07050028 -777777. 7
7777
CITY OF CUPIERTINO
BUILDING DIVISION PERMIT C1R9 OTQ ItT��r1
BUfLgiNGgO/4ESYALM AV A PERFECT CLIMATE PERMIT07050028
OWNER'S NAME: PERMIT ISSUE DATE
JOHN CHOW 10570 S DEANZA BLVD 05/03/2007
AE: (408) 86'-19545 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 � 0
i p p LICENSED CONTRACTOR'S DECLARATION Job Description
UP I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Zm with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE A/C 5 TON 14 SEER
h�w in full
t? forcend
License Cl
V
Date AR HITRCleDCLAR N
1 understand my plans shall be used as public records
)�U
,a
a Licensed Professional
y
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
<%0! which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y prior to its issuance.also requires the applicant for such permit to file a signed statement
=o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ,t,hq.Ft. Floor Area $5098
Valuation
L3 t-$ (commencing with Section 7000)of Division 3 of the Business and Proressions 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 �p]�j Number Occupancy Type
not more than five hundred dollars($500). 3 5 7 0 4 0 64 1:t��1
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 fired Ins echo ns
and Professions Code:The Contractor's Licerhse Law does not apply to an owner of 9 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.).
0 I,as owner of rhe property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's U.
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.
Q I 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:
L]I have and will maintain a Certificate of Consent to self-insure for Workefs Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
wo or 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 Worke�es Compensation Insurance Insurance carrier and Policy a ber are: � e_7�^
Carrier l�il b4kt L Policy No.: 3 V l
TCERTIFICATE OF EXEMPTION FRO WO ERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(S 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 Worker's Compensation provisions of the Labor Codc,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z'" CONSTRUCTION LENDING AGENCY
(~� 1 hereby affirm that there is a construction lending agency for the performance of
p; the work for which this permit is issued(Sec.3097,Civ.C.)
WIz,A Lender's Name
a z Lender's Address
U 0 1 certify that 1 have read this application and state that the above information is
V.'r correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction.and hereby authorize representatives of this city to enter upon the
W ahove-mentioned property for inspection purposes.
LL (We)agree to save,indemnify and keep harmless the City of Cupertino against
hF"y liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit. Date
►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE • ULATIONS.
nax�� " 9 5,.'7�� Re-roofs
Signature of Applicant/C actor Dare T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal ode.Chapter 9.12,and the Health and Safety
Cede,Section 25532(a)? All roofs,hall be inspected prior to any roofing material being installed.
❑Yes u
Will the applicant or future b'ding occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants fined by the Bay Area Air Quality Management all new materials for inspection.
District?
QYcs 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
docs not currently have a tenant.that it is my responsibility to notify the occupant of the
requirements which mustprior to rarhceofa r, leofoecupancy.� Signature AApplicant Date
S's All roof coverings to be Class "B"or better
Owner or authorized agent YY
CITY OF CUPERTINO
6 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN 35704064. 00
DATE ISSUED. . . . . . . : 05/03/2007
RECEIPT #. . . . . . . . . : BSC00001202
REFERENCE ID # . . . : 07C50028
SITE ADDRESS . . . . . : 22374 PALM AV
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER JOIN CHOW
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2710
RECEIVED FROM . . . . : REC'EIPT INTERFACE
CONTRACTOR . . . . . . . : SMITH, BYRON E LIC # 21144
COMPANY A PERFECT CLIMATE
ADDRESS 10_`70 S DEANZA BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE (4( 8) 86119545
FEE ID UNIT QUANTITY 1,MOUNT 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
BSEISMICRE VALUATION 5, 098. 00 0. 60 0. 00 0 . 60 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 160. 83 0. 00 160.83 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 321. 66 #30710, PERFCT CLIMAT
---------------
TOTAL RECEIPT 321 . 66
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
CITY OF CUPERTINO
BUILDING DIVISION PERMIT Q� �.} M`ITI�N
PERMITNO.
BUILL iVjjkl(� b
6' ARKW00D DR AVERY CONSTRUCTION 07050142
OWNER'S
JNAME: r PERMITISSUEDATE
GLENBROOK APTS 130 E;iST D,NA ST 05/16/2007
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
REPLACE WINDOWS LIKE FOR BLDG ELECT PLUMB MECH
C] D O D
Ar? 6I.ENWE)OD
100 LICENSED CONTRACTOR'S DECLARATION ,- _ -,Try Job Description
V
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, nd my license is
in full force and
j ? License Class Lic.ff
y Date ARCHITECTSRATION
Ca 1 understand my plans shall be used as public records
�yU
u.H Licensed Professional
`- OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
C O following reason.(Section 7031.5,Business and Professions Code:Any city or county
Z 0� which requires a permit to construct,alter,improve,demolish,or repair any structure
U Z> 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 >�]
4 t- (commencing with Section 7000)of Division 3 of the Business and Professions Codc)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 APN 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 Ired Ins eCU0i1S
and Professions Code:The Contractor's License Law does not apply to an owner of q 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.).
❑I,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-
cause 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
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.
❑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 Workeel.SpinpensaLion Insurance carrier and Policy9number am:
6 b
Carrier.. �"� Polity o.:�V y
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,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Dale
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
Z forthwith comply with such provisions or this permit shall be dcemed revoked.
Z O CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
R! > the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
] Z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
11. correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding consuuction,and hereby authorise representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
a (We)agree to sav 'ndcmnify and keep harmless the City of Cupertino against
liabilities,judgments,c and expenses which may in any way accrue against said City
U,Z in consequence of th nun of this permit.
-, APPLICANT WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU TI .011.1 �`..
'(6 a 7 Re-roofs
Signature of A icant/Contractor Dam Type of R sof
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(x)? All roofs:;hall be inspected prior to any roofing material being installed.
❑yes No
If a roof i:;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 contamin as defined by the Bay Area Air Quality Management all new m iterials for inspection.
District?
❑Yes
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&,W C ,Sections 25505,25533 and 25534.1 understand that if the building
d currently ve a nt,that it is mypansibility to notify the occupant of the
re uircmcnts hssuanccnfaecrifhcateofOgnpancy. Signature of Applicant Date
l/— ( 66 All roof coverings to be Class"B"or better
Owner or authorized agent Date
CITY OF CUPERTINO
4 ITEMS OF 56 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN 32627037. 07
DATE ISSUED. . . .. . . : 05/16/2007
RECEIPT #. . . . . . . . . BS000001350
REFERENCE ID # . . . : 07050142
SITE ADDRESS . . . . . : 10110 PARKWOOD DR
SUBDIVISION . . . . . .
CITY CUEERTINO
IMPACT AREA . . . . . .
OWNER GLENBROOK APTS
ADDRESS . . . . . . . . . . : 10100 MARY AVE
CITY/STATE/ZIP . . . : CUEERTINO CA, 95014-1502
RECEIVED FROM . . . . : BRIAN AVERY/MATT
CONTRACTOR AVERY, BURT LIC # 12134
COMPANY AVERY CONSTRUCTION
ADDRESS 13C EAST DANA ST
CITY/STATE/ZIP . . . : MTT VIEW, CA 94041
TELEPHONE . . . . . . . . : (9E0) 961-8330
FEE ID UNIT QUANTITY TMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 147.96 71.02 0.00 71. 02 0. 00
BPERMFEE VALUATION 7, 785.00 147. 96 0.00 147. 96 0. 00
BPLANCHK PERMIT FEE 147 .96 197.45 0.00 197.45 0. 00
BSEISMICRE VALUATION 7, 785 .00 0. 80 0.00 0. 80 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 417.23 0 . 00 417.23 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR
105 ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB & OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
307 INSULATION 308 SHEETROCK
309 EXTERIOR LATH 310 INTERIOR LATH