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07100185 CITY OF CUPERTINO " � ` �T n T BUILUING DIVIS101V PERMIT ��i�� ` ;.;.. > . ;.:<: _.. PERMIT NO. BUiLDING ADDRESS: � 1174 BUBB RD A PERF:�CT CLIMATE" 07100185 • PERMIT ISSUE DATE 1ER'S NAME: TAN NGUYEN 8375 BRENTWOOD BL SANITARY NO. CONTROL NO. PHONE: BUILDING PERMCC INFO ARCHITECT/ENGiNEER: BLDG ELECT PLUMB MECH REPLAC:? UPSTAIRS FURNACE IN 0 � � � ; o o LICENSED CONTRACTOR'S DECLARATION IOU DeSCiI]�L10❑ � V� I hcrcby afGcm tha� I am licenxd under provisions o( Cliap�cr 9(commcncing ; Z� wi�h Scction 7000) of Division 3 of thc Business and Profcssions Code. and my licensc is �< d in full Corce and eftec j � ? Liconx Class ' � L�• # • p Datc ' ` � _ ' s Conuactor : E" � ARCHITECI'S DECLA AT10N i a .� < t understand my plans shall be used as pubiic recnrdc 1yU : o y Licensed Pmfcssional OWNER-BUILDER DECLARATION j a� I hcrcby alTirm �hat 1 am cxcmpt Crom thc Coniraaors Liccnsc Law Cor Urc . p o following reason. (Sccuon 7Q31.5, Business and Profcssiuns Codc: Any ei�y or munty e° � which rcquires a permit to conswcl, altcr. im�xovc. dcmalixh. or repair any suuctwc ? Z y prior u� i�s issuancc, also rcquires thc applicant Cor such pertnit to filc a signcd summent c q , Ft. Floor Area Valuation < that hc is liccnud pursuant to thc pmvisions oC �hc Convactor's Liccnsc Law (Chaptcr 9 4 I- �(commencing wi�h Section 7000) nt Division 3 af Ihe Businccs and Prokssians Cade) or ,�, �.. ihat he is ezempt thercfrom and the buis Cor the allegcd exemption. Any violauon of Section 703I.5 by arry applicant !or a permit subjects Urc applicant to a civil penalty of ApN Number Oceupaney Type not more �han five hund�cd dollars (5500). ❑ 1, as owncr of tlx propeny, or my e�oployces with wagu u the'v sole compensauon, will do thc wurl:. and the sttucwre u not fttnded or oife[ed for sale (Sec. 7041, Basiness Required Inspections and Professions Cade: "It�e Canuacwr's License Law does not apply to an owner o( propeny who builds or improves thercon, and who does such xrork himselt ar �rougti his own employces, providcd iha� such improvements are not inlended or oRered for sak. I[, however, the buildiag or improvement is sold within one year oC compiction, tl�e owner- builder will have Uu burdan of proving �at he did �wt build or improvc tor purpose of sak.). Q t, as awner oC the propeny, am exclusively conhacting with licensed convxtars w constnut the pmject (Sec. 7044. Business and Professions Code:) The Coouxtnrs Li- ccnse Law docs not apply w an owncr of propeny who builds or improvrs ihereon, and , who conuacts Cor such pmjec�s with a conuactor(s) licensed pursuant to �he Convxtors Littnse Law. l am uempt under Sec. , B 8c P C far ihis mawn _ .+ner Daie _. . WORKER'S COMPENSATION DECLARATION I hercby afCirm under penalty of perjury anc af the fallowing declaruions ❑ t hsve and wili maintain a CertiGcam of Conscm to xlf-insure (or Workers Compen- sation, as provided for by Section 3700 of �he Labor Code. (or �he performance of Wc work for which this pertnit is issucd pg I havc and will maintain Workcr's Compensation Insunnce, u �cquircd 6y Scction , (3700 oC �hc Labor Codc, for thc perfortnance of the work for w6ich U�is permit is issued. My Worker's �C In carricr and Policy . nu ` mbcr a�c: ` Carrier��l�l:WC�v �` CERTIFlCATE OF EXEMPI70N FROM WORKERS' COMPENSATIONINSURANCE (fhis scction necd �rot 6c completcJ if the permit is fw onc hundred dollars (S I00) or IcssJ I certi(y ihas in thc performancc of Ihc work Cor which ihis permit is issucd I sha0 not employ any person in any manncr so u ta bccomc subject to the Workcrs Canpensation Laws of Calitomia. Datc Applicant NOTICE TO APPLICAM: I(, af�cr making this Certifica�c of EzcmpGon, you should become subjcct to U�e Workcr's Compcnsauon provisions of �hc Labor Codc, you muu � O forthwith comply wi�h such provisions or this permil shall bc dccmcd ccvolccd. z "" CONSfRUCI'ION LENDING AGENCY � r�-+ 1 herchy affirm ihat there is a coaswcunn Icnding agenry Cor the per(armance of . �� hc work Cur which this permit is issucd (Scc. 3097, Civ. C.) W Q Lendcr's Namc a z C.cnder's Address U � 1 ccrtify ihat t havc rcad this applieation and siatc ihat Ihc above in[o�mauun is w ►-� coRCCt. 1 agcce to comply wi�h all city and county onlinances and snte laws relating �o 0 U building conswction, and hcreby authori�e rcpresentativcs of this ciiy io cntcr upnn thc � W abovc-mcntioncd properly for inspccoon pur�wses. a (Wc) agrce to save, indcm�ify and keep harmlcss Ihe Ci�y of Cupertino against „H„� � IiabiliGes, judgments, costs and expenses which may in any way accruc against said Cry ,/ ' U z in conxqucnce oC Uie granting of this permit. Da�e 0 KJ �� ►'" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: � SOURCE REGULATIONS. Re-roofs � Signuure of ApplicanVConuactor �°� T e of R�of HAZARDOUS MATERIALS D[SCLOSURE }�P �11 thc applicant or futurc building occupant store ar handic ha•rardous matcrial icfincd by the Cupenino Municipal Codc. Chapler 9.12, and the Heal�h and SaCcty �� ,Scction25532(a)? All roofs :�hall be inspected prior to any roofing material being installed. 0 Y� � • If a roof i:� installed without first obtaining an inspection, I agree to remove wll the applicant or fuwrc Euilding occupant uae equipment or devices which cmi� harardous air con�aminants as dcfincd by the Bay Area Air Quality Managcmeni all new m�terials for inspection. Disuict? ` ❑ Ycs �io /� ! havc rcad the ha�ardcws mazcrials requircmcn�s undcr Ctwp�cr 6.95 0( thc Califor- �� ' l. � , nia Hc�lth & Safcty Cadc. Scctions 25505, 25533 anJ Z5534.1 undcrstand that if �c buildin6 �{`3 !� d i curtenily havc a tcnan4 �hat it is my rcsponsiAiliry to notify thc oceupant of ihc ' mcnuwhich ustbc � �o�w�u��,uarac�,�r,�a�ora�,w�r. Signature ofApplicant Date � C�� 6 � C All roof coverings to be Class "B" or better Owncr or authori•r.cd c �� `7 L c�c�i c�� '� CITY OF C�UPERTINO . ::.� ��n �F pERMIT APPLI�CATION FORM CUPE(�TIND APN # Date: ,� �Cj Cp U� , 0 C� /�- 2 �-o � Building Address: /.� � Y ��bd �� Owner's Name: Phone #: 3 �� e� �1� �'-- S� 73 - � 7�' Contractor: � License #: Q� �� C� R`re :� 2!/ yf' Contact: �� _ � �� Phone #:�� l 9 � ` � Applicant/Contractor: �/ ��"?% �- Gse r Fax #: c� � �� 9�- yb �ic� G.�e r �� "YY9-�6�'/ Building Permit Info: Bldg Elect Plumb Mecl� Job Description: l ' C lof�-�' /C e�! G�E2 t/ �' -� c ,'rS � /'v14'(C i �. Residential: j� Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: Valuation: � 3 �� Type of Construction: Occupancy Group: S � � Quanti Fee ID Fee Descri tion Fee Grou BAPPLOTHER Other A 1�ances MECHANICAL BBLDGFEE Bldg Permit sq. foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 10�K to SOOK Btu MECHANICAL BBOILER3 Boiler > SOOK to 1M Btu MECHANICAL BBOILER4 Boiler > 11�1 to 1.75 M Btu MECHANICAL BBOILERS Boiler > 1.''SM Btu MECHANICAL BCONSTAX Constructic n Ta}c BUILDING BCONSTAX Ind/Off/Co:nm/Quasi BUILDING BCONSTAXBQ Con. Tax fc�r BQ Zone BUILDING BCONSTAXH Hotel and T�Iotel BUILDING BCONSTAXR Constax - ltesi/Mobile BUILDING BELEC 1000 Elec 600V <= 1000A ELECTRICAL BELEC 1001 Elec 600V > l 000A ELECTRICAL BELEC200 Elec Svcs E�OOV <= 200A ELECTRICAL BENERGY Ener BUILDING BENERGYADD Ener Ad�i Multi BUILDING BINVESTIGA Investi atic►n fee BUILDING BMITIGATC Comm. Housin Mit. Fee BUILDING 1 uf 3 - CITY OF C'UPERTINO ��n °F pERMIT APPL:[CATIUN FORM � CUPf1�TIN0 uanti Fee ID Eee Descri tion Fee Grou BMITIGATR Res. Hous .n Mit Fee BUILDING BMNEWMULTI New Mult: -Famil Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bld s MECHANICAL BNEWMULTI Multifamil Res ELECTRICAL BNUCOMME New Com�n Electric ELECTRICAL BNUCOMl��IlVt New Corrvn Mechanical MECHANICAL BNUCOMMP New Com�n Plumb PLLTMBING BNUMULTI New Multi famil Res PLUMBING BNUSFD New Sin le Famil Res PLUMBING BOVERTIME Ins ection Overtime BUILDING BPBACKFLOW Ahnos he�1c Vacuum PLUMBING BPCESSPOOL Cess ool PLUMBING BPERMFEE Bld Perniit Fees BUILDING BPFIXTURE Pbl Fixti�re PLUMBING BPGAS Gas Pi in ; S stem Fee PLLJMBING BPINTERCEP Ind Waste Interce tor PLIJMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Checl: Add Multi BUILDING BPLANCKREP Plan Checl; Re eat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S ri�1clerBackflo PLUMBING BPSTORM Storm/Rai�i Water PLLTMBING BPTRAP Kitchen Tia PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InstalUAltf;r Water Pi e PLUMBING BPWHEATER Water Heater/Vent PLLTMBING BPWSVCS Main -Wate>r Service PLLTMBING BREINSPECT Reins ecti �n Fee BUILDING BREMACOVER A/C Unit =� 10,000 cfm MECHATTICAL BRE A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI A liance Install MECHAI�TICAL BREMBUSWAY Remodel Ecuswa s ELECTRICAL BREMFIXT Li htin �'ixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furn�.ce > l OK btu MECHANICAL BREMHEAT Heater Insi allation MECHANICAL � BREMINHOOD Installatior. of Hood MECHANICAL BREMMISC Misc A aratus ELECTRICAL BRENINRAPP Rem Non-:Zes A liance ELECTRICAL BREMPOLE Pole/Platfc rm Fixture ELECTRICAL 2 �f 3 � a F`� � CITY OF CUPERTINO ��n�F pERMIT APPL [CATION FORM CUPEI�TlNO Quantity Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rm�il Signs Add Branch ELECTRICAL BREMSIGNS Rem odel Signs, Marquee ELECTRICAL BREMTHEATR The:atrical Lighting Fix ELECTRICAL BREMVENFAN Ve�it Fan Sin le Duct MECHANICAL BREMVENSYS VE�ntilation S stems MECHANICAL BSCBLVD ,>cb Specific Plan BUILDING BSEISMICOM Se: smic Commercial BUILDING �' BSEISMICRE ��eismic Fee Res BUILDING BSPECIAL � pecial Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP T em orary Power ELECTRICAL BTEMPPERM Tem orar Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC �:usiness License BUILDING ELECTRIC l:lectrical s foot ELECTRICAL ' EPERMITFEE Ele c Permit Issuance ELECTRICAL MPERMFEE M echanical sq. foot MECHANICAL MPERMITFEE Me�;h Permit Issuance MECHANICAL PPERMITFEE Plu�nbin Permit Issue PLUMBING PPLBG Pliunbing Fee sq foot PLUMBING PLLONGRNGC Plannin LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin Lon Ran e Residential PLANNING 3 � �f 3 �� CITY OF CUPERTINO 6 ITEMS OF 9 PERMI'[' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl.t: Lot: APN ......... 36:?06028.00 DATE ISSUED.......: 10/26/2007 RECEIPT #.........: BS)00003086 REFERENCE ID # ...: 07L00185 SITE ADDRESS .....: 11'74 BUBB RD SUBDIVISION ....... CITY .............. CU?ERTINO IMPACT AREA ....... OWNER ............. TA:J NGUYEN ADDRESS ..........: 1174 BUBB RD CITY/STATE/ZIP ...: CU?ERTINO CA 95014 RECEIVED FROM ....: ED'aARD A GREGORY CONTR.ACTOR .......: SMLTH, BYRON E LIC # 21144 COMPANY ..........: A ?ERFECT CLIMATE ADDRESS ..........: 8375 BRENTWOOD BLVD STE B CITY/STATE/ZIP ...: BR�NTWOOD, CA 94513 ' TELEPHONE ........: (4J8)861 9545 FEE ID UNIT QUANTITY .�'IOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BREMHEAT NO OF HEATERS 1.00 7.02 0.00 7.02 0.00 BSEISMICRE VALUATION 2,399.00 0.50 0.00 0.50 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT R.ATE 1.00 4Q.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 164.75 0.00 164.75 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 258.22 MC --------------- TOTAL RECEIPT : 258.22 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL I