05090061 n CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATIQN �;:
BUILDING ADDRESS: STANFORD PLUMBING HEATING " k"05090061
OWNER'S NAME: PERMIT ISSUE DATE
NE: SANITARY NO. CONTROL NO.
(408) 286-8931
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
n .LJ -
oC w LICENSED CONTRACnderpDECLARATION 'L nII )1 /J" ff I�'1�`
1Y tttttCaas I hereby affirm that I an licensed under provisions of Chapter 9(commencing Job Descriptions nVl'(//,S3'`�N�L L D
_loo uh Section]IXIU)ofDivision3of NC Bu4nrsa and Promsshsns Cadc,atld myliccnse is
h infunfnmaanderrea REPLACE FURNACE,ADD A/C n /�
p�? Liana Chas Lk.N
—o Dam Contra tof 2005
ARCHITECTS DECLA ATION
yw w U I understand my plans shall W used u public mmrds p p p 0
Licensed Professional I VJ ®`I ,yrs �I
3 OWNER-BUILDER DECLARATION � oj lljl\\Vf{
.�<f 1 hereby affirm that 1 am exempt room the Conuoctars License Law for the
S mO following moon.(Section 7031.5,Business and Professions Code:Any city of county
— which requires a Permit to cnnswcl,area.improve,demolish,or repair any nmctum $8450
Fey poor to its issutuec.also mean.tMapplicam for such Permit to 5lc aligned statement
< don he is licensedpursuanttotheprovisimuofineContractoriLicenselaw(Chapter9 Sq. Ft. Floor Area Valuation
(commencing with Section]I)(10)of Division 3 of the Business and Professions Code)or
y
that he is exempt therefrom and de basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects be applicator to a civil penalty of
not mom than fw hundred deltas er Occupancy Type
❑I,u owner of We PropatY,ar mY cmploycu with wages u mcir talc rompenmtlon.
will do she work,and the aumctmc is not intended oroRerelBorah,(Sec.]044,Business
and Profen ions Cade:The Contacmri License Law does ant apply to an owner or Required Inspections
propany who builds or improves hemon,and who does such work himself or through his
own employees,provided Nal such improvements are not intended or offered for sale.IL
however,the building or improvement is said within one year of compleWn,Ne owner.
builder will lave she burden of proving Nat he did not build or improv for purpose or
sale.).
❑I,as owner of due propeny,am exclusively contracting with licensed contractors to
consumer the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
ci ue law does not apply W an owner of property who Wilds or improves thereon,and
w W contacts for such projects with a conuacuods)licensed pursuant o be,Contractor's
License law.
❑lam exempt under Sec. ,B&PC for this moon
1M371W
ner Date
WORKER'S COMPENSATION DECLARATION
1 hereby arms under penalty of perjury one of the following declarations:
I have and will maintain a Ccrufleate of Consent salf-insure for Worker.Campcn-
om,u provided for by Section 3700 of the Labor Code,for the performance of the
rk which this permit is Issued.
1 haw and will maintain Workcr's Compensation Insurance,as required by Section
of the I..Wr Code,for tW performance of de work for which this permit is issued.
Worke_rs4C,,ompensation^nsurance arrierSand Policy number am: _�nicr.5 sas.�e. �—IItV� �at Policy No.: QM19(D
CERTIFT+IP1'ION FROM WORKERS'
COMPENSATION INSURANCE
munsection recd not W completed if tW Permit is formic hundred dollars($100)
or it
1 cenify Nat in the performance of the work for which this Permit is issued,1 shall nut
employ any person in any manner an as W become subject to the W°rkess'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject W the Workers Compcnsesion provisions of the Labor Code,you must
.J,Z raMwith comply with such provisions or this Permit shall he deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[-a Ihereby aMO.that them is.conswninn lending sgchq for the perf.onim.of
W de work for which mis permit is issued(Sce.309],Civ,C.)
OW. A lander.Name
Z Lenders Address
U O 1 codify that 1 have read his application and state that she.bove inf.do.Fort u
U.r comma I agree to comply with all city and county ordinances and sum laws relating to
0 U Wilding conswcti.m.and hereby suthori¢representetivu of this city to enter upon he
r aWw-mentioned propcny for iro ectim,purposes
G (We)agrte to save,indemnify and keep harmless de City of Cupertino against
F'fq liabilities.judgments,costs and expenses which may in any way see=against raid City
U,'Z inconsequence of me graining or this Permit.
^ APPLICANT UNADTE�R�SryTSA�,N�D)�S AND W'ISL'/L/Cp_Mp/L/y WITH ALL
NON],
-POINT Issued by: Date
/ �--�j---g�'—
SOUR�EREGDL !/ f/ .U/) (y�/s/6vC _/ //�
Re-roofs 1 i
Signazure of ApplicaDa
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will he applicant or futon building e.Chapter
r 9.1 or handle Health ad
,
u defined by the C2(11)' a Municipal Code.Chapter 9.11,roti the Health antl Salety
code.Secties ns3z(a)T All roofs shall be inspected nor to an roofing material being❑Ye. ON. P P � Y g g installed.
Will mea meant or future building Occupant are equipment If a roof ii installed without first obtaining an inspection,I agree to remove
PP B P a it Qu or Marta which g
;mit District?
nus air contaminants as dcOncJ by he Bay Arca Air Quality Management all new materials for inspection.
Disvicl] '
❑Yes ON.
1 have mad the hanrdoua materials requirements under Chapter 6.95 or the Califor-
nis Realm&Safety Code,Seed.25505,M533 and 15534.1 understand hatir me Wilding
does not currently have a tenant,hat it is my responsibility m notify the Occupant of the
ohm . mL th h N, rhussuanceofaCestinatoofOcapaney Signature of Applicant Date .
ownetora°th°n.<dagent DoW All roof coverings to be Class"B" or better
Community Development
10300 Torre Avenue
VTY
F Cupertino CA 95014
FTelephone(408) 777-3228
OFax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
10 � 1 b, h- h PlckcQ
OWNER'S NAME: 'Go c ori PHONE #
GENERAL CONTRACTOR: a o Heft " ( FAX #
I am not using any subcontractors: OBJ
Signafure Date
Please check applicable subcontractors and complete the followinginformation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
• Linoleum/ Wood
Glass / Glazing
Heating r.
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
StCITY OF CUPERTINO FURNACE /AC
CUPEPTINO PERMIT APPLICATION FORM
APN # I \lQ Date:I
Building Address: Ipm 1 ` c _Y� rn
Owner's Name: I UC Phone#:
Cgntractor. 6
< k0 t�,Ul,5. )"Q,3-t is \7 License #: /_
S d �� 0O
Contact: hone
c-,, S2-_7
Applicant/Contractor: ^ A
Building Permit Info: lt'�
Bldg lett Plumb Mech
Job Description:
Residential: —t)(-h Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation _nn
V
Type of Construction: Occupancy Group:
Qty. if
Applicable Fee ID Fee Description Fee Grou
BENERGY Ener BUILIDNG
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit > 10,000efm MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MEC14ANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUI1IDNG