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BUILDING DIVISION PERMIT
BUILDING ADDRESS: A PERFECT CLIMATE PERMIT NO. 06100126
19737 PERMIT ISSUE DATE
'urNER'S NAME:
1 WHANG TSUNG C AND LAI Y 10570
NE. SAN17•ARY NO. CONTROL NO.
(408) 86119545
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect. -1
License Class C L L. 8
Date — Contractor I Ea i s;)C I I t ✓VI O1
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
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 file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(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
not more than five hundred dollars (5500).
❑ 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
and Professions Code: The Contractor's 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.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contraetoes Li-
cense Law does not apply to an owner of property who builds or improves thereon, and.
who contracts for such projects with a conlractor(s) licensed pursuant to the Contractor's
License Law.
❑ 1 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:
f] 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.
[a I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Codc, for the performance of the work for which this permit is issued.
My Worker's o pensauon Insurance carrier and Policy number aim:: L{
Cartier. / Sl e PolicyNo.: J�5 11060
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. 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
O forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
CA
(.� 4 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.)
W Q L.endces Name
Q. Lender's Address
V O 1 certify that I have read this application and state that the above information is
V. " correct. I agree to comply with all city and county ordinances and state laws relating to
0U building construction, and hereby authorise representatives of this city to enter upon the
ahovc-mentioned property for inspection purposes.
14 (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
V Z in consequence of the granting of this permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE R TIONS.
14
ij
Signature of Applicant/Contractor Date
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)7
❑ Yes .oft
Will the applicant or future building occupant use equipment or devices which
mit hazardous air contaminants rysdefined by the Bay Area Air Quality Management
District?
❑Yes 0 N
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safcty Codc, Sections 25505.25533 and 25534.1 understand that if the building
docs not urrently have a tenant, that it is my responsibility to notify the occupant of the
reqs' ns which must J29 met rior to i Vdvc of a Certificate of Occupancy.
.� i4 r .
Owner or authorized agent Date
Job Description
REPLACE FURNACE
Sq. Ft. Floor Area
Required Inspections
Issued by:
Re -roofs
Type of Roof
atlon
Occupancy Type
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better
APN #
Building Address: Oi
Owner's Name:
Contractor:
Contact:
Building Permit Info:
Job Description:
Residential
CITY OF CUPERTINO
FURNACE/AC
PERMIT APPLICATION FORM
00/
Phone:
Phone:
Elect L7
Commercial ❑
For Residential Into ations:
Attic El1 ' floor 2nd floor El
Adhere to min set back requiremer.
�5- 7 -
Plumb Lr'
P,r-0 4
Date:
/a/x
Phone #:
V�j 53- 7 3 /
License #:
7 R31 5 -9 -
Cupertino Business License #:
,2i/��i
Mech El --
For Commercial Installations:
Additional weight (structural calcs) F-1Structural
Replacement same weight ❑
Calculations required for new installation
New installation Planning Approval Required ❑
Cost of Project:
t2 Type of Construction- Occupancy
( �
group.
— S
7
9 364,ss
u
Strapped On Platform E]' Bonded
Sq.Ft. Floor
Area:
❑
New Location Replacement
Qty. if
A licabl Fee ID
Fee Description
Fee Grou
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 Pi inry System Fee
PLUMBING
BUSLIC
Business License
BUILDING