03070054 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACT:ORINk'l7ItMATION,'=�
BUILDING ADDRESS: MAGIC MECHANICAL SERVICE """"03070054OWJRN DR
NER'S NAME: 121- 1681 MILROY PL PERMIT ISSUE DATE
t ONE: (408) 978-6181 SANITARY NO. CONTROL NO.
ARCHITECT ENGINEER: BUILDING PERMIT INFO
9�BLDG 0 PLUMB M�H
LOO LICENSED CONTRACTOR'S DECLARATION
YYi E 1 hereby affirm that 1 em licensed under p@,Jy,a,of Chapter 9(commencing lob Description
<<6 with Socket 7000).fDlvl.lon Sof Ne Buaines andProfcssums Cade,int my license is
mor. e�derr«t. ✓✓✓ INSTALL FURNACE & A/C !
Y. -
"Ie
2 License Cles L's.a
Dam camDE 003
e ARCHITECTS DE TION U
Y t-JeeetfenJ my plane shall he rued a Wdl mcoNs O< ��
DWU V/
0 1 LicensedPrdessionel
5 OWNER-BUILDER DECLARATION
00 1 hereby romo .(Rete Inn 11. exempt from be Contractor's Co License Law for Ire
OO following uiresa eoaten 7031.5,Business and Rnfcemoli Code:Any city or county
$ which tcquirese..1soreuires bcs,alum approve,demolish, fierepair gany etrucnre
on
proton its i licensed
p tlso requite Ibe applicant for such permit to a signed shtemem
o (bout he commesccensodpupsuamtotheofDivionsMNeCommcmhndProrlaw(Chapn9 Sq.Ft. Floor Area Valuation
(commencing with Srnion 7")of Division 3 of the alleged
axe end on.Any ns Cade)or
$ Net he is exempt therefrom and be basis for be alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the Applicant o a civil penally of APN Number Occupancy Type
not more Iran rm hundred dollars($500).
1,ss owner of the property,or my employees with wages as tlmlr sole compemation.
will do the wark.Iol lhcswcture isnot inunded oroRertd Want.(Sec.7044.Business 3 - ROUGH Ij CLIODS
and Professions Cade:The Conuaclor's License Law docs not.,Ply m An owner of
propertywho builds or lagoons thereon,and who doeuuch work himself or through his 303 - ROUGH MECHANICAL
own employee,provided mal such improvements an not intended or offered fm Asia.If. 304 — ROUGH ELECTRICAL
however,be building or impnvement is sold within one year of completion,the owner.
bu)ltier will have Ota burden of proving Nn be dm not Wad or impaova fm Parmesan or 505 — FINAL ELECTRICAL
al`')' 507 - FINAL PLUMBING
❑1,as owner of the property,,Business ssi and conlnQlng with licensed cute cot[to
causwct the es not pply(Sec.t in wne, rand property
who
cmc:)71u Conlncmr'.U. 508 — FINAL MECHANICAL
cera law dmf not apply je ts owner of anter(who builds or improves Norton,and
whocontractsLa ts for such projects with a contnnor(q licensed Punuam m the ConuanoM1
1-11.Law.
❑I Am exempt unties Sec. ,B A P C for this moan
Oo
wner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby a0irm under penalty of perjury one of the following declnelionse:
I have and will maintain a Certificate of Consent to aelf-insure fm W.rkeri Compen.
sation,As provided for by Section 3]00 of be Labor cant,for be Pe formantt or du
work for which Nis Permit is issued.
❑1 ban and will maintain Worker's Compensation Insurance,As required by Section
3100 of the labor Cmc,for the Performance of be work for which this permis is issued.
M rkcr's C CERMCCO NSATION INSURANCE u EORKERS +
(Theice ion need not rte completed lithe I cmal,Is for one hundred dollars($HX))
m less.)
I certify mal in the performance of the work for which this Permit is issued,I Nall not
employ any person in any manner so As to become subject to the Workers Compensation
Lew.of California.Data
Applicant
NOTICE TO APPLICANT.If,after making this Ccr iftaam of Exemption.you should
become.uhject to be Worker'[Compensation previsions of the lahm Cmc,you must
.J O forthwith comply with such provisions at this permit shall M deemed revoked.
'zCONSTRUCTION LENDING AGENCY
�
(—i In affirmm mal inert iscontroetinn lending agency for the performance of l/
W'^ but wmrk for which this pearth is issued(Set.3097,Ci,C.)
WM p L pde/s Name
L
�z cticr'[Atltlrtss
fJ Q I certify Net 1 have read this application and sw a that the above information ie
It, correct.I agree to comply with all city and county ordinances and sine laws rehting 1.
DU building construction.and hereby authorise tcpaenotati Ma of this city to enter upon the
above-mentioned property for inspection purposes.
Imo^ g� (We)Agree to ave,indemnify and keep harmless the City or Cupertino against �f
h liabilities,judgments,costs and expenses which may in any way accrue against said City 5
in consequence of the gaming of this Permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGULA O
S ata 1i PI arc atnJ _ 2 Re-roofs
HAZARDOUS MATERIALS
Data Type of Roof
Will the applienl or future building Occupant store Or handle hazardous material
a defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(.)1
❑Yeeu All roofs shall be inspected prior to any roofing material being installed.
wn1 tet appfienl.//tri.ur miming arnpAnt use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it bumptious air conummants As dcOrmd by the Bay Arte Air Quality Management all new materials for inspection.
WricR
C]Yea Nn
1 have mad the huvardnus materials requirements under Chapter 6.95 of the Celifm-
nia Hwlth&Safety Code,Set9.m25515.25513 nu12553a.1 un@nand Nu if tM Wilding
does not amnmly hese•to I.Nn it is my maponsihiliiy to madly be mtupsot or be
'NoMancnts wM, rte at prior m issuance of a Certificate or cupancy. Signature of Applicant Date
- F.�` .o� D� All roof coverings to be Class "B"or better
ncr ser auNons agcm
CITY OF CUPERTINO
FURNACE/AC D
SUPER,TINO PERMIT APPLICATION FORM
APN# Date: 3
, 35 7_ 8 _�
Building Address: /�
l7 X D u (p ct / yr
Owner's,Name: /I Phone #:
V,75 , .-7 N Lj .�crt0 LS?
Contractor: ///' Phone: License#:
Contact: Phone: Cupertino%siness License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description:
Reside ial Commercial ❑
Foral Installations:
Attic 15 floor ❑ 2"d floor❑
dhere to min set back requirement El
1IFFor Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Ap iroval Required ❑
Cost of Project: / Type of Construction: Y"A/ Occupancy cup
Strapped El On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Re lacemefit "'
Qty. if
A icable Fee ID Fee Description Fee Group
BENERGY fnirgy 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
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
MW BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING