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04090040 (2) CITY OF CUPERTINO " TOR�INTOIt1VIATION: BmLDINC DIVISION PERMIT �ONT.R.A.Cr BUILDING ADDRESS: A PERFECT CLIMATE PERMIT NO04090040 4O9OO4O R48 KIM RT OWNERS NAME: PERMIT ISSUE DATE KEVIN WOO E: SANITARY NO. CONTROL NO. its 408 8 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH O O t� D ere LICENSED CONTRACTORS DECLARATION op lob Dest�n _ I hereby that 1 am licensed under provisions of Chapter gg(commencing with Section]ONpofOvision3arm. Busineuatl Pufcuinns CandLinJmylccnu is in fell fnreeandeffect. INSTALL NEW A/C T t1lTjr�.RALLIED UNI �? Liccnu 1 s V Lm# ^p Daa Connote - q� ARCHITECTS D[lLAFiA1 ION DEC �' 2004 �yae I understand my plans shall he exodus publierecnrds �yU ;Qy Licensed Pmfcasionel n OWNER-BUILDER DECLARATION QII-UL D� F{ II <8 I hereby affirm That I am exempt from the RATIOors License Law for the U IILII7 li\\\\VIII) O O following tea nn.(Secdun](131.5,Business and Pmfessinm CnJe:Any oily nr county IJ which requires a permit to consumer,alter,improve,demolish,or repair any structure prior as its bustmit m File once,also requires the applicant for such permit a signed statement FZ� that he is licensed persuanuo the provisions of the Contractor's License Law(Chapter 9 Sq. Ft.Floor Area Valuation asIS-$ (commencing with Section 7")of Division 3 ofilm Business and Professions Code)or y�.. phot he is exempt thearmin and the breis for the alleged exemption.Any vmintran of Section 7031.5 by any applicant for a peril subjects the applicant to a civil penalty of 3 WN90ibtar0 0 Occupancy Type not mare than five hundred dollars($500). 01,as owner of the property,or my employees with wages as their sole compensation, will do Ne work,and the swcture is not intended or offered for sale(Sec.7W.Business and Professions Code:The Commences License 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 employees,provided thm such improvements am not owevegmerrimprovementis within one yorb or cdommpollektorentl,ann o wen.er- , laild.e.rwill M1tive,th.burden of provng darlhe did not hu10 mimpove fupugmse of sale) ❑1,as be,of the property,am exclusively contracting with noticed convenors m consumer the Impact(Sec.7( .Business and professions Code:)The Cadmium's Li- come law docs not apply to an owner of property who builds or options Ihemon,and who contracts far such projects with a eomminarp)licensed pursuant to the Contmemr's Liceme Law. ❑lamexempsumu See. ,B&PCformismart Owner Dat WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: have and will maintain a Cenificau Consent of Conseno self-inane far for Walinna Compen- ..eon,as provided for by Section 3700 of the labor Code,for the Perforans of the Zwo k-for which Nis peril is issued. 1 I and will maintain Wmker's Compensation Insurance,m require)by Section 3700 of me tabor Cial ,for the performance of the work for which this Permit is issued. My Work T1s/01propAsa�i nlnsunnee caroler anLIP olicy nu her q Carver: �" I RTI lacy � C J'L CERTIFICATE OF EXE ON FROM ORKERS' COMPENSA NINSORANCE (This=Lmn need not becomplmed tribe permit is for one hundred dollars(DIfgD or leas.) I certify that in the perforence of the work for which this permit is issued,1 shall not employ any Person in any manacrsn as 1m become subject to the Wmkeri Compensation Laws of California.Date Applicant NOTICE TO APPLICANT.If.after making this CeniRcam of Exemption,you should became subject m In.Workcr's Compounder previsions of the Labor Code,you must .J O forthwith comply with such provisions or this permit shall be deemed revoked. 'Z CONSTRUCTION LENDING AGENCY (~ 14 I hereby affirm that then is a construction lending agency fm the performance of �i > the work for which this permit is issued(Sec.3(197,Civ.C.) QLender's Name .7 Lender's Address V Q I certify that 1 have read this application and spite that me thous information is L. Lanni 1 agree to comply with all city and county ordinances and sure laws relating to 0 U building cansuuction.and hereby auth rim representatives of this city to enur upon the LSI ahove-mentioned property for inspection purposes. 4. (We) 1st save,indemnify and keep harless the City of Cupertino against o-Fa fA liabilities.judgments,costs and expenses which may in any way accmc against mid City V z I. eof the of t CANTUNDERSTANDSAND WILL COMPLY WITH ALL N -PO T Issued by: Date S07R U TIONS. O Re-roofs g wrc ApplicaHAZARDOUS MATERIALS DISCLOSURE a Type of Roof Will rise applicant ser future building retention,store or handle aniem out material as defined by the Cupertino Vuno:ipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. Yes jJu^ Will the applicant future building occupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove .t is=,Zs air conmmimmm as defined by the Bay Arca Air Quality Management all new materials for inspection. ❑Yes 1 have mad the havaNtms materials mquiremcnts under Chapterfi.95 of the Califon nia Hcalih&SeRty Code,Senorita 25505,8533 and25534.1 undersandthillate building docs non cu ply ha a I nam.mat it is my r9aoiin hit' m redly the w:cupunt of the rey hi est I 'or passu/User a am rr Oce d Signature of Applicant Date Owner or aaNnri.<d agentDm All roof coverings to be Class"B" or better Ion CITY OF CUPERTINO Ion 1 of 1 PERMIT RECEIPT OPERATOR: nancyc COPY # : 2 Sec : Twp : Rng : Sub: Blk: Lot : APN . . . . . . . . : 35919038 . 00 DATE ISSUED. . . . . . . : 09/09/2004 RECEIPT # . . . . . . . . . : 26970 REFERENCE ID # . . . : 04090040 SITE ADDRESS . . . . . : 848 KIM ST SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : KEVIN WOO ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4323 RECEIVED FROM . . . . : A PERFECT CLIMATE 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 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 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 BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BSEISMICRE VALUATION 3 , 700 . 00 0 . 50 0 . 00 0 . 50 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 176 . 24 0 . 00 176 .24 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 176 .24 021218 TOTAL RECEIPT 176 . 24 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ---------------------------- -------- ------______________________ "'03 ROUGH MECHANICAL 304 ROUGH ELECTRICAL O5 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF CUPERTINO ;, � C'Vii:/Z ,C �� CUPE101 �71rv0 PERMIT APPLICATION FORM 04OX APN# Date: Building Address: Owner's Name: // e Phone #: Y lJ O LlD$- 17 Z. Contractor: Phone: License #: P4er�eCk C( � �i og-8 5�s 723 »8 Contact: Phone: Cupertino Business License #: C)8_` Building Permit Info: Bldg ❑ Elect 0' Plumb ❑ Mech O-- Job Description: c l5 n I L i7' J a Residential Commercial ❑ For Residential Installations: Attic ❑ I" floor ❑ 2r1 floor❑ Adhere to min set back requirement❑ or Commercial Installations: _,placement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction: C, Occupancy group: 37DO - Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Re lacement ❑ Qty. if Appllc 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 EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Pen-nit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING - Community Development 10300 Torte Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY Of Fax(408)777-3333 UPEF"IN® --ouilding Department JOB ADDRESS: pa 1 �C PERMIT #0q p CqQO CfO OWNER'S NAME: .evl PHONE # Lg-- --j(.0?2_ GENERAL CONTRACTOR: I am not using any subcontractors: Signature ate Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical GFllyma 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 T' r/Contractor Signature Da e