06100058 CITY 017CUPERTINO
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BUILD,NG DIVISION PERMIT
PERMIT NO.
DRESS: QUAN S ELECTRICAL 06100058
POPPY WY - PERMIT ISSUE DATE
E:
LY CHANG 10628 RANr)y TN i /in,/?nnr,
SANITARY NO. CONTROL NO.
NE:
(408) 366-1823 BUILDING PERMIT.INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
Cd Z LARATION
00 LI NTRACTOR'S DEC Job Description
U F- I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z UW with Section 7000)of Division 3 of the Business and Professions Code,and my license is
< in full force and effe,;L 2"0�2 REPLACE FURNACE AND CRAWL SPACE AIR DUCTS
License Class L
;;:,o Date t-onLrictor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
rJ
U.l'- Licensed Professional
0 W
OWNER-BUILDER DECLARATION
from the Contractoes License Law for the
I hereby affirm that I am exempt
0 following reason.(Section 703 1.5.Business and Professions Code:Any city or county
$3800
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 rile a signed statement Valuation
that he is licensed pursuant to the provisions 0 s License Law(Chapter 9 Sq.Ft.Floor Area
f the Contractor
EEC
;�- (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 any applicant for a permit subjects the applicant to a civil penalty of 00 Occupancy Type
not more than five hundred dollars(M).
C1 1,as owner of the property,or my employees with wages as their solc compensation,
will do the work.and the structure is not intended or offered for side(Sec.7044,Business Required Inspections
and Professions Code:The contractoes 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 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.).
C3 1.as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Conu=tor's Li-
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.
1-1 1 am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty or perjury one of the following declarations:
n I have and will maintain a Certificate of Consent to self-insure for Workces 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 Workees Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workces c2Epeopa. I . and Policy numtrer am:
Carrier- �5T^yt-7—'oft 7OC7 C Policy No.:_L,6T_2-z_'
CERTIFIC N FROM WORKERS'
COMPENSATION INSURANCE
(Tbis section need not be completed ifthe permit is foronc hundred dollars($100)
or less.)
I cenify 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 previsions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
C)
z. CONSTRUCTION LENDING AGENCY
1 hereby affirm that them is a construction lending agency for the performance of
the work for which this permit is issued(Sec.3097,Civ.C.)
Lendces Name
(5. Lendees Address
::)z
U 0 1 certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws rclating to
building construction,and hereby authorize representatives of this city to enter upon the
above-mcntioncd property for inspection purposes.
>4 (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 UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. Re-roofs
Signature of Applicant/ConLractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupanLstorc 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.
E]Yes If a roof is 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 as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
E3 Yes
I have read the hazardous materials requirements under Chapter 6.95 of the Cafifor-
nia Health&SafctyCodc,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a Icnant,that it is my responsibility to notify the occupant of the
require hi h t prior to issuance of a Certificate of Occu Signature of Applicant Date
MM71c me i 0,� All roof coverings to be Class"B"or better
Owner or authorized agent Uatc, I
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . 36619043 . 00
DATE ISSUED. . . . . . . 10/10/2006
RECEIPT # . . . . . . . . . 36364
REFERENCE ID # . . . 06100058
SITE ADDRESS . . . . . 1272 POPPY WY
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : EMILY CHANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . :
RECEIVED FROM . . . . : QUANS ELECTRICAL
CONTRACTOR . . . . . . . : HIEN Q TRUONG LIC # 23332
COMPANY . . . . . . . . . . : QUAN' S ELECTRICAL
ADDRESS . . . . . . . . . . : 10628 RANDY LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 366-1823
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- - ----- - -- - --------- - ---------- ---------- ---------- ---------- ----------
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
BSEISMICRE VALUATION 3 , 800 . 00 0 . 50 0 . 00 0 . 50 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 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 164 . 78 0 . 00 164 . 78 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
-- - - -- --- ---- ---- -- ---------- ------------------
OTHER 164 . 78 VISA
TOTAL RECEIPT 164 . 78
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
Comm Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
*-,UPEkT1N0
Builldin Die artment
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JOB ADDRESS: PERMIT #.,
PHONE #
OWNER'S NAME:
GENERAL CONTRACTOR: 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
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
/ ,7 11
-4�
Owner/Contractor Signature Date
CITY OF CUPERTINO OLM 009DO
11 acir FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
01--c / ob.o 0,6'
Building Address: qA-V/ 6/-
/ k ? �2-
Owner's Name: Phone#:
'E Nf-
Contractor: Phone: License
O?E�� 0 �6
Contact: Phone: C ertino Business License#:
Y-0 7) ob��t
Building Permit Info:
Bldg El Elect Plumb Mech
Job Description: 6z Ck�
Residential Commercial
For Residential Installations:
Attic El I" floor El 2"d floor 0
Adhere to min set back requirement El
For Commercial Installations:
Replacement same weight E) Additional weight (structural calcs) El
Structural Calculations required for new installation El
New installation Planning Approval Required E]
Cost of Project: �Ij Type of Construction: Occupancy,group:
J
Strapped On Platform El Bonded El Sq.Ft. Floor Area:
New Location El R�placement 0-1
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 —
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