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06050019 (2) CITY OF CUPERTINO g � '"`D"`�`' `*' 'BUILDING DIVISION PERMIT " -' 134 0,ACT,, 0W NF RMATION _y BUILDING ADDRESS: CONDITIONED AIR PERMIT No,06050019 22031 HIBSICUS DR ER'S NAME: PERAfff LSUEDATE KRISTINA POON-WU 1701 LITTLE ORCHARD PHONE: SANITARY NO. CONTROL NO. (408) 291-2220 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG O PLO MECH O j o p LICENSEDIon Ra CONTRACTOR'S DECLARATION of ION IOb DCSCTI ��® i 1 hereby afRm that I am ONTRA under S DECLA AChapter 9(commencing who Section 7010)of Divivion 3ofdw Business and Profesdom Code.aM my license r >> imm�forcoundeffen. ADD ON AIR CONDITIONER j Z,2 license Class Lia.a obe�$baes-66( Data "_L;�-�--GonDEC - tom. .,. MAY /F1 1006 As Mailb use DECubliLA cm ON ` I understand my plater Mall w used u public recnNa ■N y ��ILpyTT�� °ped Licensed Professional p �g�� OWNER-BUILDER DECLARATION evj ag 1 hereby.(Sec that 11. exempt from d r f snuns Co License Law for the D O whicrfollowing moon.(Section 707 T.5,Reagan and Professions Cade:Any clay or county 5 9 which requhes a permit re cnnatrocL alter.improv,h permit Or repair any auunum $T700 dou baits Wued pan"sawrequiresthceppOcant for markracutewrikasigned Law(ummem �< (co(commencing it pumunt alk of Dioam of the Ca estrum lhcnselaw(Code)9 Sq.Ft.Floor Area Valuation 5th` 9 got he Is comps Soudan7000)and a e bait n 3o al Rostrum worn d profession Cade)or C — that io r 31.5 b thmfrom and all aper for the alleged esempdm.Any violation PawfOf Sector than l ve any applicant s(a permit rvbkcu the applicant a ciWl penally of r Occupancy Type Out seam than Ow hundred dollars(5300). 1,u owner attics pmpmy,m my employes with vara as dean=to compensate". will do the work.and the ruucume is not intended or offoed far age(Sec.Mat.Business Required Inspections and Pmfeuw"o Code:The Communes Lohse,Law does wt apply M an awner of q P property who buildsorimpmves aeroon,and whodoessuchworkhWselferth ough his awn emplayout,provided aotauch Improvements pee amooded oraRW far eale.lf, however.the Wilding or improvement it mid within am year of impletion.the ownm- builder will ban all burden of proving that be did an,build or Improve for purpose of ole.). ❑1,to owner of the property am esdudvely conuaning with raced causuaon m comwct the pmjca(Sec.70",Business and Prolardom Code)The Cabooses Li- come Law does not apply la an Owner of property who Wilds or Improves Outman.and .who contracts for such pmjccm with aconuamods)licensed pursuant m the conuarcutes Lkenum Law. ❑lammcmptundal See .B&Pcrmarra2aW se Gate WORKER'S COMPENSATION DECLARATION I hereby aOTw under penury of perjury arc of the fallowing 4ecluoiom: ❑IMn and will maintain a CeNRmu of Coment as self-IoumforWohcesCompen- mtim,a provided fan by Semon 7700 of the labor Code.for the performance of the work for which ads permit is issued. ❑1 Mn and will maintain Workers Compensation Insurance,as mquirad by SeNw 3100.1 the Law,Code,far the performance of the work fm which laws permit is issued. My Worlmes Compensation Insurance order and Policy number art: Canter t Cf5 rt U VIPOIky,No.:O t C9C t 66u S ) CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE a (Ibis mcarm need not W complemd ifft Permit Is forone hundroddnRam(5100) of less.) 1 comfy that In the perform rev of the work For which his permit b issued,l mail set employ anypermn in my mowrm as to became subject to to Walkers'Compenadm Laws of Calwrmed.Date Applicant NOTICE TO APPLICANT.If,after making this Contifkam of Exemption,you should become subject un the workers Compensation provisions of the Labor Code,you am �Q m ec forthwith comply with each provisions o permit Nall k deemed revoked. Z tiCONSTRUCOON LENDING AGENCY (+ I hereby alRrm tut them to aamoracdnn Inking agency for he pedormsms of rL 7 the wars fm which this permit r Wood(Sec.3097,Civ.C.) W Lenders Name az Leadees Address U O 1 certify Nat I have read ads oplkatim and eau eco the awn information Is D.^ carrecL I agree m comply with all city and county Winnow and sou laws roladng m 0 rV" building convection,and hereby maestro represenutiva of xis city to cater upon the W about-mentioned pmperty for inspection purposes. a (We)agree to on,indemnify and kacp harmless to City of Cupertino against rA liabilities.judgments.costs and"persons which may in my way accrue,agdnst mid City t.1 x, in consequence of the granting of this permiL b '-t APPLICANT UNDERSTANDS AND COMPLY WITH ALL NON-POINT Issued by: Date SOURCEREGULAIO S. e c 1 Re-roofs signppll (/Can r Dam MATERIALS DISCLOSURE Type of Roof Will de applicant or future Wilding msupsm sacro orhatok haurdam maodsi U defined by the Cuporaw Municipal Code,Chapter 9.11,and six Hmlth and Safely otic.Sea w 15531007 All roofs shall be inspected prior to any roofing material being installed. pro Ra Will the applicant or future Wilding Occupant use equipment w dcvicea which If a roof is installed without first obtaining an inspection,I agree to remove emb ha'rardnm alt contsrninants u de0wd by the Bay Area Air Quality Management all new materials for inspection. DruW7 ❑Yue 0shlg- . 1 haw mad the haoathws matedar requirements under Chapter 6.95 or the Califor. nix Health&Safety Cade,Saamu 25505,15537 and 15334.1 untlentsnd that if&Wilding does wt currently haw a Immo 0.11,* my rumandbhity in wdfy de occupant or the requ no whkh raw bemet or issuance of,CeNlkatearA rampmey Signature of Applicant Date _ mthadocd,rm Dam All roof coverings to be Class"B"or better CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw COPY # 2 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32602016.00 DATE ISSUED. . . . . . . : 05/02/2006 RECEIPT #. . . . . . . . . : 34210 REFERENCE ID # . . . : 06050019 SITE ADDRESS . . . . . : 22031 HIBSICUS DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : KRISTINA POON-WU ADDRESS . . . . . . CITY/STATE/ZIP . . . . , RECEIVED FROM . . . . : RICHARD READ 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 __________ _____________ __________ __________ __________ __________ __________ BREMAIRHAN NO.UNITS 1.00 10.26 0.00 10.26 0.00 BENERGY PERMIT FEE 1.00 34 .86 0.00 34 .86 0.00 BSEISMICRE VALUATION 4,700.00 0.50 0.00 0.50 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 160.73 0.00 160.73 0.00 METHOD OF PAYMENT AMOUNT NUMBER ------------ -------------- OTHER 160.73 VISA TOTAL RECEIPT 160.73 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • Community Development 10300 Torre Avenue aClOF Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 WPEkj1,N0 Building De artment JOB ADDRESS: PERMIT# OWNER'S NAME: • SN u PHONE # - 1 GENERAL CONTRACTOR: ;•,oYt& *oe' FAX # CI I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following informatio • 60 SUBCONTRACTOR BUSINESS NAME BUS ESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet MetaV Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic T Sheet M Sheet leock Tile Owner/Con Signature Date CITY OF CUPERTINO FURNACE/AC •CUPERTINO PERMIT APPLICATION FORM APN# -?),of 6 - D -o 16 Date: Building Address: OR gS01 Owner's Name: Phone #: Contractor: License#: ,�\ els oC . 5i 6D C-90 Contact: Cupertino Business License#: IQ Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential Commercial ❑ For Residential IInsstallations: Attic ❑ 1" floor '�^-2"d floor❑ Adhere to min set back re uirementZg�- For 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 Constrtruction: Occupancy�oup: Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location �'— Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 chn MECHANICAL BREMAMHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMITFEE Elec Permit Issuance ELECTRICAL / MPERMITFEE I Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING