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03040127 (2) S CITY OF CUPERTINO 13UILDINGDIVISION PERMIT CONTRAGT,0W�IN 0RMA LON ,2"OuPS11DDI TLVERAD0 AV FOREMOST HEATING PERMIT N003040I27 Q9)PJ8$'A%WOK 770 CHESTNUT ST ""`T`SSffn9/2003 ONE: (408) 287-9234 SANITARY NO. CONTROL NO. ARCHITECIyENGINEER: BUILDING PERMIT INFO BLDG ELECr PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 1 Ilemby affirm that]am licensed under Provisions of Chapar 9(commencing Job DBSCrIpIIOn with Section] ) Divitlon 7of the Butl PmfsA.oACode.andmylicenmts ^� in full forte an m 5'� uaan:c7 �� Lie .f8 f FURNACE REPLACEMENT . FINALE® q Dau - - Conus - A N� zt�U7` ARCHITECTS RATION �i i understand my plans shall he uwd m hlic records MAY 0 2 2003 4 C Licensed pretend...I OWNER-BUILDER DECLARATION BUILDING I hemhy affirm that 1 em exempt from do Contractors License Law for IM UILDI NG Eo? following resson.(Sudan 7(D I.S,Business and Profession Ca e:Any city or county ID u�$ which requires a permit to construct.Blur,improve,dcmoltsh,or repair any structure FSS° prior to its issuance.&too requires the applicant for such permit to file asigned comment that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 Sq.Ft.Floor Area $IVgb1®[ion 60 (commencing with Section 7000)of Division 3 of lbe Business and Profusions Code)or T that he is exempt therefrom and du buts for the alleged exemption.Any vloledon of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of 3"N9Q&Ber 0 0 Occupancy not awe man raw hundred dalims(M), P y ir1k, '� ❑1,as awns of Re property.or my employees with wages as their sole compensation, will do the...and Neawaure Is net inended or offered for sale(Sao.7W,Business Jui — muuuh '1 and Professions Code:Tia Contractors License Law does not apply o an owner of 3 0 3 - ROUGH 9UOns pmpeny whobuilds a improves thereon,and whodoes suchworkhimself orthrough his E1LL own employes,provided thauuch improvements are not inendedarorteted ser sole.IL 304 — ROUGH ELECTRICAL however,Ne building or Improvement is told within one year of completion,the owner. builder will ban the burden of pmvmg ren he did not wild or improve for purpose of 505 — FINAL ELECTRICAL ore')' 507 - FINAL PLUMBING ❑1.as aver of the property.am exclusively contracting with licensed contractors to construct he project(Sec.7ow,Business and Profusion Code:)Tia Contractor's u- 508 — FINAL MECHANICAL ns,Law does not apply to an owner of property who wilds or improves Neaten,and, who canacu for such projects with a con"clor(.)licensed pursuant to the Contractors License Law. 0 l nm exempt under Sec ,B k P C for this mown OwnerDae WORKER'S COMPENSATION DECLARATION 1 he Air under peµlly of perjury on of the following decl.ntlon: I haw and will melntsin aCenlBcae of Co.. tore u provided fes by Section 3700 a a-f6or Code,fu Ne performance of Ra work for which this permit Is i ❑1 haw and w main Workers Compensation Insurance,as required by section 370D of or Coale,for Ne performance of the work for which this permit is issued. M es Compensation Inwunce nmier and Policy number ore: er. PBI64 No.: CERFICATOFEXEEM IFROM WORKERS' COMPENSATION INSURANCE (Tbbsection need nolwumpleted If the parcels Is faro ebundreddollarsalon) or less.) . 1 unity that in the performance of the work for which this permit B issued,I shell am employ any pawn In any mannrj 1'ba"a, bjul wlo ROWorkupe s-Comamion Law.of California.Dau Applicant la43 T/µ4 NOTICB TO APPLICANT.IL after making this CenlOcale or Exemption,you&cold become subject to the Worker.Compensation provisions of the labor Code,you mum .JO foMwitheomply with weir previsions or this permit Mall he deemed revoked, CONSTRUCTION LENDING AGENCY F+ Ihemby afirm that them is a construction lending agency for the perfermanmo of a > Rte work fur which this permit ts issued(sec.3097,Ce.Ca 6Wi Lenders Name .7. z Lenders Address U 0 I modify that 1 have maw ad this application and state that the es Infominiun Is - G t correct.l agree to comply with all city and county ordinances and some laws minting to 0 building construction,and hereby authodre mpmenutires of this city to enter upon the {Ll 'hove-mentioned property for inspection purposes. gy (9/c)agree to arc,Indemnify and keep harmonica;the City of Cupertino against was y Ila6ilidµfr�.,li.gd.a coeswhlch may In coy wayeume againmaid City () APPLneq . DND WILL COMPLY WITH AfL NON-POINT Issued by: VJUW Date SOURCE . 07 Re-roofs Ist num of ApplicanlYContnaor Dow HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant om or handle haordons material As defined by the Cupertino Municipal Coco,Chapter 9.11.and the Health and Safely Code.Section 155314)? All roofs shall be inspected nor to an roofing material being installed. I [3 Y. 1<ytNa P P - Y g g Will the applicant or f�utium building occupant use equipment or device'which If a roof is installed without first obtaining an inspection,I agree to remove It haardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes f(Nu Lha eh..Insts`maurialt mquimmcnuunderCMpur6.95oftheCelifor- nlelicel S.r Coda so". 25533 aed2553a.lundcnund thm it the wilding 4tas,routt c Y w.swan my res hility te notify tte¢cupant of do tome wit' mu a p' so .cemr sof "P-q- Signature of Applicant Date Owner u aahorixed agent Doug All roof coverings to be Class"B"or better (( � CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEfi,TINO APN# Date: Building Address 3S/ S/L Owner's Name: Phone#: Contractor: License #: Contact: r Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mch r Job Description: Residential X . Nr Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Pr tom / Occupancy Gro --- Type of C n iruction: E41i FNS w Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> IOOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax —Resi/Mobile BUILDING BELEC1000 Elec 600V <= I OOOA ELECTRICAL BELEC1001 Elec 600V > I OOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING AIL BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING Pof3 J 7 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM Ah CUPEkTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 din MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2of3 t It salm CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEI�TINO Quantity Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC -Electrical s foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL LV MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 i CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng: Sub : Blk: Lot : APN . . . . . . . . : 36939009 . 00 DATE ISSUED. . . . . . . : 04/29/2003 RECEIPT # . . . . . . . . . : 21711 REFERENCE ID # . . . : 03040127 SITE ADDRESS . . . . . : 20351 SILVERADO AV SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER JESS KWOK ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4437 RECEIVED FROM . . . . : FOREMOST HEATING CONTRACTOR . . . . . . . : CHAPMAN, ROBERT LIC # 18537 COMPANY . . . . . . . . . . : FOREMOST HEATING ADDRESS . . . . . . . . . . : 770 CHESTNUT ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95110 4TELEPHONE . . . . . . . . : (408) 287-9234 EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL ---------- --- ---------- ---------- -- -------- ----- - ---- - --- - - -------- BREMFURN NO UNIT 1 . 00 12 . 21 0 . 00 12 . 21 0 . 00 BREMRECEPT NO. OUTLETS 1 . 00 1 . 11 0 . 00 1 . 11 0 . 00 BENERGY PERMIT FEE 1 . 00 23 . 10 0 . 00 23 . 10 0 . 00 BSEISMICRE VALUATION 1, 200 . 00 0 . 50 0 . 00 0 . 50 0 . 00 MPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 BUSLIC FLAT RATE 1 . 00 100 . 00 0 . 00 100 . 00 0 . 00 EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 ---------- -- ------ ---------- ---------- TOTAL PERMIT 207 . 96 0 . 00 207 . 96 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER -- --------------- ------------ ------------------ CHECK 207 . 96 11671 TOTAL RECEIPT 207 . 96 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL