030800620 �
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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTRACTQR INFORMATION:`''.
BUIDING ADDRESS:
1844 BENT7,TTT CT
A PERFECT CLIMATE
PERMIT NO03080062
OWNER'S NAME:
10570 S DEANZA BLVD
PERMIT ISSUE DATE
TENNEY GLENN H AND FRANCES Is
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3
NE:
(408) 861-9545
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACrOR'S DECLARATION
Job ZDesenpBnoa n
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I hereby affirm that l am licensed under provisions or Chapter 9 (commencing
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with Section 70(11) of Dwiaio Sof Ne Businatend Pr ssin Cod dmy)icense is
in full fogrtep and I.
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ADD A/C
SFP 39; 2003
Dtaense �b C.�"aclnr
ARCHITECTS DECLARA 1
I understand my plan. mail be used as public records
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BUILDING
tl G
Licensed Proremi... I
OWNER -BUILDER DECLARATION
_
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 703 1.5. Business and Pndeesiun Code: Any city or county
which requires a permit to Cm%IruCI. alma improve, demolish, or repair any structure
8
Prior or its issuance, also requires the applicant for such permit to rile a signed statement
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the Commetarh License Law (Chapter 9
(Commencing with Section 71W) of Division 7 of the Business and Profession Code)or
32649029.00
that he "exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a pints subjects the applicant to a Civil penally of
not more than Ove hundred dolls.. ($5110).
1, as owner of the property, or my employees with wages sa their sole compensation,
3 01 —
t50Ds
will do the work, and Ne awcwre is not intended or offered for sale (Sm. 7044, Bainess
and Profession Code: The Conosctorl License Law docs not apply to an owner of
3 03 - ROUGH Litt
property who builds or improve thercoo,and who dommich work himselfor through his
own employees. provided that such improvements me not intended ororfered formic. If,
304 — ROUGH ELECTRICAL
however, the building or improvement is sold within one yeas of completion. the owner.
builder will haw On burden of proving Nal W did not build or improve for purpose of
501 - FINAL ELECTRICAL ENERGY
.ala.).
502 - FINAL PLUMBING ENERGY
❑I. as owner of The property, am exclusively contracting wit licensed convectors to
503 - FINAL MECHANICAL ENERGY
construct the project (Sec. 7044. Business and Profusions Code:) The Convenors U.
comm Law does not apply to an owner of property who Wilds or impni themom,end,
505 — FINAL ELECTRICAL
d pursuant To the Conoes
who contractsfor such projects wit a convamor(q licensevad
507 - FINAL PLUMBING
uoenr eLaw.
❑ I am exempt under Sec. . B k P C for this reason
508 -. FINAL MECHANICAL
he, Data
WORKER'S COMPENSATION DECLARATION
1 hemby e1Bam under penalty of perjury one of rhe following declaration:
1 have and will maintain a Certificate of Consent to self -insure for Worker's Compcn-
svtion u provided for by Section 77W of the labor Code. for the performance of the
o it for which this le, mit is issued.
I have and will maintain Worker's Compensation Insurance, as required by Section
of the Labor CaOc, for the performance of the work for which this permit is issued,
M error's in n anion loan.. Curti., an PolicyA41
GBnler: ` y No.:
CERTIFI A cOFEXEMPr10 FROMWORKERS'
COMPENSATION URANCE
(TMs aealnn need not hecomploted iOrt Permit is far one hundred dollars (SIM)
less.)
I cenify that in the performance Lir the work for which this permit is issued, I shall not
employ any porton in any manner so as tit become subject to the Workeri Compensation
-
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Ccni ricato of Eaem prion, you should
become subject to the Worker's Compensation provisions of the labra Code, you must
forthwith comply with such prnvisina or This Permit hall W deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby thi Nutherelaseni(S.C.3nlending for The performance Lir
ich .)
the wash for which This permit is trod (Sec. 3097, Civ. C.1
Lender. Name
-
Isndeh Addreu
I ttnify dust I have mad this application end sure that the above information is
carton. 1 agree t9 cam ith tll city and county oNinarue and las¢ laws rtlating to
and creby euThorim rtpruenutiwa m(this city to cner upon 0u
ert for inspection poroses.
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(We ,indemnify and keep u y of Cupertino geinsr
(//�'�j-r////
au and expe K meyln any accrue egeinmaid City
Lin,.me,umgaming oft'u.RSTAND A WILLC LY WlTiya{, ON -POI
/EGULAnONS.
Issued by: Date
ONS. (KV/'
Re -roofs
of Roof
Sign roof ApplIlConir D
HAZAROWMATERIALS DISCLOSUREType
al
the applicant or from building Occupant store or handle havudoa materiel
c rood by the Cupertino pal Code. Chapter 9.12, and the Health and Safely
25532(07 -
gigmbi, SccdooYu
All roofs shall be inspected prior to any roofing material being installed.
❑ Nu
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or tutu building Occupant ere equipment sur dcvlcca which
ill hanrdnus air contaminants do d by the Day Arca Air Quality Management
all new materials for inspection.
istrict7
❑ Yos
I have real the rdnuson e' me isunder Chapter 6.95 of the Califon
ndcand that ifthc Wilding
ria HealthSt Or c, 'rat 25X15 onJ 5574. 1 um
Jana not Cu a or, N is res nihilirymnoutyt oocupmL.fthe
requ' C um dart an nracertinua 177"
Signature of Applicant Date
All roof coverings to be Class "B" or better
ownrurautholaeda enl Due
0
•
CITY OF CUPERTINO
PERMIT APPLICATION FORM
APN # n � �
Date:
BUILDING
Building Addres•:�
Relocation of Furnace
MECHANICAL
BREMACOVER
Owner's ame:
Phone
BREMAIRHAN
Contractprt —
License #:
BREMRECEPT
Contact:}
Cupertino Business License
#:
Building Permit Info:
BUILDING
EPERMITFEE
Bldg ❑ Elect Plumb El
Mech
MPERMITFEE
Job Description:. C,
MECHANICAL
PPERMITFEE
Residential Commercial ❑
PLUMBING
BPERMFEE
For Residential Installations:
BUILDING
BPLANCHK
Attic ❑ 1" floor ❑ 2"d floor
BUILDING
BUSLIC
Adhere to min set back requirement ❑
BUILDING
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required
Cos9f 0. ect: Type of Construction:
Occu an y g ou
EVAt
44
Strapp d L On Platform LJ Bonded L
Sq:Ft. Roor Are :
New Location ❑ Replacement
Qty. if
Annlicable
Fee ID
Fee Description
Fee Grouo
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 d, Switch & Outlets
ELECTRICAL
/ BSEISMICRE
Seismic Fee Res
BUILDING
EPERMITFEE
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