07030281 CITY OF CUPERTINO ��
7-77
77777
BUILDING DIVISION PE�v11�7�
1 C0 � � � � '
PERMIT NO.
aulLzlbbGADDRESS:6DERWOOD CT CONDITIONED AIR 07030281
- PERMIT ISSUE DATE
OWNER'S NAME:
TSAI JENQ HSIUN 1701 LITTLE ORCHARD ST 03/27/2007
SANITARY NO. CONTROL NO.
NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: REPLACE FURNACE AND ADD A/C BLDG ELECT PLUMB MECH
i 0 p LICENSED CONTRACTOR'S DECLARATION Job Description
W
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z uJ with Section 7000)of Division 3 of the Business and Professions Code,and my license is
tad in full force and effVL
i n z License Class 1, 7[7 Lic.S r�
F p D.E._'KIR ContractorC�Sf►il t�---(�� -
ARCHITECTS DECLARATION
i < I understand my plans shall he used as public records
)WU
a.y Licensed Professional
a OWNER-BUILDER DECLARATION
jam I hereby affirm that 1 am exempt from the Contractor's License Law for the
.Q0 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
prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
-Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
2 F o (commencing with Section 7000)of Division 3 of titc Business and Professions Code)or
i F 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 APN Number Occupancy Type
not more than rive hundred dollars(5500).
❑I,as owner of the property.or my employees with wages as their sok compensation,
will do the work and the structure is not intended or offered for side(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 employers,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-
ccnse 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.
❑I am exempt under Sec. B&P C for this reason
Owner Date
WORKERS 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 Workees 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
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. 8 %rte _k�-_Polity No.: 2-71M �� 1
RTIFICATE 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 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
2 forthwith comply with such provisions or this permit shall be deemed revoked.
z OCONSTRUCTION LENDING AGENCY
E�-t rte-+ 1 hereby affirm that there is a construction lending agency for the performance of
fx.7 the work for which this permit is issued(See.3097,Civ.C.)
W 0 Lender's Name
aL.cndersAddress
U 0 1 certify that I have read this application and state that the above information is
t-. cor L I agree to comply with all city and county ordinances and state laws relating to
rJ Ubuilding conswction,and hereby authorize representatives of this city to enter upon Lhe
U ahove-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
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 f(
■+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
S CE REGULATIONS.
,. � �-7_74 Re-roof:;
tipdGrcofAppliant/Conuactor Date Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
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 ❑No
Will the applicant or fu re building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
:mit hazardous air contamiriaw.As defined by the Bay Area Air Quality Management all new materials for inspection.
District?
O Yes �Na
I have read the hazardous materials requirements undcrChaptcr 6.95 of the Califor-
nia Health&SafctyCode,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
requi nts which must be m prior to iss an f a Certificate of Occupancy. Signature of Applicant Date
t All roof coverings to be Class"B"or better
Ow.r authormcd agent Date
CITY OF CUPERTINO
8 ITEMS OF 8 PERMI`C RECEIPT OPERATOR: bethe
COPY # 1
Sec: Twp: Rng: Sub: Bl.c: Lot:
APN 35329024 . 00
DATE ISSUED. . . . . . . : 03 /27/2007
RECEIPT #. . . . . . . . . BSJ00000795
REFERENCE ID # 0730281
SITE ADDRESS 7636 ELDERWOOD CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA
OWNER TSAI JENQ HSIUN
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
RECEIVED FROM RECEIPT INTERFACE
CONTRACTOR RICHARD READ LIC # 22334
COMPANY CCNDITIONED AIR
ADDRESS 1701 LITTLE ORCHARD ST
CITY/STATE/ZIP . . . : SPN JOSE, CA 95125
TELEPHONE (408) 291-2220
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 3, 000 .00 0. 50 0 .00 0 .50 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 .24 0 .00 176 .24 0 .00
METHOD OF PAYMENT AMOUNT , REFERENCE NUMBER
----------------- --------------- ------------------
CREDIT CARD 176 .24 VISA
---------------
TOTAL RECEIPT 176.24
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- --------------------------- ------ -----
204 UNDERFLOOR FRAME 301 ROUGH PLUMBING
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS
-CITY OF C'UPE(RTINO
U N10E/AC
CUPEkTINO PERMIT APPLICATION FORM
D,7b3oE3)
Date:
APN # D Z� D,Zy 2J ' 0
Building Address:
Owner's Name: Phone#:
Contractor: 'hone. License#:
Contact: Phone: Cupertino Business License#:
2 v��i`'f
Building Permit Info:
Bldg ❑ Elect :dumb (ff Mech
Job Description:
}
Residential Commercial F11_
For Residential Installations:
Attic ❑ 1St floor ❑ 2nd floor❑
Adhere to min set back requirement
For Commercial Installations:
eplacement same weight ❑ Additional weight(structural calcs)❑
Structural Calculations required for new installation ❑
New installation Planning A roval Required ❑
Cost of Project: _ Type of Construction: Occupancy group:
� i "3
Strapped ❑ On Platform [T- Bonded C Sq.Ft. Floor Area:
New Location ❑/ Re Iacement
Qty. if Fee Group
A77T-0
Fee ID Fee Description P
GY Energy BUILDING
URN Furnace MECHANICAL
BREMACOVER YVC Unit> 10,000 cfm MECHANICAL
BREMAIRHAN -,VC Units<= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch& Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM 30eismic Commercial BUILIDNG
EPERMITFEE :-lec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMTTFEE Plumbing Permit Issue PLUMBING
BPERMFEE 1,31dg Permit Fees BUILDING
BPLANCHK :'Ian Check Fee BUILDING
BPGAS as Piping System Fee PLUMBING
BUSLIC Business License BUILDING
Community Development
". 10300 Torre Avenue
Cupertino CA 95014
�.: . P
Telephone(408)777-3228
CITY OF Fax(408)777-3333
-UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
q6 SG 6��t`cowa- C} `7C U l
OWNER'S NAME: 7 cxo,j'75-a PHONE # g10?F 1 � - �U
GENERAL CONTRACTOR: FAX # Cyto 7A - -cM
G�
I am not using;Y"SutonActors: 7
Sf anatur Date
Please check applicable subcontractors and comvlete the following information:
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LI SE #
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 Roc
Tile
Off- .
�, Owner/Contractor Signature Date