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06050096 CITY OF CUPERTINO BUILDING DIVISION PERMITT� � �� ' BUILDING ADDRESS: CONDITIONED AIR PERMIT NO,0 6 0 5 0 0 9 6 21506 MONROVIA ST PERMIT ISSUE DATE OWNER'S NAME: GRACE CHO 1701 LITTLE ORCHARD ST 05/11/2006 )NE: SANITARY NO. CONTROL NO. (408) 291-2220 ABUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 i p p LICENSED CONTRACTOR'S DECLARATION Job Description est I hereby affirm that I am licensed under provisions of Chapter 9(commencing z with Section 7000)of Division 3 of the Business and Professions Code,and my license is ADD AIR CONDITIONER n zo H in full force and effat j vn z License Class �) Lic.M t-a Date 4.1 A Contractor �� ARCHITECTS DECLARATION '75 U I understand my plans shall be used as public records 'U.M Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the COO following reason.(Section 7031.5,Business and Professions Code:Any city or county $3600 `< Pi which requires a permit to construct,alter,improve,demolish,or repair any structure yy prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation R,< that he is licensed pursuant to the provisions o[the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y _ that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of r Occupancy Type 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 q p 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 be did not build or improve for purpose of sale.). I,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 does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractors)licensed pursuant to the Contr cies - License Law. Q I am exempt under Sec B&P C for this reason Owner Date 1 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declaradoi, � J t J ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Com L./ F 1 E J _ L sation,as provided for by Section 3700 of the Labor Code,for the performance of the j work for which this permit is issued. ❑1 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 am: Cartier._ QA:Cv,a i I gee' • Policy No. � CE FICATE EXEMPTION FRO CERS' 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 fru which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z, CONSTRUCTION LENDING AGENCY 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.) WIl.Q Lender's Name L Z ander's Address U C) I certify that 1 have read this application and state that the above information is VL COMM I agree to comply with all city and county ordinances and state laws relating to CV building construction.and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. CY (We)agree to save,indemnify and keep harmless the City of Cupertino against tIn liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date L APPLICA NDERSTANDS AND WILL OMPLY WITH ALL N POINT Issued by: SOUR G LATIONS. Re-roofs Signwel App ontractor are Type of Roof HAZARDOUS MATERIALS DISCLOSURE 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. C]Yes No 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 �_ 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Cade,Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant that it is my responsibility notify the occupant of the reyuiremcntsh must be me2pnor issuartcc of c ate or Occupane. Signature of Applicant Date aG All roof coverings to be Class"13 or better Owner or a4griild agent Date Community Development 10300 Torre Avenue S Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ",M TINO Building Department JOB ADDRESS: PERMIT # C) 0 G G S" C Q g� OWNS 'S NAME: C c, PHONE # GENERAL CONTRACTOR: C - - FAX # I am not using any subcontractors: f Signature Date Please check applicable subcontractors and complete the following inform on: 60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting i Linoleum/ Wood Glass/ Glazing Heating Insulation .' Landscaping Lathing Masonry < Ornamental Sheet tal Painting/ Wallp er Paving Plastering Plumbin Roo ' g Se 'c Tank eet Metal Sheet Rock Tile ft X06 Owne ontractor Signa Date CITY OF CUPERTINO d 6105 ON FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN# [�DG _ 0 3 . 0 0 5 Date: o c j • it - d 6 Building Address: 6 m s CL) a.0V%\rno CA q' SokL? Owner's Name: Phone#: 3 �) - 15 650 Contractor: License#: oY� Sao c• C• U Contact: Cu ertino Business License M .d, Building Permit Info: Bldg ❑ Elect Plumb U,` Mech CnY Job Description: Residential CJ<- Commercial ❑ For Residential Installations: Attic ❑ 1St floor`Et-2"d floor❑ Adhere to min set back requirementtEr--- For Commercial Installations: Replacement same weight ❑ Additional weight(structural Elctural calcs) Structural Calculations required for new installation New installation Planning Approval Required ❑ Cost of Project: Type of Construction: Occupancy group: 3, 6 oo v ti _ Strapped ❑ On Platform El Bonded El 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 cfrn MECHANICAL BREMAIR.HAN 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