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07050194 CITY OF CUPERTINO BUILDi.NG DIVi-'ION PERMIT ; � R ItEQItM�1TION PERMIT NO. BUILI�jAJG,{\gDR�$=j�DERWOOD CT E & I CENTRAL HEATING & AIR 07050194 OWNER'S NAME: PERMIT ISSUE DATE CHAN GILBERT AND PAULINE 372 RIVERCREST LN 05/21/2007 NE: (510) 37'1-4352 SANITARY NO. CONTROL NO. ARCHITEC IENGiNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH C p LICENSED CONTRACTOR'S DECLARATION Job Description UF`- 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 REPLACE FURNACE, ADD 4 TON A/C UNIT 40 AMP a- in full force and�effect r�z License Class �� 2v Lia tf ( CIRCUIT E & I CENTRAL HEATING RENEWED BL. w Date S 2 — C Contractor ✓XS CV 0.1- .ar TJ,i ARCHITECTS DECLARATION 2wa 1 understand my plans shall be used as public records )yU U.y Licensed Professional y J OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county `t which requires a permit to construct,alter,improve,demolish,or repair any structure a Z y prior w its issuance,also requires the applicant forsuch permit to file a signed statement t' ,Ft. Floor AreaValuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 .oq F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $9255 9255 i 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 35929026 �Number Occupancy Type not more than five hundred dollars($500). ❑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 (1 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 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- cense Law docs 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 Contractor's License Law. ❑I am exempt under Sec B&P C for this reason OwnerDate 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 Jh.=d fch this permit is issued. will maintain Worker's Compensation Insurance,as required by Section of the Labor Code,for the performance of the work for which this permit is issued. oc er Compensation InsuraSnce carrier and Policy number C )icy Noare: . artier. K. U .:W' RTIFICATE OF EXE ON 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' CONSTRUCTION LENDING AGENCY F-r 1 hereby affirm that there is a construction lending agency for the performance of (Y the work for which this permit is issued(See.3097,Civ.C.) aQ Lender's Name a Lender's Address U C) 1 certify that 1 have read this application and state that the above information is r-' correct.I agree to comply with all city and county ordinances and state laws relating to 0building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspecuon purposes. Q. (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 U z in consequence of the granting of this permit. APPLICANT UNDER S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU GULA NS. Re-roofs Signature Applicant/Con Date HAZARDOUS MAARIALS DISCLOSURE Type of Roof 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 Cede,Section 25532(a)? All roofs E hall be inspected prior to any roofing material being installed. C]Yes No If a roof is installed without first obtaining an inspection,I agree to remove Will Y 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 materials for inspection. District? ❑Yes ("Co have read the hazardus`'materials requirements under Chapter 6.95 of the Califor- nia Health&SafelyCodc,Sections 25505.25533 and 25534.1 understand thatif doe building docs not currently ha n t it is my responsibility to notify�LheXuocupant of the wire ts which m be met pri r w issuance of a Ccrtificatc of cy. Signature �f Applicant Date LILO owner authorized ager) Dare All roof'coverings to be Class"B"or better CITY OF CUPERTINO 9 ITEMS OF 9 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN . . . . . . . . : 35S29026 . 00 DATE ISSUED. . . . . . . : 05/21/2007 RECEIPT #. . . . . . . . . BSC00001391 REFERENCE ID # . . . 07C50194 SITE ADDRESS . . . . . : 7624 ELDERWOOD CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER CHIN GILBERT AND PAULINE ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4327 RECEIVED FROM . . . . : E & I CENTRAL HEAT CONTRACTOR . . . . . . . : MAXIMINO R FLORES LIC # 27533 COMPANY . . . . . . . . . . : E & I CENTRAL HEATING & AIR ADDRESS . . . . . . . . . . : 372 RIVERCREST LN CITY/STATE/ZIP . . . : HAYWARD, CA 94544 TELEPHONE . . . . . . . . : (510) 377-4352 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 9, 255 .00 1. 00 0 .00 1. 00 0. 00 BUSLIC FLAT RATE 1 .00 107. 00 0 .00 107. 00 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 283 . 74 0 .00 283 . 74 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 283 . 74 1602 --------------- TOTAL RECEIPT 283 . 74 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF 41UPERTINO av-0 FURN ACE/AC c11Y Of CUPEkTINO PERMIT APPLICATION FORM �P 7a5Z)1�X APN# Date: Building Address: C L-n02w 01> C-r Owner's Name- Pon #: ��v�-fir`►� ��•-E rte.r.� non Contra or: r z License#: Contact: /b 77 � ��— Cupertino u4 ss Licensef: Building Permit Info: ,/✓ Bldg ❑ Elect Plumb Mech Job Description: �U{ZNrkCC G •4,�` 'GST S dinrte" LVE ?ice A�� `� 70�► /k�� `io GtfzG,✓ Residential A Commercial ❑ For Residential Installations: Attic ❑ 1 st floor ❑ 2nd floor ❑ Adhere to min set back requirement 14 For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) Structural Calculations required for new installation ❑ New installation Planning Approval Required Cost of Project: Type of Construction: Occupancy group: Strapped ❑ On Platform 17 Bonded Sq.Ft. Floor Area: New Location Replacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Enemy BUILDING BREMFURN F:elocation of Furnace MECHANICAL BREMACOVER AJC Unit> 10,000 cfm MECHANICAL BREMAIRHAN AJC Units<= 10, 000 cfm MECHANICAL BREMRECEPT Pec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Flumbing Permit Issue PLUMBING BPERMFEE E:Idg Permit Fees BUILDING BPLANCHK F Ian Check Fee BUILDING 1 BUSLIC Business License BUILDING E & I Central Heatir:g and Air Conditioning 30982 Huntuxrod Ave Suite 206 Hayu and CA, 94544 I, Pascual Flores, of E and I Central Heating and Air (License number 7759 1) will allow Juaji Zamora of E and I Central Heating and Air to pull my required city permits. If you shall have any questions about this please feel free to contract me at the number listed below. Thanks in advance for you coc peration, Pascual Flores-Owner 510-315-7312 SCommunity Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -TPEkTINO Building Department JOB ADDRESS: PERMIT# 7G-2-9 L.-� L"') OWNER'S NAME: POA,vL-� PHONE Z�;S- - �S GENERAL CONTRACTOR: A, o g,� FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical F- ".T- A� Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Eq:- " Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ ontractor Signature Date