04040135 COPY OF COPliR"I'INO
BUILDING DIVISIONPERMIT CON, TORJNFORMATION:3
3 zsz: .z ^x r
BU I LDING A DURESSA PERFECT CLIMATE PERMIT N00 4040135
OWNERS NAME: PERMIT ISSUE DATE-
ELIZABETH DELANDRO 10570 DEANZA FIND 04 /21 /2QQ4
ONE: SANITARY NO. CONTROL NO.
(408) 861-9545
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O p LICENSED CONTRAcl'OR'S DECLARATION - qqq qrt�pEP��
y w F 1 hergby affirm that 1 am licensed under provt, of Chapter 9(commencing lob DescrlptionFI NA LE
aZw with Sc litv(v!(IrN))nf D' ixion3of the Businessand i,mica dc.and myliccn -is TN
in
Fid in . > DD A/C
;E Date Lie.r MAY 20' 2004
Fw Date Contractor
CL .
<f-a AS Hll13CTS DECLA O
y a a 1 Inde smnJ my plans shall W used as puhlic rcnnJs
=o� LicersedPrnfcssi,nal BUILDING
S OWNER-BUILDER DECLARATION
a E I hcrcby affirm that I am exempt from the Contractor's LiOhmc Law fur the
p o following reason.(Section 9031.5.Business and Professions Code Any city or county
K m which requires a permit n,construct,niter,improve,demolish,m repair any,dmnurc
dzi prion,i¢issuance,also requires the appliam for such permit wflcasigneJ stammem
q < that he is licensed pursuant to the provisions Of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
Is IG (cnmmcucing with Seml,n]I%10)in Division 3 of the Busing and Ethicist
or
i thou he is exempt throe mon and Ne basis for the alleged exemption.Any=of
action 9031.5 by any applicant for a permit subject the applicant to a civil finally of 3-AT10CQb*Zer0 0 Occupancy Type
not more than five hundred dollars(S50P.
D L as owner of the property,or my employees with wages as their sale eompenhumn,
will Ju the work,and the structure is not intended or offered for solo(Sec.7044.Business
and Professions Code:The Cmurcel .License Law dace at apply to an owncr of Required Inspections
property who builds or improves thereon.and who does such work himadf m through his
awn employees,provided that such improvements are not usu ndcJ.,offered for sada IL
however.the buildingor improvement is sold within one year ofenmpletion,meowner
-
builder will have the burden of proving that he did not Wild or improve for purpose of
sale.l
❑1,as owner of Ne property,am exclusively contracting with licensed contractors to
consumer the project(ac.9BE4,Business and N.C.,,mns Code:)no Conl Sam's Li�
Come law does not apply to an owner of property,who builds or improves themon,and
who contracts for such projects with a eontracmrEd licensed pursuant to me Contractor's
License Law.
❑ 1 Can exempt under See. .B&P C for this reason
1C337371M
ner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affnnt under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate,(Consent to acif-home for Worker'xCompcn-
inn,as provided for by Section 39W of me tabor Code,for the performance of the
rk for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
of the Labor Cotte,for the performance of the work for which this permit ix ie ted.
Wnrkcr's n pensatinn Insure cc carticr and yPutNo.�ntbcrEEESc . C Policy Nu.: 'bl�l/x:1jL)/LGE—/7
C R IF[CATE OF OMPENX IINN iBPN E RKERS'
COMPENSA NIN ANCE
(This sermon need not be completed if the Permit is for one hundred dollars(SIPut
tr Iess.7
I cenify mat in the Performance of the work for which this permit is issued.I shall not
mploy any Person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,alter making this Cenilieote of Exemption,you should
become subject to the Workers Compensation previsions of the Labor Code,you most
.J z forthwith comply with such provisions or this permit shall W deemed revoked.
z CONSTRUCTION LENDING AGENCY
I hereby affirm mal mere is a emetioulm.lendingagarey for he perrurmencc of / '"
(Yi the work for which this permit is issued(See.3099.Civ.Cf ///����
W Q lender's Name
5 z Under's Address
U O 1 certify that I have read this application and state that me above information is
W Hcorrect.I agree to comply with all city and county ordinances and state laws relating to
W buildingconstruction.
fac and farcbyaum ini S2prescnlativcs of this city menter upon the
W ahovc (We) gree to save fm emnify and kctpscs.
(~ t1 (We)agree m save,indemnify and keep harmless the City nc Cupertino id Citagainst
z liabilities,C e.fthe"Crindexpenscswhichmayin anyway accmc a&ainssaid City
V z In,
eF
coftheFraming,(thispermit.
PUNDERSTA gal Np WILL COMPLY WITN�i-L 1' N-POINT Issued by: DateGULATIO
Z, d Re-roofs
si nacre fAp 'caMQno mr Dam
I IAZAItDGUS M ERIAL CLOSURE Type of Roof
Will the applicanlmfulurc bui gneeupanlstoremhanRe hamandm,material
as defined by the Cupertino Cg Chapter 9.12.and the Health and Safety
ode,Se❑cyeCS 25532(a)? unNo a All roofs shall be inspected prior to any roofing material being installed.
Will the applicant m f e it 'ns,«,pam,.a ey,ipmem or dcvlees which If a roof is installed without first obtaining an inspection,I agree to remove
,it haaamma, it eonmml to as teed by tha Bay Area Air Quality Management all new materials for inspection.
o-in?
❑yes r
I have read me rardnusm •rials myuircmcntx under Chap¢r6J5 of me Califnr
nig Health&Safcly Code,Seeuons 25 .25533 and 25534.1 onder,mad mot if the building
Jces not curzenlly vc a tenant,mm it is my MNiuuly the c<upant of me
gma,mentsw - mustbc pora pan'r- Signature of Applicant Date
an"
Fenl ate All roof coverings to be Class "B" or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS;( RMIT # I�
��
OWNER'S N 1 - Cl r-O PHONE # CIO g 9
GENERAL CONTRACTOR: 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
eating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
'&�eVtontractor Signature Date
CITY OF CUPERTINO
CC � FURNACE/ACo� 6 �( 3S -
ITY OF
UPERTINO PERMIT APPLICATION FORM
APN # Z31 IS 0 Date: `"1 Zl I CH
BuildinVCd AA &'+-
Ow �)aC/l�'INam �� �IPhone #:
IAN P-731 :`� z(Dz l
f
C ntractor: Phone: License #•
G -�t S 0,11
231 S
Contact:LASC� Phone: 1 i l
. ( G�I ' Cupertino Busine License#:
Building Permit Info: — l
Bldg ❑ Elect Plumb ❑ Mech
Job Description,
Residential Commercial ❑
For Residential Installations:
Attic ❑ ls` floor ❑ 2nd floor❑
Adhere to min set back requirement❑
or Commercial Installations:
eplacement_same weight ❑ Additional weight (structural calcs) ❑
Structural Ca'Iculatioins re� ed for new installation ❑
Now installation Planning Apbroval Required ❑ 1
,Cost o Project: Type o Construction: Occupa cy gr
t a pie n Platform ❑ onded ❑ Sq.Ft. Floo
New Location ❑ Replacement ❑
Qt .-if
A 1' ab Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfin MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 elm 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 Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License L - BUILDING
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