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- CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
ONT,RACTOR
BUILDINGADDRESS:
AMADOR OAK 97
SCHAUMANN AIR CONDITIONING
PERMITND05050040
OWNER'S NAME:
NA
PERMIT ISSUE DATE
ONE:
-
SANITARY V05. OL NO.
ARCHITEC iENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
LICENSED CONnRd
Job Descri tlo
took, provisions of CON
I hereby affirm that I am licensed under of Chapter 9 (rommense
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dPrle is
with Section 7gkq Of Division 3 of the Business sand Pmfcssiun<Cndc, and my license is
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� ED
in full force and effect
Lieenam Cl... Liz. g
REPLACE FURNACE & ADD A/C
Dale Contractor
ARCHITECTS DECLARATION
1 undersund my shall he used a rcmrds
_ 4
plans public
/ 2005
pp
Licensed Penfeamor l
OWNER -BUILDER DECLARATION
ATIO
L ATIOlor's
1 hcrchy affirm Out 1 ore exempt from License Lew fur the
I LDINLOF
remain. azn. (Section 7031.5. Business and Professions Code: Any city or county
which requires a immix no eonsuom. alter, improv, dermilruch. or repair any structure
prior m its issuance, also mquims the applicant for such Monitor rile a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
mommmtcing with Section 7") of Division 3 of On Business and Promaeions Codc) or
Nat he u exempt therefrom and the bests for On alcgc l exemption. Any violation of
3 q�erp p
Occupancy Type
Schon 7031.5 by any applicant for a permit subjeeu On applicant to a ovil Penalty of
not mom than five hundred dollars (5500).
❑ 1, an Owner of the property, Or my employees with wages a their able compensation.
Required Inspections
will do the work and me acture is not intended Or Offered for sa4 (Sm. 7044, Business
and Professions Code: The Contractor's Limve law tiara not Apply m en owner of
pabpiny who builds crimprows thereon, and who doessuch work himself oribrough his
Own employees, provided mm such improvements arc not intended or OlTefrd for ale. If.
however, the building or improvement is sold within One yar of completion. the Owner -
builder will have the burden of proving that he did vel build Or improw for purpose of
salt.).
❑ h as owner of the propeny, am exclusively contracting with licensed contractors to
construct me protect (Sec. 544, Business and Professions Com) The Comrmms's Li-
mean law does not apply in an owner of property who builds or improves thereon. and
who comment for such pmjecss with a conmemr(s) licensed pursuant in the Conmclor's
License Law.
❑tom ex e lander Sec. B k P C for thin mazon
Owner CLUQ Date 7
WORKER'S C01 NSATIO DECLARATION
1 hereby trillion under Mnaty Of Pelphy One of the following declarations:
I haw and will maintain a Ccrtifau of Conant to alf-insure for Worker's Commit.
ation, an provided for by Section 37W of the Labor Code, for Ne performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Comperuatimn Insurance, az required by Section
3700 of dre Labor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation Insurancn aricr and Policy number art:
/--
Carrier:�ftie,.e'ao{ C;Le Policy No.:/ F! qS 2VY '
CERTIFICATE OF EKEMPnON FROM WORKERS'
COMPENSATION INSURANCE
PITH section need not he completed if the Permit Is for one hundred dollsrs (51(X1)
or less.)
1 cenify that in the performance of thc work for which this Mrmil'u issued, I shall not
employ any person in any manncrso is to Income subjmCt to me Worker3 L'ompmrsomen
Laws Of California. Date
Applicant
NOTICE TO APPLICANT: IL after making this Cenifcatc of Exemption, you should
become subject in Ne Waher's Compensation previsions Of the Iabnr Code, you mus
forthwith comply with such provisions or Nis permit troll be deemed rewkmd.
CONSTRUCTION LENDING AGENCY
1 hereby Mo. Nat mere is a coosutretion tending agency for the performance of
tic work for which this hermit is issued (Sec. 301 Civ. C.)
L i ndm's Name
Lender's Address
1 certify that 1 have mad Nis application and sure Nn the above information is
'
cornet I agree to comply with all city and county ordinances and sum laws relating to
building convection, and hereby authorize mpresenutives of this city to enter upon the
above'llmmiond plurality (Or impletion Purposes.
(We) agree to ave, indemnify and keep harmless the City of Cupcnuo against
liabilities, judgments, costs and expenses which may in any way secret against aid City
in consequence Of the granting of this hermit. .
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:S Date
SOUJtCfi REGULAnO�qjS.
Re -roofs
Type of Roof
()eA&, �J a«
S,, nammol'ApplicamiContraii,ar Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or fuwrc building occupant Hare m handle hvsrdon matetla
as def nod by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
vent. semaen zss3no?
❑rex No
All roofs shall be inspected prior to an roofing material beim
P P Y g g installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will Ne applicant or future building occupant use equipment or devices which
it barardmus air conuminanu as defined by me Bay Arca Air Quality Management
all new materials for inspection.
D3oia?
❑Yes Nu
1 have read me hazardous materials requirements under Chapter6.95 of me Califor
ria Health A,. Safety Cedc. Smuon 25515, 25533 and 25534.1 undersund thmif the building
dmx no`euremly haves a nant mat it u my respoiisihility m nouly the=upmt or the
rcuvinc, cess which mot mol In missuasme Ofa Cerdfcateof Occupancy.
S ignature of Applicant Date
All roof coverings to be Class "B" or better
Owner
or auudioon" agent 'atm
r - Community Development
'R 10300 Torre Avenue
( Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
�UPEt�TINO
Building Department
JOB ADD
6f 3
ESS:0 n
ec Q (
PERMIT #
00o ( o
OWNER'SNAME: ()M
RO'(
PHONE# 21d23 252- 7Y75 -
GENERAL CONTRACTOR: q 1,1 v1
FAX #
I am not using any subcontractors: klaeeeze�i
Signa re Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
Date
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
Owner/ Contractor Signature
Date
CIN OF
UPERTINO
CITY OF CUPERTINO
FURNACE/AC
PERMIT APPLICATION FORM
APN#�' 34 Z —32
BENERGY
Date: 519/05
Building Address:
Owner's Name:0 v '� A �1'
7
BREMFURN
Ph 4! "2 - 71/7 S
Contractor: Phone:
License #:
Contac hone:
MECHANICAL
Cupertino Business License #:
BRENIAIItHAN
A/C Units <= 10, 000 cfm
MECHANICAL
Building Permit Info:
BREMRECEPT
,f
ELECTRICAL
Bldg 11 Elect LJ Plumb ❑
Mech
Job Descrip' n:
e i/C
/
accl�/ °L
Residential CoWunercial ❑
BSEISMICOM
For Residential ]Installations:
BUILIDNG
Attic ❑ 1s ` floor M 2"d floor ❑
EPERMITFEE
dhere to min set back requirement ❑
ELECTRICAL
or Commercial Installations:
MPERMTfFEE
Replacement same weight ❑ Additional weight (structural calcs) ❑
MECHANICAL
Structural Calculations required for new installation ❑
PPERMITFEE
New installation Planning Approval Required ❑
PLUMBING
Costo f Project: Type of Construction:
Occupancy group:
Strapped ❑ On Platform ❑ Bonded ❑
Sq.Ft. Floor Area:
❑ Lh
BPLANCHK
New Location Replacement
BUILDING
Qty. if
AoDlicable
Fee ID
Fee Description
Fee Group
P7 JJ 1 17
BENERGY
Energy
BUILDING
BREMFURN
Relocation of Furnace
MECHANICAL
BREMACOVER
A/C Unit > 10,000 cfm
MECHANICAL
/
BRENIAIItHAN
A/C Units <= 10, 000 cfm
MECHANICAL
BREMRECEPT
Rec tl, Switch & Outlets
ELECTRICAL
/
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILIDNG
/
EPERMITFEE
Elec Permit Issuance
ELECTRICAL
/
MPERMTfFEE
Mech Permit Issuance
MECHANICAL
/
PPERMITFEE
Plumbing Permit Issue
PLUMBING
BPERMFEE
Bldg Permit Fees
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business Licens
BUILDING
— A -
P7 JJ 1 17