03090092 CPCY OF CUPERTINOoaOf- # e x s '-'vs
BUILDING DIVISION PERMIT �CONTRAst«:y,CTORINFO RMATION '
BU ILDINGADDRESS: ALLIED AIRE SERVICE INC PERMIT"03090092
9640 A111�11JRN DR.
OWNER'S NAME: 661 SINCLAIR FRONTAGE RD PERMIT ISSUE DATE
NE: (408) 934-8844 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
I O Zp LICENSED CONTRACTOR'S DECLARATION- )pb Description
E F I hereby art.,.Net 1 em licensedde
under provisions of Chapter 9(com
mencing p
6y with Section70M)of Division 3 of Me Business and Pmfiss�n�r�''and my license is w.
.g- Lc'mte leande�j. zn REPLACE FURNACE & A/C P',VAL ..�
a to License rce a Lic.M
�t Date Co e<
yq ARCHITECT'S
EWO lander....dmyplans shall ho,used aspublic recnrds SEP 2 3 2003
6
e O Licensed Professional
OWNER-BUILDER DECLARATION 1, ' n
f 1 hereby affirm tial 1 am exempt from Ne Contractor's License Law for the BY�w'��
00 fallowing rearen.(Section703I.S,Business and Professions Code:Any city or county wY
<m which requires a Permit ns conswct.alter,improve,demolish,or repair any structure
prior to is issuance,also requites the applicant for such Permit to file a signed statement
< that he is licensed pursuanrto be Provisions of the Copmettr'sLicense Low(Chapter 9 Sq. Ft. Floor Area Valuation
2Hth (commencing with Section 70W)of Division 3 of the B usiness and Professions CWe)or
that be is exempt therefrom and de baza for the alleged exemption.Any violation of 3
Section 7031.5 by any applicant for a permit subjects the Applicant to a civil penally of APN NumberOccupancy Type
not more Nan love hundred doll...($500).
❑ I,As owner of the propeny,or my employees with wages As their sole compensation,
will do the work,and lineament.letter intended or offered(creak(Sec.J0e4,Business 3 Ul —
and Prafeauons Code:The Conuactoh License Law does not apply to An owner of 303 - ROUGH M CHANT AL ns
progeny who builds or improve,Maroon,Mern,and who does such work himself or through his
own employees,provided that such impmrcmenu am not intended oraRemd for sale.If. 304 — ROUGH ELECTRICAL
however,Ne building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did not Wild or improve fur purpose of 505 - FINAL ELECTRICAL
sale.).
❑1.as owner of the properly,am exelusivdy convening with licensed contractors to 507 - FINAL PLUMBING
construct the project(See.7044,Business and Profcuiom Code:)The Cmuounori Lt. 508 — FINAL MECHANICAL
come law does not apply to an owner of progeny who builds or borrower thereon,and
who contracts for such projects with s conusctor s)licensed pursuant to the ConsamM1
License 4w.
❑I am exempt under Sec. B k P C for this ration
Owner Date
Alik WORKER'S COMPENSATION DECLARATION
thereby air under penalty of do,one of the following declarations:
14 I hew and will,remain a Cenifcate of Content,self-insure for Worker's Compete
.duh.u provided for by Section 3700 of the labor Code.for Ne performance of de _
work for which this Permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of Ne labor Code,for the performance of the work for which this permit is Wood.
My Worker's Compensation Insurance earlier and Policy number art: C
Cenicr. J Fw-A Policy NO.:?t Z
-d —SB- /
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Rhes snotion need not he completed if the Peron is for one hundred dollars(5 1(1(8
or lets)
1 certify Nn in the performance of rho work for which this Permit is issued.I shall not
employ any person in any manner an az,kcomc subject to the Workeri Co urimSAtimn
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Ccntfrea,of Exemption,you should
become suhjcat to Ne Worker's Comrcrsstion provisions of the Labor Code,you mum
7z fonhwith comply with such provisions err this re.it shall he darned revoked.
zO CONSTRUCTION LENDING AGENCY
I hereby afrum Met Nem its construction lending agency for the performance of
Ya7 the work for which this permit is issued(See.3097,Civ.C.)
YQ lender's Name
z Lender's Address
J Q 1 ceni(y that 1 have read this application and ser,that Ne above information is
(~ correct.)agree to comply with all city and county ordinances and state laws misting to
7 V buildingconstruction.pro and hereby inspection
rposexmalives of this city to enter upon the
4 shove-mentioned property for impaction keep ha.
We)aju egme m rave,indemnify and keep harmless the City o Cupansts against
ry oabiltttes,judgmcna.cmaang eapemm which may in any way acerae against said City
:.3�'[ APcom"PLIC ucncc ofN gaoling salthis r 1.
APPLICANT U RSTAND A � LL COb Y WI'JH ALL NON-POINT Issued by: Date
SOURCEREG ATIO
q //LO Re-roofs
HAZA
Sigof ApplicaDatc
HAZARDODO US MATERIALS DISCLOSURE Type of Roof
Will thee,Cupertino
or(mire building k,Chapter
or handle luvutlous material
As defined by Ne Cupertino MuniciW tCodc.ChaP,r 9.12.and the Health and Safety
Code,Sacuon 35533(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will W applicant,future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havardnus air contaminant As defined by the Bay Arca Air Quality Managcmcnt all new materials for inspection.
¢?
❑Yea u
I haw read!Me IuaaNnusmelcrialsreyuimn,nss under Chap,rb.YSofthe Cali for.
nix H.IOISafcty Ca .Smdms25505.B533and35534.1undcnandthstifthe building
does not currently haw nuns that it' m onsihilily notify the 0.TmPanl of the
tees Out com llyh ten ' ofaCe �a,ef Occupy Signature of Applicant Date
_ / //oz All roof coverings to be Class "B"or better
Dwncr or authorind agent Dale
CITY OF CUPERTINO
aoxFFURNACE/AC 03 v �o o �2—
CUPERTINO PERMIT APPLICATION FORM
APN#
Building Address: Y o
Owner's Name: / �/ n I J Phone#:'/ 9-1-9 6 3 9
Con ct Phone: License#:
, . 9i3 4 X6003 s
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech
Job Description:
ace, er,c� - 60. 0 0 0 6 tU w 9�G �7pn
Residential Commercial ❑
ForidentialI s Ilations:
Attic ls`floor A 2nd floor❑
Alh Adhere to min set back requirement❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction: Occupancy group:
39oo . ub
Strapped ❑ On Platform Bonded ❑ Sq.Ft. Floor Area:
New Location Replacement ❑
Qty. if
A ble 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
OF BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
EPERMTI FEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
! PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING