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07100036 CITY OF CUPERTINO n � , � T � ��s BUILDING DIViS10N ' �E1�1v11T �'!-�� ' , ;: ;:: ,..:.. , .. . ,;. . . — PERMiT IJO. BUILDIN ADDRESS: O 1 O O O 3 G • 21761 MEYERHOLZ CT JBK AIRf;, INC PERMTT ISSUE DATE OWNER'S NAME: . R.AY CHIANG 18450 TF;CHNOLOGY DR 1 2 7 SANITARY NO. CONTROL NO. NE: (408) 7"9-3296 BUILD[NG PERMiTINFO ARCHITECT/ENGINEER: HLD j E� PLU�MB M r EC� j p Q LICENSED CON'TRACTOR'S DECLARATION JOU DeSCflpLlOil :�� I hcrcby afGrm that I am licenscd unJcr provisians oC Chaptcr 9(cammencins � z� wi�h Sccdan 70cx1) of Division 3 of ihc Busincss and Profcssions Codc, and my Iic V st� � RE P LAC E FURNAC E �= y in fu0 foccc an d e f f r e t � 7� O � � v� Z Licensc ass (- - Lic. It p Da�c � v' Conuactor t �s! C_ : f" � ARCHITECTS DECLARATION j a Q 1 undcrstanJ my plans shall bc uscd as public recorcis JyU ' w y Liccnsed Pmfcssional • � a OWNEA-BUILDER DECLARATiON � 6� 1 hcrcby alTirm ihat 1 am cxempt Crom �hc Contrxtor's Liccnsc Law for thc p o following rcawn. (Sccrion 7031.5, Busincss and Profcssions Cafc: Any city ar coun�y <,°, �i which requires a pcnni[ to construc4 altcr. improvc. dcmolish. or repuir any stiuctu�c �" y prior w i�s istuancc, alw ccquires thc applicant for such permit to filc a signcd sn�mcm � Ft. Floor Area Valuation �_< thai he is licenscd pucwant to thc pro�isions ot u�c Convacwr's trccnsc I.aw (Cnapicr 9 q• $ S 6 7 7 ,� F- �(commcncing wi�h Scction 7000) of Division 3 of �hc Business and Profcssions Cadc) or y�.. ihat he is exempt the�cfrom and the basis for the allcgcd exempdon. Any violauon o[ ��J Number Occupancy Type Secrion 7031.5 by airy applicant for a pertnit subjccu U�e applicant �o a civil pcnaliy of not morc than fivc hundrcd dollars (5500). 3 2 6 4 8 � 3� ❑ I. as ownec o[ ttie propertY� or my employca with waga u their sole compeosation. w illdotheworkandthestcucwreisnotintendcdoroffered�orsalc(Sec. 7044 . Business Required Inspections and Professions Codc: The Conuactor's Licenu Law docs not appty w m owner of propeny who yallds or improves thercon, and wha daes such work himself or thmugd his own employces. providcd that such improvements are not imm�ded or otieced Cor sak. I[. however, lhe building or improvement is sold wi�hin one year o[ complc6on, the owrcr- builder will have the barden o[ proving �at hc did not build or improvc Cw pa�pose o[ sale.). ❑ I, as ownu of the property, am ezclusively conuacting wilh licensed contractocs to construct the p�ojett (Sec. 7044. Business and Profcssions Code:)'Ibe Cantractors Li- ccnse Law docs not spply to an ownu o( propeny who builds or improves the�eon. �nd . who contracls Cor sucA pmjects with a contractoRs) licensed pursuant to U�e Conuactu�a License Law. ❑ I am uempt undu Sec. , B 8c P C[ar �his � Owner Date _ .. -. WORKFR'S COMPENSATION DECLARATION 1 hereby a[ficm under penalty o( pe�jury onc of the following declantionx ❑ I hsve and will maintain a Cenificate of Consent to self-insme for Workets Compen- satian. as provided for by Sectian 3700 oC the Labor Code. Car �he pertormance o[ �Ix work for which Ihis pertnit is issucd. ❑ I havc and will maintain Worker's Compensation Insurancc, u reyuired by Sixtion , )700 oC the [abor Codc, for thc performance of We work far which Nis pe�mie is issued My Work Co uon Insurance eartiu and Poliry nm er are: I � p _� �� Cartier: ` /a/1�� -/�= Policy No.: �� ` CEIt1'IFtCATE OF EXEMPCION FROM WORKERS COMPENSATION INSURANCE (1'his section necd not be complcted i( the pecmit is !or anc hundred dollus (3100) , or IcssJ I cenify thas in thc perfortnancc of thc work for which this permit is issucd. I s6all not cmploy any person in any manncr so az to bccome wbject io �he Workcrs' Comprntatla� Laws of Califomia Datc Applicant NOTICE TO APPUCAM: If, aftcr making �is Ccrtifica�c of Excmpuon, you shou�d bccome subjcct to lhc Worker's Compcnsation provisions of thc Labor Codc, you must �� forthwi�h comply with such provisions or this pccmi� sha0 bc dccmcd revokcd. z � CONSfRUCTION LENDMG AGENCY F � 1 hcceby affirm �hat there is a constructinn lcnding agcncy tbr the perfarmar�cc oC - �., . ihc wurk for which �his permi� is iuucd (Scc. 3097, Civ. C.) . W Q Lendcr's Namc a � C.cnder's Address V � � cerLjY Iha� I have read this applieation and sia�c �hat the above infortnaliun is w F cortec� I agree to comQly with all ciry and county ontinantts and su�e laws celating to � U buifding conswction, and hcreby authoriie represcnutivcs of ihis ci�y to cntcr u{xin thc abovc-mcnaoncd property for inspcction purjwses. � �� (Wc) agree to save, indcmni(y and kecp harmleu ihc Cily o[ Cupertino against "�'"„+ � liabilitiu, judgmcn�s, cos�s and expcnscs which may in any way accruc againsl said City U z in consequence of granting of �his permi4 Date �Q- �-�� APPLICANT U ER DS N WILL COMPLY W1TH ALL NON-POINT Issued by SOURCE 170 . -t� Re-roofs � SignaturcofApplicam/Conuactor a � T e of R.00f HAZARDOUS MATERIALS DISCLOSURE YP �11 du applicant or futurc building accupant storc or handle ha•rardous ma�crial u defincd by the Cupenino Municipal Codc. Chaptcr 9.12, and thc Heal�h and SafctY coa� Section 25532(a)? 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 - wll thc applicant or futurc building occupant usc cyuipmcnt or dcviccs which all new rr.aterials for ins ection. emi� hvardous air contaminan�s as defincd by the Bay Arca Air Qualiry Management p District? �ya �No 1 havc rcari tlie ha�ardous matcrials requircmcn�c undcr Chapter 6.95 af tbc Cali(or- nia Hcalth & S ry Codc, Scctions 25505, 25533 and 25534.1 undcrstand that iC�hc 6u�1dio6 docs not c iIy vc a tcnant, ' is my ccspansibiliry w notify �toc occu�ant nf thc Date rcyuire wn� uu met � toissuancco[aCcrtificaicofOccupancy _ Signature ofApplicant �"'`� All roof coverings to be Class "B" or better Owncr or authorized agcnt • Datc J��n�� CITY OF (:UPERTINO �'�� FUR'V �C�:IAC CuPE�T�NO PERMIT APPLICATION FORM APN # _. Date: ��o� � � � .� � � C� c7 ��-- � -e� - 7 Building Address: j � � �� l ��O! �e � w c�� Owner's Name: /j Phone #: (�c4 � I � >`� L,/ / C/� � �p� ,S'— �--� � Vr Contractor: , License #: � � 3 �� c � -�.,� IC �t ��; ��e� Contact: Cupertino Busine s License #: e`-� �� . G� �... �, � �� Building Permit Info: Bld ❑ Elect C�� Plumb � Mech Job Description: � ( /'C.� � � C-e d'v fr-�/�i � = -2. Residential � Commercial ❑ For Residential Ins allations: Attic � 1 St floor � 2" floor � Adhere to min set back requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight (:�tructural calcs) � Structural Calculations required for new installation � New installation Planning Approval Required Cost of Projec� Type of Construc;tion: Occupancy group: s; � �� ! � � v�.- Strapped On Platform ❑ Bonded C Sq.Ft. Floor Area: New Location � Re lacement � Qty. if Applicable Fee ID Fee Description Fee Group BENERGY :Jnergy BUILDING BREMFURN Zelocation of Furnace MECHANICAL BREMACOVER �/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN �/C Units <= 10, 000 cfm MECHANICAL . BREMRECEPT Recptl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Vlech Permit Issuance MECHANICAL / PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING CITY OF CUPERTINO 6 ITEMS OF 6 PERMI'I RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN ......... 32E48035.00 DATE ISSUED.......: 10/03/2007 RECEIPT #.........: BSC00002879 REFERENCE ID # ...: 07100036 SITE ADDRESS .....: 21;61 MEYERHOLZ CT SUBDIVISION ....... CITY .............. CUF'ERTINO IMPACT AREA ....... OWNER ............. RA�' CHIANG ADDRESS ..........: 21"'61 MEYERHOLTZ CT CITY/STATE/ZIP ...: CUI'ERTINO CA, 95014 RECEIVED FROM ....: JBI: AIRE INC CONTRACTOR .......: GEF;ALD E. KERR LIC # 29160 COMPANY ..........: JBI: AIRE, INC ADDRESS ..........: 18�650 TECHNOLOGY DR CITY/STATE/ZIP ...: MOI:GAN HILL, CA 95037 TELEPHONE ........: (4l)8) 779 FEE ID UNIT QUANTITY i�MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -�--------- ---------- ---------- ------- BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BREMFURN NO UNIT 1.00 14:31 0.00 14.31 0.00 BSEISMICRE VALUATION 5,677.00 " 0.60 0.00 0.60 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 172.14 0.00 172.14 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 172.14 #1218 --------------- TOTAL RECEIPT : 172.14 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL