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07050231 CITY OF CUPERTINO BUILDING DIVISION PERMITINF ORTION BUIL I DRES PERMIT NO. RNNINGTON LA A PERFECT CLIMATE 07050231 OWNER'S NAME: PERMIT ISSUE DATE TSIANG JERRY H TRUSTEE & ET 10570 S DEANZA BLVD 05/22/2007 A:T (408) 86:_19545 SANITARY NO. CONTROL NO. ABUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH a 0 0 0 i p Q LICENSED CONTRACTOR'S DECLARATION Job Description v E 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing _ :Z w with Section 7000)of Division 3 of the Business and Professions Code, nd my license is ADD A/C 3 TON 13 SEER y in full force and sff ? License Class t-w Date Contractor A CHrPEcrs DECLARATIO i a< 1 understand my plans shall he used as public records 5,u U.l- Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p o following reason.(Section 703 1.5,Business and Professions Code:Any city or county < which requires a permit to construct,alter,improve,demolish,or repair any structure °Z} prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation - < that he is licensed pursuant to the provisions of the Contractor's Incense Law(Chapter 9 ;>q.Ft.Floor Area $5245 C l-- (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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 2 0 3 02.3 �Number Occupancy Type not more than five hundred dollars($500). ❑1,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 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 Contractors Li- cerise Law does not apply to an owner of property who builds or improves themcat.and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractors 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. ❑I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Work s Uo Insurance carrier ipd Policy number c: Carrier. No.: �Q CERTIFICATE OF EXEMPTION FROM WOR)MRS' 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z"" CONSTRUCTION LENDING AGENCY Er rte- I hereby affirm that there is a construction lending agency for the performance of a> the work for which this permit is issued(Sec.3097,Civ.C.) Wei.Q Lender's Name Z Lender's Address U 0 1 certify that 1 have read this application and state that the above information is V. t" correct.I agree to comply with all city and county ordinances and state laws relating to (] U building construction,and hereby authorize representatives of this city to enter upon the a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rn liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. 2 �G APPLICANT UNDERSTANDS AND WIL COMPLY WITH ALL NON-POINT Issued by: Date J, ? SOURCE REGULATIONS. Re-roofs Signature o Applicant/Con for Dare Type of Roof ti 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:ihall be inspected prior to any roofing material being installed. ❑Yes If a roof i: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 contaminants rued by the Bay Area Air Quality Management all new m 3terials for inspection. District? ❑Yes u I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 75505,25533 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 It must bemet ' rtoissu ° Ikate Signature of Applicant Date All roof coverings to be Class"B"or better Owner or authorized agcilltJDatc CITY OF CUPERTINO 7 ITEMS OF 22 PERMIT RECEIPT OPERATOR: kiersaw r COPY # 1 Sec : Twp: Rng: Sub: Blk : Lot: APN . . . . . . . . : 36203028 . 00 DATE ISSUED. . . . . . . : 05/22/2007 RECEIPT #. . . . . . . . . : BSC00001432 REFERENCE ID # . . . : 07C50231 SITE ADDRESS . . . . . : 1038 PENNINGTON LA SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER TSIANG JERRY H TRUSTEE & ET AL ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4930 RECEIVED FROM . . . . : A PERFECT CLIMATE CONTRACTOR . . . . . . . : SMITH, BYRON E LIC # 21144 COMPANY A PERFECT CLIMATE ADDRESS 10E70 S DEANZA BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE (4C8) 86119545 1 FEE ID UNIT QUANTITY 714OUNT 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 BREMRECEPT NO. OUTLETS 1 . 00 1 .20 0 . 00 1.20 0 . 00 BSEISMICRE VALUATION 4, 995 . 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 161 . 93 0 . 00 161 . 93 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 500 .60 30713 --------------- TOTAL RECEIPT 500 . 60 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -,UPEkTINO Building Department JOB ADDRESS: c CDs PERMIT #0 3-D OWNER'S NAME:` Iv ` i N PHONE # GENERAL CONTRACTOR: FAX# I am not using any subcontractors: K Sijiature Date Please check applicable subcontractors and complete the following 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/Co4dracior Signature Date