Loading...
03110067 I CI'T'Y OF CUPEwrINO ,., BUILDING DIVISION PERMIT CONTRACTOR INFORMATION BUILDING ADDRESS: SAN JOSE AIR CONDITIONING PERMIT NO-03110067 6354 BLAC WOOD DR OWNER'S NAME: 880 N. 8TH ST. PERMIT ISSUE DATE IAN OGLESBY 11/13/2003 NEI (408) 286-2047 SANITARY NO. CONTROL NO, ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 loo LICENSEDCONTRACTOR'S under DECLARATION _ U F 1 hereby affirm that 1 am licensed under provixiu s nr CAaptcr Y(commencing Job Description E=N w;1hSCctien70 � fD1VilOn3orthCBOilnssand I IORtGOd. dmyllCCn411 mufn :eNy�r�a� "q REPLACE FURNACE & A/C, ELEC"PINAp em >,y,? LiccnuC Lt.p =Fp Dale Comma £H ARCaITECRSDFARATION E W u 1 under an�ykpY�Ilyuusc as pubHt records FEB a Licensed Professional / r 1 �O 04 ca< OWNER-BUILDER DECLARATION <ST 1 hereby affirm that 1 am exempt from Ne Contractors License Law for the ®�'. S'� p o following mason.(Section 7031.5,Business and Pmfcsnions Coda:Any city ar county ® ■`GL/1 which requires a permit in construct,alter,improve,demolish,or repair any uruauu 4 0 ^i„ pnono i,issuance.also requ;res the applicant for such Permit o file a signed statement < that mislieensetlpursuanllothe rivisim¢ofthe Contractor aLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation 2�a (commencing with Section](NIO)of Division Sof the B usinces and Professions Coca)or 36917052 . 00 Nat he is exempt Ihcmfrom and the lines for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicinuo a civil penally of AFSN Number Occupancy Type not more man RW hundred dollars($500). P Y YP 1,as owner or the property,Or my employees with wages m their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Councilors License law mei not apply to owner or Required Inspections property who builds or improves thereon.and who does such work himself or through his own employ.,provided thin Such improvements are not intended oroRened for site If. however,the building or improvement is mid whhin one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the pmject(Sec.7044,Business and Pl ofcisiomi Code:)The Contractor's Li. cove taw docs not apply to an owner of property who builds or On pmvm memoo,and who contracts for such projects with a contractor(s)licensed pursuant o the Cannelton's License law. ❑ 1 am exempt under Sec. B At P C for this reason Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury ane of Use following declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker'sCompcn- 7371M pn,u provided for by Section 3700 of dx later Code.for the perPoamorm.of the rk for which mia permit is isamil. 1 have and will maintain Worker's Compensation Insurance,ss required by Section of the labor Cotle,far the performance or the work for which this permit is issuedWorkc' omp satin Insumna conic otM P y nu�slMra r 01 ` f CERTIFICATED EXEMMO FROMWORKERS' COMPENSATION INSURANCE Mix Section need at Meompleted irme Permit is for one hundred dollars($100) or less.) 1 Sentry mat in the perforroanea of the work for which this Permit;s issued,1 shall not employ any person in any manner an as at became subject to the Workcri Compensation Laws of California.Dale Applicant NOTICE TO APPLICANT:if.after making this Certificate of Exemption,you should become Subject to the worker's Compensation pmvinov of the labor Cour.you moa z forthwith comply with such provisions an this permit shall be deemed mvokcd. Z O CONSTRUCTION LENDING AGENCY I hereby affirm mal mere is a conswction lending agency Or the performance of the work rur which this permit is Wood(See.3097,Co,C.) W 0 Lender's Name = z lender's Address U O I Senify mat I have read this application and sed" that the shove information is Pcontact.I ague to comply with all city and county oNidem.a and Scale laws relating te 0U building construction.and hereby authorim representatives of this city to enter upon the � alible-mentioned property for inspection purples Fin co%j liabilities e)agree tnto cos,internal nt mpcnuswhie harand kep ridan to Caty of accvcapertino against U'Z Y Y Y against said City vc of the granting of this permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale SOURCE REGULATIONS. , :wren Appl"anVFtbr Contra ✓Y a Re-roofs te HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the aPPlicam or future building occupant score or handle havmtlous material as defined by the Cupertino Municipal Com.Chapter 9.12.and the i and Safety C.Section 25532(:)? 0y. PNo All roofs shall be inspected prior to any roofing material being installed. ' Will the applicant of future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove it hazardous air contaminants ss defined by the Bay Arca Air Quality Management all new materials for inspection. ;atria? ❑Yes XNo I have mial the hvaNtms materials requirements under Chapter 695 of the Califor. does an ateatiov2terit1 myoand2S534.l in molly Ithmifthcnt or r docs not ms whit has:a tenant(mal it is sac neipor a eery, notify the occupant of the mquiremen,which mow mel pnos,w;ssnantenn cntirtmte9r, Oc Signature of Applicant Dale r t U5i;offl adivin.il agent Date All roof coverings to be Class "B" or better FROM :Mary Kurtls `?r' FRX NO. :415 276 2304 'Jul. 06 2003 03:21PM P1 ` CITY OF CUPERTINO 63 ( 1 / FURNACE/AC MPE NO PERMIT APPLICATION FORM ) APN# Date: 1 31 Building Add Lwx Owner's Name: phme ,t 1 c5L�S�i Cu,i [or� /�- phone{ :, � a Ol L Contact Phone: rtino Buts cense#: L Building Parona Infe: Bi ❑ Elect ❑ } Plumb D Mach 13 Job DmrljNlon:,Z 1i�Cft— lam? fv r� C� JE,UEZ,�U t-0 Residential ' Commercial [I • For)ieskle LJ IuatLJallafl13 , Artie t flo[x Td floor Adhere to mitt set back uirement❑ For Comaterchd Installatiom; IReplace,ttdtt same weight ❑ Additional weight(sLund calcs) Structural Calculations mquimd tar now installtaion LJJ New installation A uired rlM Cost of Project I � Typo of Constrastion; ocaipitncy up: Strapped On latfonn 11Bondod C3SgYt.Floor •NewLtxtttitm ❑ Re latxnlettt ��• Anif ] We pei ID Pee DescriptiGn Fee Group BENEROY Energy BUII,DING BRBMPURN Relocattioa of Furnace' MECHANICAL BREMACOVER A/C Unit y 10,000 cfm MNCHANIC:AL BREMAWLkN A/C Units<- 10,'000 cfm MECHANICAL TlRFMRW.FP'r d,Switch&Outlets ELECTRICAL BSMMICRB Scismic FCC Rcs' WELDING 5ERMIITF1 Rkc Permit ksuance ELECTRICAL c MpERivinnE Mech Permit L%ua= MECHANICAL PPERMI RE Plumbing Permit Issue PLUMBING $pEkMFEE Bld Permit Nees BUIWING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUI MING ` R P Customers Name Crossan, Keith - Wcvd From Sears 11/6/2003 t Address .2690 44th Ave ._ i San Francisco 94116 - Value $11998.00 Sob No. -3391049 A Customer Ph.. (415) 664-1102 Department Windows MBNA? Permit Fee ... Business License Fee Copies' R L Mileage Postage Post to Job Site QO photos A Q 1> Plot Plan U To Customer To Sears Final Inspct Set for H'Ownr Notified by- Final Inspct Set-On.- 11 stoke W/ H'ownr • ' , a.' — LR MSG on Machine - Lit MSG W/ Family Mb Notes l�`t\C:�O�J �- !-�W ��N� . Canty � 6�-�•iJ� s1�xv.k�;. - i Saturday, November 08, 2003 Page 121 of 565 I 'd 9241 BSE 916 42;WS RJew ' 'd14:21 EO of Aou i