05050047 CITY OF CUPEwrINO == - '--- ---- - -
BUILDING DIVISION PERMIT � CONTRACTOR INFORMATION:
BUILDING ADDRESS:
COLD CRAFT INCh PERMIT N X5050047
h nnr r ATIRTANTA All _—- -__ _.. .. _ .__ .. —
IOWNER'S NAME. PERMIT ISSUE DATE
PAULA OUTNTF. NO l.£,F,n T)RT,L_ AVR _. _ .. ___0s /�nQ //?nn5,
ONE: SANITARY NO, CONTROL NO.
(408) 374-7242 _._. _.,_._ .—, _. _
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
top
LICENSED I am underSDECLARATION
F 1 hereby.Rpm that 1 am httrtu0 under pmvhsmns of Chapter Y(commencing Job Description
iW with Secdon T011u7 of Division 3af rite BUSinexsanO Professions Code.and myli<ensc rs
<p. moN(area and effect
ti DUCT FOR FLUE/AIR PLENUM FILTER
Z C
Dow Can
_rg on
License DECLARATION �I p
ARCHITECTS DECLARATION fJp II L D
-r I understand my plans shall be used u public records (�pMtlMH trrp�l�
]yU tl
O t; Licensed Professional
9 OWNER-BUILDER DECLARATION
4 i
1 thereby affirm No t 1 em exempt from Nc Conlnll e,License Law for the S n
00 following mason Section 7031 5,Business and Pmfcssmns Code Any city or county •E��oOC
x$ which requires a permit to construct,elan.improve,demolish,or repair any structure
prior to is issuance.also acquires the applicant for such Permit o Blc a signed statement �1
< that M is licensed pursuant to Or provisions of the Contractors Liccnm,Law(Chapar9 Sq.Ft.Floor Area Valuation
yIre-$ (commencing with Section ARID)M Division 3 of the Busmen and Professions Cadc)or higglik
ENE that he is exempt Ncmfmm and the bass fm IM alleged ascription.Any vmlation of N MY Altair,
Sccdon 70315 by any applicant for a permit subjects the applicant to a civil penalty of 3 2AP OM-BrOPO 0 upaney Type
not mare than raw hundred dollars($500).
❑I,a owner oftM prepony,or my employee with wages as their sole compensation, - h
wdldo the work.and the structure is not intended or ofkpd fors.$.(See.7061,Business
and Pmfessons Code:The Contractor's License Law does not apply to an owner of Required Inspections
pmpemy who buildsor improves;Ncren,and whodoessuch work Mmmlf of through his
Own employees,provided Nat such improvements arc not ntended orolkred for sale,if,
however,the thriding or hmpmvem na a to wathm one year of compl.d.m.the owner"
Wilder will have the burden of proving that he did not Wild or improve for purpose of
sale.).
❑1.as owner of the property,am esclusively contracting with licensed contractors to
Construct the project(Sec.7044,Business and Professions Code)The Contractor's Li
eme taw dons not apply in an owns of property who Wilds or improves Outman,Anil
who contracts for such Patricia with a eontracter(s)Iiansed pursuant to IM Contractors
License law.
I am exempt under Sec ,B&PC for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby AfRrm under penalty of pequry ant of air fallowing declarations:
v� I ham and will maintain a CemReaa of Consentt to ae$f-imme for Wmkets Contrail-
morn,as provided for by Section 3700 of Ne labor Code,for the performance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Instuancc.as regmred by Section
37M of the Labor Code,for the performance of the work for which this permit is issued
My Workers Compensation Inmpntt cantor and Policy mark,are.
Came,: Polity No
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu aecunn need not becomphaid if the loan u foram hundred dollars(SIM)
or
tax.)
1 ccmfv that in the performance of the work for which this permn hs h ssu.d.l shall not
employanyperson in anyp as�O become sublet to the Workers'Compcmauon
Laws of Califarni rim,
Applicant 4' Q• T• ^-
NOTICE TO A LICANT:IL alter making this Cemfc le of Exemption,you should
become subjem to the Worker's Compensation provisions of the tabor Code,you must
.,2 fmhwnh comply with such provisions or this Permit shall W deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
Fw Ihereby AT=that there is a construction lending agency for the performance of
C. Ne work fur which Nrs permit is issued(Sce.3091,Co,C I
tgl Q Lcndcr's Nam-
0. z lender's Adds•
U Q 1 comfy that I have read Nis applaenam and sate that the above automation is
F' correct 1 agree in comply with all city and county ordinances and state laws plating to
building construction,and hereby authanw representatives of Nu City to enter upon do
Wshow mentioned property(a,inspection puTOSes.
(-' C (We)agree to save.indcmmfy and keep harmless 0<City of Cupertino against
to liabilities,judgments.costs and expcnees which may in any way seem,against said City
U Z at consequence of the granting of this Permit
'-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGyy�ATIONS Q
_,D, ,&I ✓w.�q s ��09 D S Re-roofs
Signature of ApplicanuiContsacar Data Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding occupant store or tortilla hazardous maanal
At defined by tM Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code.Scotian 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes p Nu
Will the applicant or(.lot.budding occupant use equipment or dcvmes which If a roof is installed without first obtaining an inspection,I agree to remove
n ha,sm out air contaminants m Jcfncd by Or Bay Area An(]oalny Managcmcm all new materials for inspection.
Drsmn7
❑Yes vSrl Nu
1 haveoral the heard/susm.a6.1eregoirerecntsunder Chapar695o(thc Caldor
ma Health&Safety Cod,.Seam x 2 8)5.25533 end 25534 I undersand lhatif the Wdthng
does not currently ham a ananL Nat it it my resp ins bday to nosily the meupani of Nc
pyui¢mcn mehmtrvbe mprioraippNttaracemhnaara. Signature of Applicant Date
- r- .?.� All roof coverings to be Class"B"or better
Owner or amhmiie agent Doc
Sit,- CITY OF CUPERT INO S Oj b v �4
FURNACE/AC
E `aUPRINO
PERMIT APPLICATION FORM
/ Date:
IAPN # 3 Z° p- � OS109 / 0-5
Building Address: 10 Ofo5 4Ch( QYI.Q ,. , n i
e O ,�b 1 q�
Owner's Name: Phone #:
Prt-u�l, Ou j`n+er n o (f R) Q S 1 , /
Contractor: Phone: E6 ense #:
Cold (2 M4-�t D8).�7Li -7x9J b3i837
Contact: 'hone: Cupertino Business License#:
"cAae-) Mfl`rl (rr(� P�
Building Permit Info: 1
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description: PC-k n4 ae a i'n s-i all y le n c m a i, d dLd For P" r J re-4-urn a67
Ftilir <caj;ea,, d rnS 0JJ ve,furn 0irVl&huvr
Residential Commercial ❑
For Residential In tallations: 1
ttic El 15` floor 2"d floor❑
adhere to min set back requirement❑
or Commercial Installations:
Replacement same weight ❑ Additional weight (structural El ctural calcs)
Structural Calculations required for new installation
New installation Planning Approval Required ❑
Cost of Prot: Type of Construction: Occupancy group:
jec
A jJ,! `
Strapped 0 On Platform Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. if
Applicable Fee ID Fee Description Fee Group
f BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL 1
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL 1
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL 1
BREMRECEPT Recptl, Switch & Outlets ELECTRICAL
/ BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL 1
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING 1
BPERMFEE Bldg Permit Fees BUILDING 1
BPLANCHK Plan Check Fee i l ` O BUILDING 1
BUSLIC Business License ��V BUILDING
-1$ 7j �b,