07020088 CITY ff CUPERTINOic
BUILLTiNG DIVISION PERMIT �llR�Gt? IIYE ?RM4TI�N�
PERMIT NO.
BUILDING ADDRESS:
20095 NORTHWIND SQ KESTER HEATING AND AIR COND 07020088
PERMIT LSSUE DATE
OWNER'S NAME:
WEN HUANG 4351 GLENPAR
SANITARY NO. CONTROL NO.
NE:
(408) 2E5-1103
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p C LICENSED CONTRACTOR'S DECLARATION Job.Descrlptlon
vp I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
z�d with Section 7000)ofDivision 3 of the Business and Professions Code,and my licenses REPLACE FURNACE AND ADD A/C
t y in full force and of -Zv # S S Ny
License Class
pale Contractor
A HITEC 17S DECLARATIO
i a< 1 understand my plans shall be used as public records
)WU
U.� Licensed Professional
O a OWNER-BUILDER DECLARATION
aI hereby affirm that I am exempt from the Contractor's License Law for the
p o following reason.(Section 7031.5,Business and Professions Code:Any city or county
< which requires a permit to construct,alter,improve,demolish,or repair any structure
u y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
-?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
r I= (commencing with Section 7000)of Division 3 of the Business and Professions Cc&)or $4719
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of N Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3163801.00 Number
not more than five hundred dollars(5500).
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees.provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law docs not apply to an owner of property who builds or improves themon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec B&P C for this reason
. Owner Pate_
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
J 1 have and will maintain a Certificate of Consent to self-insure for WorkcesCompen-
sation,as provided for by Section 3700 of the Labor Code,for the performance-of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner IV me sub'e to the Workcrs'Compensation
Laws of Caltfor�a Date Z"m',b
Applicant ^,)
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Fr tom• I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lenders Name
jz Lender's Address
U C) I certify that I have read this application and stare that the above information is
P correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
A. (We)agree to save,indemnify and keep harmless the City of Cupertino against 1
HCej liabilities,judgments,costs and expenses which may in any way accrue against said City ` Q
U Z in consequence of the granting of this permit. Date (C
►" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCEREGj1LATION'
'Z-' I"'� Re-roof;
Signature of Applican ontract r Dale Type of Roof
HAZARDOUS MATERIALS DISCLOSURE yP
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal 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
Will the applicant or future building occupant use equipment or devices which
If a roof'is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes Nu
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently pave a tenant,that it is my responsibility to notify the occupant of the
requ; rits whict must be met prior to issuance of a Certificate of Occupancy. Signatu-e of Applicant Date
' All roof coverings to be Class"B"or better
Owner r author zc gent Date
CITY OF CUPERTINO
9 ITEMS OF 9 PERM::T RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: B--k: Lot:
APN . . . . . . . . . 3:_638010. 00
DATE ISSUED. . . . . . . : 0::/16/2007
RECEIPT #. . . . . . . . . . B:3000000477
REFERENCE ID # . . . : 0''020088
SITE ADDRESS . . . . . : 20095 NORTHWIND SQ
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER W1 W HUANG
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0549
RECEIVED FROM . . . . : RHCEIPT INTERFACE
CONTRACTOR . . . . . . . : KESTER, DAVID M LIC # 22101
COMPANY . . . . . . . . . . : KHSTER HEATING AND AIR COND
ADDRESS . . . . . . . . . . : 4:351 GLENPARK DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95136
TELEPHONE . . . . . . . . : (,608) 265-1103
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- ---------- ----------
BENERGY PERMIT FEE 1. 00 34 .86 0. 00 34 .86 0. 00
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
BREMRECEPT NO. OUTLETS 1. 00 1 .20 0. 00 1.20 0. 00
BSEISMICRE VALUATION 4, 719 . 00 0.50 0. 00 0.50 0. 00
BUSLIC FLAT RATE 1. 00 107 . 00 0. 00 107 .00 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
PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 283 .24 0. 00 283 .24 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 283 .24 VISA
---------------
TOTAL RECEIPT 283 .24
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- --------------------------- ------ ----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
Community Development
YA- -,,, 10300 Torre Avenue
Cupertino CA 95014
A
Telephone(408)777-3228
�CITY OF Fax(408)777-3333
r,UPEkTINO
Buildin7 De artment
JOB ADDRESS: PERMIT # A
41
OWNER'S NAME: 35 L`f- P �l v,� �" PHONE # 3 z _ ZSR
GENERAL CONTRACTOR: �r�ST�,r2_ FAX #
I am not using any subcontractors: '
Signature Date
Please check applicable subcontractors and complete the followinginformation:
SUBCONTRACTOR BUSI14ESS 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
— 116
Date
Owner/Contractor Signature
CITY OF CUPERTIN
..
FURINIACE/AC
CUPEf�TINO PERMIT APPLICATION FORM
ATN# Date:
Building Address:
Owner's Name: Phone#:
YID
Contractor: Phone. License l:
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description:
A IL
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1St floor 22nd floor❑
Adhere to min set back requirement 0'
For Commercial Installations:
teplacement same weight ❑ Additional weight (structural Elctural calcs)
Structural Calculations required for new installation
New installation Planning Approval Required ❑
Cost of Project: Type of Constntction: Occupancy group:
Strapped ❑ On Platform ❑ Bonded Cl Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY ]?nergy BUILDING
1 BREMFURN Fumace MECHANICAL
BREMACOVER ,VC Unit> 10,000 cfin MECHANICAL
BREMAIRHAN -,VC Units<= 10, 000 cf n MECHANICAL
BREMRECEPT ]tec tl, Switch& Outlets ELECTRICAL
e BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE 131ec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE 131dg Permit Fees BUILDING
BPLANCHK flan Check Fee BUILDING
BPGAS (Jas Piping System Fee PLUMBING
BUSLIC 13usiness License BUILDING