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08100090 CITY OF CUPERTINOF ,7taee.,ex as _TNT_7 BUILDING DIVISIQN PERMIT pOl\+1=1AGfoi1 NFOAT110L� BUILDING ADDRESS: PERMIT NO. 21055 RED FIR CTA & H HEATING 08100090 OWNER'S NAME: PERMTr ISSUE DATE LO TSAI—HUNG AND SHUI—LAIN 770 CHESTNUT ST 10/16/2008 lopNE: (408) 279-0722 SANITARY NO. CONTROL NO. ARCHTfER7ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH I� I� E t� u 0'z LICENSED CONTRACTOR'S DECLARATION Description Descr u I hereby affirm that I am licensed under provisions of Chapter 9(commencing JOp with Sectio]alMffect. isirn3o(dm ButinusalM Profession Cade.andmylimu }nseV/RPLC FURNC & CNTRL A/C) RECONN ELECTRCL n con ro and encs 36 Z p Date /' Contractor � 7th Ll k ARCHITECTS DECIAR rj W V 1 uMersuW nJ my p s W shall used u public.,& . 4 G t; LKCKCd Professional 3 OWNER-BUILDER DECLARATION t� E I bunchy affirm Nat 1 am exempt from roc ConOectoes License Law for the i O o following reason.(Section 101.5.Business and Professions Cade:Any city or county $� which acquires a pmmf to connotes.alter,impure.dopa-IM.or now any someone :4'n prior to its issuance.also requires the applicant for such permit W file a signed statement < thatImislicensedpursuanttothepoiswmoftheConuacWr'sUcu—Law(Charm'9 Sq.Ft.Floor Area $ Valuation 1�0 (commencing with Section 7000)of Division S of the Business;and Professions Code)or 4650 Q 9 the he Is exempt therefrom shot the psis for the anornd exemption.Any violation of Section 7031.5 by atry applicant for a permit objects the applicant Ir s Civil penally ofNumber Occupancy Type het mum than Rw hundred dolens($500). 35905015 :V� ❑I.0 cores"al the polwtY,or my uoployru with wage uthe"v ole emnpewtion, with dathewods,andthe he CWuhetthtendede aw(m(male(Sec.7044,Boer Or And PIa,whobu Cade:The C sthereora ndwho Law uch or apply Wan rough of Required Inspections Own cro wyces,pdsarimpovsuchimpr and who am mrwork himulfar through his over employees,poWMd the wnrim is mid n ti art not inu.or maReacd ro cone IL however.ilex have thWilding orimpovement ll sold within on,year or completion,the owner- Wiltrr NB have ties WNco of proving that K did wt build or improve for purpose of tele.). ❑1,As comer of the property cera exclusively crowned.,with Bceme d ontrnemra to comment the pojeo(See.7044,Business red Prefesdom Code:)The Contrnemra U. come Law does not apply to an owner of property who builds or improca thereon,and, who conwace for such projects with a conustur(s)licensed pursuant to the Commutes Liccme law. 0 l am exempt under Sec .B A PC for this wan Owner Date WORKER'S COMPENSATION DECLARATION I hereby nlr.ander penalty of perjury me of the following declaration: 1 haw and will maintain a CesuReste ofConent to self-imam for WooersCompen- suion,u Provided for by Schon 3700 of the labor Code.for du performance of the work for which this permit is issued. 0 I Mw W will maintain Workers Compensation Imursno:,As acquired by Section 3700 of Ne labor Code,for the pehfahmoce of tie work for which this permit is iumd. ' My WkeraC.unpeuadon�Inyranocarricrand Policy aCIZALz I PolicyNo.: nr Cartier. Vey— CERTIFICATE OF EKEMP ION FROM WORKERS COMPENSATION INSURANCE (This action need notbecmnpleted If the permit is faster hundred call.(51001 or leas) 1 certify that in the perli m mcc of dm war for which this permit is issued.l shell not employ any person in my manner an az W become subject W the Worker'Compensation Laws of Califomia.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become object W the Workers CompemNon provisions of the tabor Code,you must �O forthwith comply with such proviumm orchis Pemdl shall la,detmed remand. z '--' CONSTRUCTION LENDING AGENCY IIneby affirm that Nero is•construction lendingagehtcy for the perfomumee of IYthe wan for which this permit is Issued(Sec.3097.ch.C.) DJ Lender"Name Z)z L<ndnesAddmas U Q I unify&.11 haw read this application and state the the above information is U. H correct.l agree W comply with all city and county ordinances and sum laws muting W O U Wilding construction,and hereby authorim mpwautiwa of this city W cuter upon the W atom-mentioned pmpeny for imPectian[Intrudes F G (We)agree to um,indemnify Nd keep harmluu the City of Cuperlino against rn liabilities,judgmcnW coats and expert.•s which may in any way accme against mid City U Z in ermequcoce of the grand.,of the permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCLATIONS. ���� Re-roofs Shgrmum a(ApplkaDau HAZARDOUS IaAZ plicant rho,=building MATE RIALS DISCLOSURE Type of Roof with the Cupertino Muni o occue.Chapter rrr 12.lundle Health Andnious Safety u al definN by Ute Cupertino Mum'cip9LCode.Gapter 9.13,and bite Health antl Safety Code.Section 255320)? Cl/ All roofs shall be inspected prior to any roofing material being installed. ❑Yen No wen tic,pplicaut or future Wilding occupahn use c(imp rmuL or devices which If a roof is installed without first obtaining an inspection,I agree to remove it ho'raMous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection. ."h' ❑Yo No I hive real the luc dous materials requirementsmm1c,Chmur6.95.fth.Calif.,. at.Hcalth&Safcly Code,Sccdmu 25505,25533 and 25534.1 understand thatif tle Wilding dos rot curmndy haw•errant the it u my respo 'biltry W ratify tle aecupent of tie rogalacmcnu tchmustbemetPriormissu Curti ate oft3ccupatey Signature of Applicant Date �,,,� All roof coverings to be Class'J�."or better Owner or authYed agent Dau' CITY OF CUPERTINO • 6 ITEMS OF 6 . PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35905015 . 00 DATE ISSUED-. . . . . . . : 10/16/2008 , RECEIPT # . . . . . . . . . : BS000006366 REFERENCE ID # . . . : 08100090 SITE ADDRESS . . . . . : 21055 RED FIR CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LO TSAI-HUNG AND SHUI-LAIN ADDRESS . . . . . . . . . . : 21055 RED FIR CT CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4249 RECEIVED FROM . . . . : DALE PHELPS CONTRACTOR . . . . . . . : PHELPS, DALE LIC # 12079 COMPANY . . . . . . . . . . : A & H HEATING ADDRESS . . . . . . . . . . : 770 CHESTNUT ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95110 TELEPHONE . . . . . . . . : (408) 279-0722 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---- ----------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 4, 650 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 1MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 1MRRAA UNITS 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00 1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 --------- ----- ---------- ---------- .TOTAL PERMIT 224 . 85 0 . 00 224 . 85 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 224:85 MC --------------- TOTAL RECEIPT 224 . 85 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --- ---------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • Community Development 10300 Torre Avenue Fv Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 qFUFEkTINO Building De artment JOB ADDRESS: PERMIT # 210 H IZ C- E) ood�;o OWNER'S NAME: 51 Wgpo Q PHONE # GENERAL CONTRACTOR: n FAX # 27 — O I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followin 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 cl�cuPEr�TiNO PERMIT APPLICATION FORM APN# .nU�D�� d � Date: Building Address: Owner's Name: Phone'51 #: mo Contractor: t� 7 Phone #: 2-79 _ C -2 Z Z- 6� Fax #: 2 7 g — Contractor License#: O Cupertino Business License#: / 079 Contact: ! Ptf6- --P5 Phone #: Fax #: 2 —(D( Building Pen-nit Info: Elect Y Plumb E Mech Residential Commercial ❑ Job Description: For Residential Installations: Attic ❑ 151 floor © 2nd floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Proje Type of Construction (Usa e Class); Strapped ❑ On Platform Bonded ❑ New Location ❑ Replacement Project Size: Express [2;Siandard ❑ Laze ❑ Major❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. cg Revised 6/16/08 CITY OF. CUPERTINO aLIAOFFURNACE/AC CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE F,URN/AC 1MCRAA Commercial-Repair/Alteration/Add to M ca heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system incl installation of controls regulated by this code. 1MCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1MCSUSHTR Commercial Install/Relocate ea M suspended heater,recessed wall htr, or • floor mounted unit heater. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed &not incl in an appliance permit. 1BSEISMICO Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1MRAPPVNT Residential for the install/relocate/ or M • replacement of ea appliance vent install & not incl in an appl permit. Quantity Fee ID Fee Description Fee Permit Type f n� F