06010042 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CpONTR 'CTOR INFORMATION `,
BUILDING ADDRESS: A PERFECT CLIMATE - PERMIT NO.06010042
10970 NORTHSKY SO
OWNER'S NAME: PERMIT ISSUE DATE
ROGER CHEN 10570 S DEANZA BLVD 01/09/2006
NE: SANITARY NO. CONTROL NO.
(408) 861-9545
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Soo LICENSED COWMACfOR'SDECLARATION IobDescri ti nO EE O O
1 hereby )of that 1 em licensed under provisions of Chapter 9(commencing is p Q �� /� �f t;,s r'�
withS Ikmbya of Division 3 of am
Businessder pr Professionshade,uWm Iemcb I+Cllr-_v 4�t�[\1C1�1!F/!/J'It111rtjl sl`kP tID���}�Qt
n Infullforceend ��// �S� REPLACE FURNACE
i ? 'a Cl O V Conlncmr
D ARCHITECTS DECLARATION
l umleruand my plans shall be used u public rani
APR
Dry 2006
;6S Licensed Professional
f�(fA
y OWNER-BUILDER DECLARATION ,,�I111�^���a n tJ{� ty
K O� I hMaso .flim that 1 1. exempt from the Conmcmrs :Any c Law for Nc a.4^a!� 'f��I$ �v �y}ML+,,
O O fallowing salon.(Section t I am,Business m Professions Code:My city m f r the ���w,y�7tv41 I'9-J2!'r "'h'•1'174
� + e'f
which requires a permit to rnunimet,alter,improve,demolish or repair any structure $234'3
Prior m its issuance,slaw squires the applicant for such Permit o rile a signed mtement
< Nat he is licensed pursuant in the provisions of the Convector's IJcenm Law(Chapter 9 Sq.Ft. Floor Area Valuation
FFA (commencing with Section 7000)of Division J of the Busincasand Profedlou Code)or
3. Nu ha b exempt therefrom and the bub far due alleged eaemptlom My violation of
Section 7071.5 by airy applicant for a permit mbjevts Na applicant an e civil penalty of
not moan I n hundred dollars(5500), r Occupancy Type
re N
0 1,as owner of the property,or my empioyaa with wages as their sok compensation,
will dM the work aM Ne awnum 1,nor ktermed oroffered our We(Sec.70M.Businw
and Prefcsomru Cada:The Cmunclors Liceme Law does not apply m an owner of Required Inspections
property who builds or improves Merton,and who does such wart hinesel(or through his
own employees,Provided thatsuch Imprommu n t ere not intended croQered for ale,If,
however,Ne building or Improvement is sold within one year of completion.the owner.
builder will Mw the burden of proving dm W did not build or tmpmve for purpose of
ale.).
0 1,u Manor of the pmperty am exclusinly connecting with licensed mnuacms in
construct the project(Sec.7044,Business and Professions Cade:)The Contrumes U.
cense law does not apply in an owner of pmWny.wW builds or improves Narcan.and
who contracts for such projects with a contnctor(O licensed pursuant in the Contractor's
License Law.
0 1 am exempt coda Sec ,B&P C for this rcuon
owner Data
WORKERS COMPENSATION DECLARATION
I hereby Nim under penalty of perjury aro of the following dalaratiou:
I am and will maintain 11CenlOcateo1'Consent mslGlnsus far Workers Compere
on•u provided for by Section 3700 of the labor Cook.for Ne performance of Ne
work
Permit which this Peir is issued.
er,I Iran and will maintain Workers Compeniat fmmeance,as squired by Section
3700 of the labor Code,for the perfomanm of the work for which this pomit b lowed.
My Workers Cmaptaadon Luunnce carrier and Policy nu/m(�rpam�• Q
Cartier. / ,{ MON N�.:�L_
CERT( CAIS OF E%EMPPON FROMWORKERS
COMPENSATION INSURANCE
(This It.need amWcomplered if f e Permit Isforone hundred dollen(5100)
or Max)
I cent Net in the Performance of the work for which this pcmit is Issued.I s)tsll not
employ any Nixon in any manner an as In become subject in the Workers'Compenwdon
laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this CeniHcam of Exemption.you should
become Subject in the Workers ComPcuation previsions of the labor Code,you must
z forthwith comply with such provisions or this pemR shall be deemed revoked.
O CONSTRUCTION LENDING AGENCY
Ihereb afam that Nen is a construction lending g a genes fm dm perfomancc of
DC�y the duh for which this permit Is issued ued(Sec.7097,Civ,C
Le
A Lender's Name
=z lenders Atlnm•.
U O I certify that l ham mad this application and mm that the anon Information Is
(y E coma.1 agree in comply with all city and county ordinances and swe laws slming m
OU building constroaion,and hereby suNader sprtsenmima or this city m enter upon Ne
0W ahovcmentioned property for impcwon purposes
. (We)agree to an.Indemnify and keep hamlets the City of Cup isho against
U I,I4 1.connue tan gmenW cesta and expeues aitch may in any way xecroe agaiul said City
U FFZ77 t.
APPLIICgANTeUNDEof th.RSTANDS ANDof WILLWILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signuurt of ApplieaDam
HAZARDODO US MATERIApsLmo DISCLOSURE Type of Roof
ed the applicant or forum building Mceupantnama handle Health and
M defined by the Cupertino Municipal Codc,Chapter 9.@,and the HuIN and Sefcty
caue,seetianus3l(.)7
Yes I // All roofs shall be inspected prior to any roofing material being installed.
❑ QNo
_ If a roof is installed without first obtainingan inspection,I agree to remove
WIII the applicant mtutu¢bu' my occupant use equipment or devices which g
J I haumnus air canmminants alined by the Bay Area Air Quality Management all new materials for inspection.
aWnT
❑Yes Nu
Ihenread Nehc.S.cd maM.25quiremc5534.ler Chapterti.9sof Ne Cahfoe
nie Health&SafcryCedc,SectiaM 197f15.15373 am1135Jd,i onNruand Nu if cite buil0in
does not arm ham a Orion,that It b my responsibility m notify the aavpppp t ofthe
rents ch bare rio duan fa Ce tkcapmmJ^ /ch bare da esuan race Ocint m 9 Signature Date
Owner orauthoricedagent [l DaamN/ IWln All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Cl OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
N(jA S 1C. Sq. I o / /
OWNER'S NAME: Y PHONE # r7 --)d 63
GENERAL CONTRACTO • 0..i P I FAX #
I am not using any subcontractors:
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
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN# � a o � / Date:
Building Address:
I-0q Z o No ��sk S
Owner' ame: Phone #:,
7-
Contract i
-- w�
License #:
• er e- � CJ 31�l
Contact Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech
Job Description:
Residential Commercial ❑
For Residential Inst lations:
Attic El I" floor L2nd floor❑
Adhere to min set back requirement[] .
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Co of Project: e of Construction: Occupancy cup:
a ►q-.5. � �e t � v-vi
Strapped ❑ On Platform ❑ iBonded Sq.Ft. Floor ea:
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN 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
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING