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04100002 CITY OF CUPER'1'INO "" °r"+w 7777"77777-777777777 0RJNFQRMATj6r4'.-se " se -- BUILDING DIVISION PERMIT CONTRAC*,T®R INFORMATION st a BUILDING ADDRESS: A PERFECT CLIMATE PERMITNoO 4100002 OWNER'S NAME: PERMIT ISSUE DATE CHI Z ryE_ SANITARY C NOL NO. (4nR) R61 -9545 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG EIFLT PLUMB MECH 0 0 0 0 L O j LICENSED CONTRACTOR'S DECLARATION - Job Description til I Immby affirm that 1 em limrue l under provision of Chapter 9(commencing i� withl iG ")of Division 3 of J¢Burmese Professions Code.and my license is � ? Ln anaerr Z I Sg" REPLACE FURNACE Licen lav Lic.p - n F Date---�'��Cantncmr -_— __ _ ._ ARCid"..DEC1.� neem / or 5y or< 1 undcor,_ y plans shall be used u pWfic acorda - --- - yLLU Oe Licensed Pnrfessionel OWNER-BUILDER DECLARATION - —' "- �, `� — —'------ +� 1 hereby affirm that I am eacmpt from the Crdr License law for the `J Z no following anon.(Section 7031.5•Business and Prefco iutu Code:Any city Or County K m which mquires a permit to mummer,niter,improve,demolish.Or minor any structure yai prior to ib issuance.also mquires the applicant forsuch permit to rile a signed summer, < that Ise is licensed pures,In Ne povisiov of the Comment's limnu Law(Chapter 9 Sq. Ft.Floor Area Valval O❑ zH$ (Commencing witit Section 7")of Division 3 of the Business and Professions Code)ro - - that he is exempt therefrom end the hnsu for the alleged eaemption.Any violation of Section 7031.5 by any applicant file a permit subjects the applicant to a civil penalty of 36er00 Occupancy Type not mom than five hundred dollars($500). 0 1,as owner of the pmpcny,or my employees with wages as their sole confirmation. will do the work.and the structure is not ntended on offered for sale(Sce.7044,BudM•• Required Inspections and Professions Code:The Contreaor's Likenu e law docs not apply to an owner of - q p property who builds or improves thereon.and who dmssuch work himulfor though his Own employers,provided urnsuch improvements ea nolinuedcel at offered fortude.if. however,On building orimprovement isuld widucom yeerofcomplcuon.Ocowner. - --- -- builder will have the burden of proving that he did not build or improve for purpose of sale.). O I,as owner of Oc property,am exclusively contacting with licensed contractors in construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li. cense law does not apply o an owner of property who builds or improves theoon,ad, who contracts for such projects with amnukelor(s)licensed pursuing to the ConlrxoYs License Law. l sm exempt under Sec. .B&PC for this assort - Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby Num under penalty of perjury aro of the following declarations: I have and will maintain a Certificate of Contin to self-insure for Worker's Compere -- sasion,as provided for by Section 3700 of the labor Code,for the perfmmanm of the work for which this permit is issued. C36ave and will maintain Worker's Compevmion Insurance in required by Section - .. 3700 of Use labor Code,for the performance of the work for which this permit is issued. My W k.,Compensation In nn¢canim and Policy monberr�a�a��2 Carue7!' ( �— -e Iblico.:f�L_LI.LL"LL� CERTIFICATEOFEX MONFROMWORKERS' COMPENSATION INSURANCE r (This section need not W completed if the permit is Intone hundred dollars($Im)) or leu.) 1 certify that in the performance of the work for which this Permit is issued.I shall not employ any person in any manmrso in to become mbjecun the Workeri Compensation Laws of Califomia.Dam Applicant NOTICE TO APPLICANT:If,afar making this Ccnificme Of Eacmption,you should become subject o the Worker's COmpcvedon provisions Of the labor Code,you more ,JO forthwith comply with such provisions or this Permit shall be deemed revnkcd. Z N CONSTRUCTION LENDING AGENCY I hereby Nem that tnea u a eonstvcdnn lendingagerey fm dm Mrfurronceof a the work for which this permit is issued(Sec.3097,Civ.C.) W lender's Name =Z Lender's Address U Q 1 certify that 1 have rad this application and sum Nat Use above infoanadun is L$. P correct 1 agree to comply with all city and county ordinances and some laws mlaling to 0U building construction.and hereby autharm,represenutives of this city to cmr upon the r W above-mentioned popery for inspection PLOPoua (~ G (We)agree to save,indemnify and keep harmless he City Of CUPCTUMQ against _ fn liabilities,pilipa m.Casa and expenses which may in any way...against said City r'$� U Z in conugommc of On granting Of Nis permit. ll ^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: - e SOUR ONS. t Re-roofs at eco ApplieanUContraeor au HAZARDOUS MATERIALS DISCLOSURE Type of Roof Wilt the applicant or forum building occupam store or handle havardous amm rlal as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety ede Sccdnn zsslz(e)? = All roofs shall be inspected prior to any roofing material being installed. ❑Yes No Will the applicant n more building ocenpenl pY nwipmnnt n;devmea wmcn `If a roof is installed without first obtaining an inspection,I agree to remove emit havardnun air cents az defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yee I have mad the haves runsmm:6.1a requimmcnu under Chapter 6.95 of the Cabin. . nia Hcahh&Safety Code. ethus25505,25533md25534.lundeaund Natifthcbeilding or..not,sero y ho a mnanc that it is my responsibility to nodfy the Occupant of the _ mquircmcn rt et poor tolae r nam ofOccuPmc. Signature ofApplicant Date ow pr sothorivrJ ascot oat All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 " r Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building Department JOB ADDRESS: PERMIT # O OWNER'S NAME: PHONE GENERAL CONTRACT, R: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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 M6 er/ ontractor Signature Date CITY OF CUPERTINO UPERTINO PERMIT APPLICATION FORM APN # l 1 � Date: ( 0 Building Address: I l Owner's Name: Phone #: Contractor: one: License #: L-�-r.�e_dk7z 3 5g Contact: Phone: 8(01 Cupertino Business License #: be cu�- Building P nit Info: Bldg Elect Z Plumb ❑ Mech ❑ Job D scription: Residential Commercial ❑ For Residential Installations: Attic ❑ 1" floor ❑ 2"d floor❑ Adhere to min set back requirement❑ or Commercial Installations: eplacement same weight ❑ Additional weight (structural talcs) ❑ LNew l Calculations required for new installation ❑ allation Plannin A rova] RProject: Type of Construction: Occupancy group: trappe ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty A 1' a> le Fee ID Fee Description Fee Group ILL 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 EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Pen-nit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License 2,6,0 BUILDING