03080058 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CON JOR INFORMATION ,,
, n, a,, ; r,
BUILDING ADDRESS: SCHAUMANN AIR CONDITIONINPERMIT ND03080058
19752 BIXBY DR
OWNERS NAME: HEATING & PLUMBING INC PERMITLSSUEDATE
SCOTT & STACEY RYDER 3 2003
ONB: (408) 428-0640 SANITARY NO. CONTROL N0.
ARCHITECnENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I� C=
.06 LICENSED CONTRACTOR'S DECLARATION
�i� I hereby spot.that 1 am licensed under provisions of Chapter 9(commencing Job Description
tan with Section 7")of Division 3 oflhe Business and Proportions CoJgand my license is ��r� n ^ p
+< mmnro.eondertem REPLACE FURNACE p \ !c 'a�t
j n.- Licu Coo Lic,1t
39 cnDow Contractor
ARCHITECTS DECLARATION SEP 2 . 2003
I I understand my plana shM u ell used puhlic rccards
>yU
f 0
Licensed Pmfessinnal
1se� OWNER-BUILDER mDECLARATION BUILDING DING
2OO 1 masa ,(firm that I am exempt from the Contractor's Co License Lew for the IDV 6.
❑O followhich
re requires
archon 7(13 tr Business
am,am rPr,d oornns Code:Any city or county
3$ which rtyvis a a permit ac construct.alcor,ice for such
deermit t fi repair any structure 91
Prio.n iutensedPaoumquircet.,Isla,ofcant for Contratorlmmcse signedcomment
rm< (commencing wU Pursuant to 70thc provivions3 of the ntaiessnittmfssio(Chaptermik)or Sq.Ft. Floor Area Valuation
F$ thatMIsexemitOcreion70o0)of One iasis,frnftheegedexaand on.AnyonsCnde)of 36909017 . 00
Nat he Is exempt therefrom and Ne bola far Ne alleged ezemptlon.Any violation of
Section 7031.5 by any applicant for a permit ubjects the applicant to a civil penalty,or APN Number Occupancy Type
not more than Bvs hundred dollars(SSW).
0 I,a owner of the pmpeny,or my employees with wages as their sole compensation,
will do the we&,and the aummuw is not intended or ffered for sale(Sec.7(144,Business 3 01 —
.it Professions Cads:The Contractor's Ltcenx Law Ones not apply to an owner of 3 03 — ROUGH CLIOnS
property who builds orimprom thereon,and who does such work himselfor through his F1L
ownemployces,provided mmauchimpamwoenusm amimended aroffosd hersaw.It. 304 — ROUGH ELECTRICAL
however.the building or tmpwwmcm is told within nae year of eo.pledon.the owner.
builder will have the burden of proving that he did not wild or Improve for purpose of 505 — FINAL ELECTRI CAL
sale') 507 FINAL PLUMBING
01,as owner of the propcny.am exclusively contracting with licensed contract..a 508 — FINAL MECHANICAL
consumer the project(Sec.7044.Business and Professions Code:)The Contractors Li.
cane law two;not apply to an owner of progeny who wilds or improves thereon,and,
who contracts for such projects with a contractor(a)licensed pursuant to the Consomme,
License Law.
❑1 am eaempr oder Sec. .B&P C far ..on
wn Dale 3 O
WORKER' M ION DECLARA
I hereby affirm undo naltyof rjury one of the following declarations:
I hoe and will maintain a Cerdficom of Consent to self-imum for Worker's Compcm
sation,u provided for by Scetion 37W of the labor Code,for the performance of the
work rot which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,a required by Section
37W of the labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Imuran.emierand Policy number am:
Cartier: Policy No,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TMs rection need not beeompkewd If the Permit Is for one hundred dollars($1 00)
nr leas.)
1 sanity that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner an as W become subject o the Workers'Compensation
Laws of California.Dem r
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificaw of Exemption,you should
become subject to tum Workers Compensation provisions of the labor Code,you must
.JO forthwith comply with such prnvons inor this permit be deemed.vokca.
z r~co). CONSTRUCTION LENDING AGENCY
[—i I hereby affirm that there is a comtruc'Iinn lending agency for the racaufmance or
CG 7 the work fur which this permit u issued(Sec.3W7.Civ.C.)
UA
A Lender's Name
z Leader(Adtlress
U Q I certify Nat 1 Mw read this application and show that the above information is
{A F commit.I.&me to comply with all city and county ordinances and sow laws relating to
O U building comsuclion,and hereby aulhodu representatives or this city in enter upon the
W shove-mentioned property for inspection purposes.
(We)agree m save,indemnify and keep harmless the City of Cupertino against
W liabilities,judgments.coats and expenses which mayin anyway acec againsaid City
U Zin consequence of the granting or this Permit. rotr /
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
SOURCE ULATIONS.
Re-roofs
Oswr
sesta of ApplicsHA ARDOr ATERIAIS DISCLOSURE D! Type of Roof
Wdl the applicant tar future rodding..panumre orhaadw haran7uvs material
u dcMetl by the Cupertino Municipal Cole,Chapter 9.12,and the Health and Safety
ode.&Llcsn 35532(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yr. P�No
Will the applicanwr future wilding Occupant uxeyuipmem orJcvices which If a roof is installed without first obtaining an inspection,I agree to remove
It haudnes air contaminants a defined by the Bay Area Air Quality Management all new materials for inspection.
"Ota"
0Yes �o
1 haw.aJ the wamrmsmawrials requiremcnho under Chapwr6.95 drum,Califon.
nia Real"Safety Cow Scc ore 25")5,25533 m,25534.1 undcrtund thatifNs wilding
does not currently haw a tenant,that it is my responsibility W notify the occupant or the
rcquircmenl, ichmusrbemm Ort niaaacennraccmreawnr exPuncy. Signature of Applicant Date
.amortno. o e All roof coverings to be Class "B" or better
-� CITY OF CUPERTINO U
��O FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN# Date: A
.JCS ust 1 ,2r�v3
Building Address:
18752 Bixb ,PrWZ �u 7'hvw CA 6(50ly
Owner's Name: Phone#:
5Coit & 6+Acc 2 61CV/ C41)E)) 255--709
Contractor: License#:
SGlhAIAWA A hC,k�eah(L3 XP —7'70D54 C4 M C310
Contact: Cupertino Business License #:
.10tH ri M- G i ever
Building Permit Info:
Bldg ❑ Elect Mech
Job Description:
Pe [&Ce old �uYna,Ace w� a rtw a
Residential NO Commercial ❑
For Residential Installations:
Attic ❑ 1' floor K 2°a floor ❑
Adhere to min set back requirement[I
• For Commercial Installations:
Replacement samewei ht C] Additional weight(structural calcs)❑
Structural Calc anon' d r new installation ❑
New installation Planning A r al Required rl
Cost of Pr sect: I I oa ' Type of Constructio Occupancy oup: r,
Strapped On Platform Bonde Sq.Ft. Floor Area:
New Location ❑ Re laceme
Qty. if
Ap a 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
BREMRECEPT Reeptl, 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
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