07060162 77 7.7777777.7777
CITY OF CUPERTINO
BUILDING DIVISIGN PERMIT � R�GTa INS RM iiTI
PERMIT NO.
BUI11'�IT s :ASTLETON ST A PERFECT CLTMATL E 07060162
PERMIT ISSUE DATE
OWNER'S NAME:
LIAN, TIONG-HU 10570 S DEANZA BLVD 06/ 7
SANITARYARYNO. CONTROL NO.
'NE: (408) 86119545
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
I p O LICENSED CONTRACTOR'S DECLARATION Job Description
m p I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z with Section 70(X0)of Division 3 of the Business and Professions Code.and my license is REPLACE FURNACE AND AIR CONDITIONER
>>y in full force and effect
j vn Z License las Lie•N
p Datc —Contractor
ARCHITECTS DECLAR Tl N
j < 1 understand my plans shall be used as public records
)yU
u.H Licensed Professional
O a OWNER-BUILDER DECLARATION
>. I hereby affirm that I am exempt from the Contractor's License Law for the
p O following reazon.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to concoct,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 .Ft.Floor Area Valuation
-?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q $11269
4 t=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5 618 05'7 . Number
not more than five hundred dollars($500).
0 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 does 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.).
0 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 does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
0 1 am exempt under Sec B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
(]I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 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 Workees Compenlauo Insurance carrier and Policy number arc: tea
Carrier: S r�_Policy NoAl*n IS l b%Q
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,1 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
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
z t" CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a concoction lending agency for the performance of
the work for which this permit is issued(Sec.3097,Civ,C.)
W QLender's Name
az Lender's Address
U 0 1 certify that I have read this application and state that the above information is
Gl. correct.I agree to comply with all city and county ordinances and state laws relating to
U building construction,and hereby authorise representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
fFt rA 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 / G�
►-+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS. 1� — , 7
`�•�•�� f& 6
�'1`I—o� Re-roofs
Signature of Applicant/Contractor Dare Type of Roof
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.
0 Yes v �g No
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection.
District?
0 Yes b15,No
1 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
does not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements whiff' 'usl be met p to rssuamcc of a Certificate of Occupancy. Signature;of Applicant Date
All roof coverings to be Class"B"or better
Owner or authorized agent Date
CITY OF CUPERTINO
8 ITEMS OF 31 PERMIT RECEIPT OPERATOR: bethe
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 35618057. 00
DATE ISSUED. . . . . . . : 06/19/2007
RECEIPT #. . . . . . . . . BS000001699
REFERENCE ID # . . . 07060162
SITE ADDRESS 21573 CASTLETON ST
SUBDIVISION
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LIAN, TIONG-HU
ADDRESS . . . . . . . . . . : 21573 CASTLETON ST
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4702
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 AMCUNT 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 11, 269 . 00 1 .20 0 . 00 1 .20 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 176 . 94 0 . 00 176 . 94 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- --------------
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
CITY OF C UPERTINO
URNYkCE/AC
CUPEkTINO PERMIT APPLI=CATION FORM
APN# 35(p r IC& - 05'7 Date:
Building Address:
Owner's Name: Phone#:
-----
Contracror: Phone: License#:
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect 19- Plumb Mech TK
Job Description:
v,cR. �J r,�aclt -E Q,�• c � v�:�1��-
Residential 12� Commercial ❑
For Residential Installations:
Attic ❑ 1" floor T141 2nd floor❑
Adhere to min set back requirementt•
For Commercial Installations:
.eplacement same weight ❑ Additional weight(sbuctural calcs) ❑
Structural Calculations required for new installation
New installation Planning Approval Required ❑
Cost of Project: Type of Construction: Occupancy oup:
Strapped ❑ On Platform ❑ Bonded M Sq.Ft. Floor Area:
New Location ❑ Re lacement t•
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER AX Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A,'C Units<= 10, 000 cfm MECHANICAL
BREMRECEPT R,:cptl, Switch& Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Scismic Commercial BUILIDNG
EPERMITFEE El ec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS Gas Piping System Fee PLUMBING
BUSLIC B.isiness License BUILDING