier and Policy number am: -
CAokr. Polley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu semlm need mtbeeompleuJ lfthe permit la foram hundred dollen(5100) r '
or teas)
1 oenify that M the performance of the work for which this Permit u issued.l dull not
employ any person in Any manner um ma rob' I OUe Warkerf Compnutian
Lam of California.Dae __ p 7 r
APpllcant ]f t,.tL.IA
NOTICE TO AppucANP.If,al making this Conifinu of Exemption,yen should
become subject as the Workers Compensation provisions of the lobar Code,you am
.,ZO forthwith comply with such provisions or this permit shall be deemed revoked.
z= CONSTRUCTION LENDING AGENCY
(^ Ihembyalow that there tea mnuronlm coding sIcncy for du perfarmana of
ai 7 the work for which Oda permit Is Wood(Sec.3097.Civ.C.)
Qtondos Name
.`7 Z Landers Add.
fJ Q 1 ovtify that 1 hate read this application and sou than the show information It
F correct.I agree to comply with all city and county odimmcn sod sue law,reusing to
QU building consuuction,and hereby audemine mpmsematiM of this city 10 enter upon the ,
U above-mentioned property for inspection purposes.
(..,y (We)agrm to save indemnify Me keep harcnleu the City of Cupertino Against
4y h liabilities.judgments,costs and expenses which may in any my accrue against aid City
U in coneryuenee of the graeun5 of this permit
n.i APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCE ECULATIONS
!+ 5 2 2 a Re-roofs
Sisnarum afAINI1canUCmuncmr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applleantm fume Wilding oavpatstwe rehandle hanrdow nesurfai
as defined by the Cup corm Municipal Cade.Chapter 9.12.and the Health and Safely
Cade,Section 25532(4)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yca pgr
Will the applicant or fumre building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Omit hvaNnw air canwnirunu as delmed by the Bay Amo Air Quality Management all new materials for inspection.
District?
❑Yea _cw
IhawmWdehuardrusmucAbequimm munJ rC'Wpur6.95ofthe C+lifon
nu Health&SafetyCode.Secuou2f505,25533ad25534.lundemund WtBde building
does not currently haw a umant.that It u my espemihlllly to mufy the amupml of the
mquimmcn�wnicn mwlmmcl yapn rmitpeaance ar.cenlnatgpr, ,paay. Signature of Applicant Date
Gwmr`.trmar ed ag �� f zD�te All roof coverings to be Class "B"or better
Community Development
& 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
4JUPERTINO
Building Department
JOB ADDRESS: PERMIT#
Qgb -e�atw Pla csL ��� .� c r4 �1 sZ>> oho
OWNER'S NAME: NT bt\JYLAI KVJVC3T- PHONE# (q-0 8 1 --p 1 c7-3—
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors: - V ab, 5 7 2 �)-y
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
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
IT
5 zz -L�o(o
Owner/Contractor Signature Date
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32619130 . 00
DATE ISSUED. . . . . . . : 05/22/2006
RECEIPT # . . . . . . . . . : 34506
REFERENCE ID # . . . : 06050186
SITE ADDRESS . . . . . : 21860 EATON PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ANTHONY LAI & VIVIAN KOT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : VIVIAN KOT
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
�EE 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 6, 000 . 00 0 . 60 0 . 00 0 . 60 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 . 14 0 . 00 175 . 14 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 175 . 14 1656
TOTAL RECEIPT 175 . 14
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
lqF1 FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN # 32 / ^ I9 Date: 2
Idi
B ng ddress`F_ JV I Cp
Pl�r� G� (h_K�o cry- 9n(L�-
Own r°s Name: Phone#:
Contractor: License
Contact: Cupertino Business-License #:
Building Peimit Info:
Bldg ❑ Elect 0�' Plumb ®-' Mech
T Descri tion:
L SF & C��Nj�)
Residential Commercial ❑
For Re ' ential Installations: -
Attic LIst floor ❑ 2°d floor ❑
Adhere to min set back requirement❑
• For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required
Cost of PXo jeo ct: Type of,.0 sttruction: Occupancy gr
q�p
C6 :
O �ulj_J s
Strapped On Platform ff Bonded Sq.Ft. Floor Area:
New Location ❑ Replacement E5-
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
BREMAIR14AN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
i • BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING