03060046 CITY OF CUPERTINO •,tib"+' +`" w '��" "' -
_ BUILDING DIVISION PERMIT �CUNT9""TUR INI?URMATION .,
BUILDING ADDRESS: PERMIT NO.
AAA FURNACE & AIR CONDITIONING 03060046
R M PERMIT ISSUE DATE
1712 STONE AVE 06/05/2003
(408) 293-4717 SANITARY N0. CONTROL N0.
ARCHI'IE MNGINBRR: BUILDING PERMIT INFO
SLDO ELECT PLUMB MECH
I�
.86 LICENSED CONTRACTOR'S DECLARATION Job Description
1 I hereby AM.Net 1 We lianxd under provisions of Chapter 9(....,King
r� With Section 7000.1'Division 3.1'dm Buurem.11 Proferalnm Code,and my license is FW
6•A D ISO
in lull farce and eff n �� , u Uro^^77 N'�ss.4.e 1 m 14rJ
License Cl ee Lic.N ADD 42 , 000 BTU AIR CONDITIONER
ARCH1Dsu TSDECL
QQ plane
ON JUL 8 0 2003
1 underwnd my Piero Thal be used u public records ,
J
e Licomed Professional
5� OWNER-BUILDER DECLARATION BUILDING
�F
I heady affirm that 1am 1. ,Busi from the Cantrmtms License LAWCity
a for the
Sgi D fallowing wan.(Section IIDIS,Bmtness and o mfessiou Cade:Any city or manly
5$ which its iso•Paan re tones ft roar.Wpmve,demolish permit t fi repur ed tu0care
�^
prior miuip also tle aisionsof far sochpermitmfikaeLAW(Chamrnt
ggggbFo
(commencing
that bee comae licensedwithSection70th)ofDisision3 rtheSusumuhe sndProelsw(Chapur9 Sq.Ft.Floor Area $4��t6[ion
d$ (cmnmene atempth Section TBddth bash n3 or alleged
exemption.
Anynvi Cade)or
distio 7 eaempl thewfeem
Appli and the bash fit We alleged eeempdm.Any it Penalty
of
not a than by hundred
fm•aanll sobjmu tc appliunt m a civil penally of Occupancy Type
not mare than raw hurarea adnm(sero). 3 2`�W6�e6 0
❑I'm owner of the property mmy employees wit"gas"their sole compensation,
will do the work end the)mumu ,B not inmaded or offered Battle(See. Business 303 - ROUGH ISJf�hl���l�lOnS
and professions Code:The Convector's Lloeue Law does not apply m an owner Of
property who Wilds or improves deman.erd who does such work himself or Waugh his 304 - ROUGH ELECTRICAL
own employees.provided that Inch improvements ase not intended moaered fmsalc it, SOS — FINAL ELECTRICAL
however,the Wilding or improvement is mid Within one you of completion,tne
o owr-
builderwillhaveteWrdcnof proving than M did am Wild or Improve fm purpose of 508 — FINAL MECHANICAL
salej.
❑I.As owner of the property am nelumvely comosming with licensed contracon to
comtmm tie preject(See.,Dad.Business and prediction.Code:)The Cmmoh
mLi-
..LAW dens not Apply man use.of property who Wilds or improve,theuon.And,
who contacts for ouch prejeets wit a con scar(s)licensed pursuant m the Controann's
License Law.
❑I me uemp,under Sec .B&PC fm this won
Owen Dau
WORKERS COMPENSATION DECLARATION
I hereby effirn under penalty of perjury one of the following daluatbv:
I haw and Will maintain a Cerafuna of Cement to Ulf-btsure fm Workm`ACompen-
�- sation.u provided fm by Section 37M of de tabor Code.fm the performance of de
wart for which Ws permit is issued.
I hew and will maintain Workers Compensation Insurance,sa inquired by Section
of the Labor Code,for the performance of the work for which this permit it Issued.
My Worker"Compensatia muanct arner And Policy rumba,w:
curter: Q U Policy No. DY
RTIFlCATEO-EXEMPTION FRO 0 KERS
COMPENSATION INSURANCE
(Thhmmim need not heaompleud Iffire permit 11 faro.hundred dollars($100)
mdse)
1 certify that in the perfmmance of the work far Which this permit is issued,I"I not
employ any person In any muancrm as to become aubjmt to the Wohca'Onepeoudon
Laws of California.Dem
Applicant
NOTICETO APPLICANT:If,afar making ibis Certificate of Emmption.you should
become subject to the Workv's Compemation Provisions of the LAW Cade,you man
0z forthwith comply with such provisions or this permit AMR W dmmW revoked.
yCONSTRUCTION LENDING AGENCY
Ew Thereby African that then is a construction lending agency for the perfarmence of -
a 9 the Warts for which mu Pont,is issoed(Sm.3097.Civ.C.)
Wh 0 Lender'Name
7 Z Lander's Add.
V Q I malty that I hew read this application and mm that the above Inrormadon is
Uwcaned.I agree m comply With all city and county ordinances and mu laws mining in
C building convection,and hereby autorin mprnerutim or this city to cater upon tM
W show-mentiomd property for tui ection purp0mL
(We)agree in saw,indemnify am keep harmless the City of Cupertino.&AWA
In liabilidn,judgmenu,emu and expemes which may in anyway amu)Against aid City
V in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9102� Date
SCE REGULATIONS.
OJyR
J /] //lL----- �d � Re-roofs
dignatum of pplicano ntrmtor uAm
HAZARDOUSMATERIAISDISCLOSURE Type of Roof
Wit)the epplicanl or future building occupant mom or handle hanNous material
As derimd by de Cupertino Municipal Code,Chapter 9.11.end the Health and Safety
Cade,Scotian 255320)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
Will the applicant o fmure building occupem use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
alt hasardous air contaminants a dented by the Bey Area Air Quality Management all new materials for inspection.
Dimrie,7
Oyu rye/u�o
I hew read de hemdmhmamrlalsrequitemenu under Chapvs6.9Sof due clifor.
nice Health&SafclyCode,Smbom25M5,25533md25531.lundm mdlhulfW building '
does not currently hew a annual.that It is my respomiblllty in notify d o occupant of W
aqui entswhichmuuthe met poor toIssuance at&CorinalcofOccupancy. Signature of Applicant Date
Owner or outhorivsd Agent'
DoleAll roof coverings to be Class"B"or better
CITY OF CUPERTINO (�
FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN # �4/_ z� _ D� Date:
pG_o3_ 0 ,7
Building Address:
%D 7d,(� /!1 uLET /O ACE"
Owner's Name: Phone#:
D e lt4e 3 - 9 sc
Contractor: Phone: License#:
o A f/a c c o -d i- /7 76eee ll
Contact: Phone: Cupertino Business License#:
44.4,b 0
Building Permit Info:
Bldg ❑ Elect Plumb Mech
Job Description:
Residential Commercial ❑
For Re idential Inga llations:
Attic " I" floor 0 2"d floor❑
• Adhere to min set back requirement[]
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation
Ne 'nstallation lannin Approval Required ❑
ost of Project Type of Cons ion• / Occup c rout:
d a I
Strapped ^On Platform ❑ Bonded ❑ Sq.Ft. Flo .
New Location ❑ Replacement ❑
Qty. if
A is bl Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch& Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMTTFEE Elec Permit Issuance ELECTRICAL
MPERMTTFEE Mech Permit Issuance MECHANICAL
PPERMTTFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
0
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