06100217 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �+ d�NTRACTflR I (�IIAtTI�r1
BUILDING ADDRESS: CONDITIONED AIR PERMIT NO-06100217
7 PERMIT ISSUE DATE
OWNER's NAME:
YONG TIAN 1701 LITTLE ORC14ARD ST 10'131/2006
SANITARY NO. CONTROL NO.
NE:
(408) 291-2220
ARCHiTECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p p LICENSED CONTRACTOR'S DECLARATION Job Description
V f hereby affirm that I am licensed under provisions of Chapter 9(commencing
Zwith Sccdon 70(X0)of Division 3 of the Business and Professions Code,and my license is
=y in full force and effect. REMOVE AND REPLACE FURNACE AND ADD A/C
? License Class Lic.#
:Fp Date Contractor
t
uJ ARCHITECTS DECLARATION
C< 1 understand my plans shall be used as public records
ryU
'
U.r- Licensed Professional
:0W OWNER-BUILDER DECLARATION
I herebyaITtrm that 1 am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county 4 5 0 0
��, which requires a permit to construct,alter,improve,demolish,or repair any structure
r Z y 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 License Law(Chapter 9 Sq.Ft. Floor Area
p (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of p 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 docs 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.).
❑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.
❑1 am exempt undzi Se. B&P C for this reason
—. v 3 G►
Owner % Date
ORKER'S COMPENSATION DECLARATION I
I hereby affirm under penalty of perjury one of the following declarations:
J 1 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 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. Policy No.:
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 certifv that in the performance of the work for which this permit is issued.1 shall not
employ any person in any manner so o yE¢9rpc jtlbct to the Workers'Compensation
foroi
Laws of CaliD T—I�
Applicant
NOTICE TO A—POCANT:If,after 'ng 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
[~-t 1z 1 hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
WW0 Lender's Name
0 Lender's Address
U 0 1 certify that I have read this application and state that the above information is
V.1-4 correct.I agree to comply with all city and county ordinances and state laws relating to
OU building construction,and hereby authorize representatives of this city to cater upon the
W above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
,..q to 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: � 3�
SOURQ TIONS.
- A Re-roofs
Sig re of ApplicanUContractor Date
HAZARDOUS MATERIALS 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
Coote,Section 25532(a)?
[:1 Ya No
All roofs shall be inspected prior to any roofing material being installed.
'�
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes -0 No
1 have read the hazardous materials requirements under Chapter6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs not current) have a tenant that it is my responsibility to notify the occupant of the
rcgai must x mel prior to issuance of a Certificate o(ocLpanrZ Signature of Applicant Date
0 { All roof coverings to be Class"B"or better
Owner or authorized agent Date
CITY OF CUPERTINO
r
'm 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36934043 . 00
DATE ISSUED. . . . . . . : 10/31/2006
RECEIPT # . . . . . . . . . : 36617
REFERENCE ID # . . . : 06100217
SITE ADDRESS . . . . . : 10700 LA RODA DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . . YONG TIAN
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : YONG TIAN
CONTRACTOR . . . . . . . : RICHARD READ LIC # 22334
COMPANY . . . . . . . . . . : CONDITIONED AIR
ADDRESS . . . . . . . . . . : 1701 LITTLE ORCHARD ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 291-2220
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - - - - - - -- - - -- - - ---- - -- - ---------- --------- - ------- --- ---------- ----- -- -- -
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
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 4 , 500 . 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
- ----- ---- - ------- -- ---------- --- -------
TOTAL PERMIT 176 . 24 0 . 00 176 . 24 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- - - - --- - - - --- - --- --- --------- - ---- ----- --------
OTHER 176 . 24 VISA
TOTAL RECEIPT 176 . 24
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
CITY OF CUPERTINO ()C)21-1
FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
.G- 34 - X43
Building Address:
PO c3 c
wner's Name: Phone#:
C93q-
rt-t-IC-7ts
ractor: - Phone: License#-
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X12 L L� / a�'
Contact: Phone: Cupertino Business License#:
9aa
Building Permit nfo:
Bldg ❑ Elect Plumb [2" Mech
Job Description:
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1St floor ❑ 2nd floor❑
Adhere to min set back requirement ff"'
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
C ,st of Project. Type of Construction: Occupancy group:
L Z D
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement E
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfin MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfin MECHANICAL
BREMRECEPT Recptl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
r PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING