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06060120 CITY OF CUPERTINO hUILDING*DIVISION PERMIT BUILDING ADDRESS: A ECT CLIMATE PERMIT NO 06060120 21860 EATON PL PERMIT ISSUE DATE OWNER'S NAME: ANTHONY LAI 10570 S DEANZA BLVD 06/15/2006 SANITARY NO. CONTROL NO. )NE: (4 08) 86119545 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH 0 o a 0 v p 0 LICENSED CONTRACTOR'S DECLARATION Job Description V (= I hereby affirm that I am licensed under provisions of Chapter 9(commencing 2 a. with Section 7100)of ecDivision 3 of the Business and of�gsit)<tsCn my licensa is INSTALL FURNACE & A/C n H in full force and effec ''_JJ'')I`�//�� vE2 2 License Lte•M 4;:,a F-w Contractor ARCHITECTS DECLAR TIO I W U I understand my plans shall be used as public records go. u.y Licensed Pmfcssional Z y.< OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the in O following reason.(Section 7031.5,Business and Professions Cale:Any city or county $6707 K which requires a permit to construct.alter,improve,demolish,or repair any structure AJ prior w 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 xt= (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 30 MMeroo 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 dos not apply to an owner of property who builds or improves thereon,and who dos 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.). 7 ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and. Tom\ who contracts for such projects with a contractor(s)licensed pursuant to the contractors License Law. ❑1 am exempt under Sec B&P C for this reason ^� Owner Date t ^ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: t_I I have and will maintain a Certificate of Consent to self-insure for Workers Compen- �� ) 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 3710 of the Labor Calc,for the performance of the work for which this permit is issued. My Workerscep ns Gon Insurance carrier and Policy n m edam: Cartier. s Policy No: 5 ✓'r"o 7� 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,l 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 Workers Compensation provisions of the Labor Code.you must ,J O forthwith 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 IY, the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lenders Name � Landers Address U C) I certify that 1 have read this application and state that the above information is 4. correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorise 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 liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence granting of this permit Date �+ APPLICA UND RSTANDS ND ILL COMPLY WITH ALL ON POINT Issued by: SOURCEREGULA r � Re-roofs SignatureUContracwr ate T of Roof HAZARDOU MATERIALS DISCLOSURE Type 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 Io 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 ❑7Dft� 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505,25533 and 25534.I understand that if the building docs not c3p ly have a tens t th is my responsibility to notify occu t of the requirerpbnsw 'c btstj rior issuanceo[aCcrtificate�{ 7aana Signature Of Applicant Date (/ All roof coverings to be Class B or better Ownkr or rixed agent ate yr Community Development - 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 �'C1T1f OF Fax(408)777-3333 1.1-UPEIZTINO « //-,6 4�*-Lo Buildin De artment 6 6 0 G JOB ADDRESS: PERMIT # l �— OWNER'S NAME: 3;1n,, PHONE # 40F GENERAL CONTRACTOR: C FAX # I am not using any subcontractors: ignatur 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 J Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile i Owner/Contractor Signature Date CITY OF CUPERTINO :m 1 of4 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32619130 . 00 DATE ISSUED. . . . . . . : 06/15/2006 RECEIPT # . . . . . . . . . : 34862 REFERENCE ID # . . . : 06060120 SITE ADDRESS . . . . . : 21860 EATON PL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . ANTHONY LAI ADDRESS . . . . . . . . . CITY/STATE/ZIP . . . : , 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) 86119545 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 7, 000 . 00 0 . 70 0 . 00 0 . 70 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 .44 0 . 00 176 .44 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FiTRNA.CE/AC CUPER,TINO PERMIT APPLICATION FORM Date: Building Address Owner's Name: Phonc A. Contractor: one: �, License#: Contact: �, �� Mono: G��pettin�us�i License#: r1 � lei ��s y� 11 Building FeiLzit Info: Bldg O .Elect Plumb D Mech , Job Description: 11 "/4 ob Lam/ Residential Cothmercial ❑ For)(�identiial tions: Attic U I"floor H 2"d floor❑ —/ Adhere to min set back r remcnt L9' For Commercial Installations: Replacement same wcight E] Additional weigbt(s ructuraI Gales)❑ Structural Calculations required for new installation New installation Pla=in ApLrnval RSguired ❑ Cost of Proje t: yr Iq Type of Construction: Occupancy group: Strapped On Platform Bonded Sq.Ft. r'loor Area: New Location Ca"' Replacement ❑ Qty. if Fee Descri on Fee Grou A licable Fee ID BUILDING BENERGY Energy BREZV2FURN Furnace MECHANICAL BREMACO'VER A/C Unit> 10,000 c in MECHANICAL BREMAIRHAN A/C Units<-- 10,000 cfm MECHANICAL BREMR F.C;FPT Reepil, Switch&Outlets ELECTRICAL Seismic Fee Res BUILDING BSEISMICRE BSEISMIC E Seismic Commercial BUILIDNG EP)±,RMTTFEE Elec Permit Issuance ELECTRICAL. MPERMTI'FEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbingpermit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING UIL BPLANCHK Plan Check Fee PLUM DING P BPGAS Gas Pi in S stem Fee PLUMBING 13USLIC Busiincss Liccnse El JU WGWG