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03050107 CITY OF CUPERTINO a BUILDING DIVISION PER C0N:'TRACTQRINI+'0RMf1TI0N _ Bu1LDINGADDRESS: CONDITIONED AIR PERMITN0.03050107 92 CANTFIRIXInOD MR OWNER'S NAME: 1701 LITTLE ORCHARD ST2/2003 J ME: (408 2 91-2220 SANITARY NO. CONTROL NO. ARCHOECTrIENGINEER: BUILDING PERMD INFO BLDG ELECT PLUMB MECH ioo LICENSED CONTRACTOR'S DECLARATION I� T hereey rfim, v t l am lia fieonscd under Prelim.Prelim.of Chapter 9 mcomp-Acing Job Description wise$cctiont of saof a'ncas mfrs m,Code.and my license is , N mmurerceande oC 51�p REPLACE FURNACE & A/C k v2 z License Clam -Fp Dow Corer mr £S AR erl E RATION I C� I�!M•+�anJ my plans shall le use uMic records a U W lwsv y A 0� Licensed professional NOV 1 0 �] OW NER200v1BUILDER DECLARATION 1 i fI family aRrm that 1 am ucmpt from the COm acmh License Law for the po followingmurn.(SAMi 7131.5.Business and Pmrcimns Code:Any city of county <m 8 which requires a permit m en.L alter,improve,demolish,or repairmysvucture uzi Prim m its im......1.require the applicant for such Permit o file a signed suumem BUIYAw < that he is li<cnuJ Putwanum tie provisions of Ne Crntncmr's Liccnsc law(Chaper9 .Sq, Ft. Floor Area n 2F0 (commencing with Section 7")of Division 3 Of the Business and Professions Cnle)or s '59 Nat W is eacmps tMmfmm and the bete for the alleged eaempslon.Any violation of Section 7031.5 by any applicant for a permit subjecu the applicant o a civil penalty of 3$$hI B10rAheC 0 0 Oeeu ane Type not more man five hundred dollen(350(y. p y yp ❑1,as owner of me .,0,At my cmplryee with wags As their sol.Cron,astlan. ,,p g��--tpp�t�T[�f]� 'S will do lie work.and the atmomm is not intendMi or olfated formic(Sec.7001,Busimas UGH SQC� Ctions and Pmfeuiom Code:The Contrum/s License law doe not apply b an owner of propcnywh.builds orimpr.ves Narcan,and whoduessuch work himulforthmugh his 303 - ROUGH' M CHAN CAL employees.provided lost such impmanocom...Iint.rwwnroBerwfmsam.If. 304 - ROUGH ELECTRICAL however me building of imp snvemenI is sed within orc yea of compledun,th.owner- . builder will have the burden of proving that x did not build or improve for purpose of 505 — FINAL ELECTRICAL ml'.)' 507 - FINAL PLUMBING ❑L u owner of the progeny,,mum.And contracting with:)Thic d con.acmrs to mmwn theprojectpply to an weer of andny who Wit" Coximpr C.demon,u- 508 - FINAL MECHANICAL come law dam not b an owner of p emot.who builds or improves thereon,and, who nse Lace for such pmkeu with a crnvacnorts)licensed punuam to the ConuacmM1 License law. El I am excmpo..it.,Sec. .B&P C for Nis moron Owner Dat WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of Perjury One of Ne following declarations; I have and will maintain a Cenificam of Consent m selGinmrc for WorkeesCompen- 73700.1fth, on,u provided for by Section 37M of th.labor Code,for the performance of the k for which this pemnit is issued. 1 have and will maintain Worke!s Compinsmon Insurance,at r.gaired by Section tabor Cede.for the Kd.rmanee of theryfis for which this permit is issued. Worker's pe alio/ Imunnee cavi e ry ther. �r dicy No.:no nl CERTIFICATE OF EXEMPTION FROM WORKERS)_�1•`]Y1�1-1 COMPENSATION INSURANCE (This section need not becomplcied if the permit is intent,hundred dmllan(SIM) M­less.) 1 comfy that In to performance of the work for which this permit is issued.1 shall not employ any prom.i.my manner An as m Imu mr subject m the Wimlor.Compensadon Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making this Ccnifica c of En.mpsion,you should become subject to the Worker's Compensation provisions of the Labor Code,you must .J O foMwuh comply with such prnmvm viAmis or this Permit Ise deemed reked. Z' CONSTRUCTION LENDING AGENCY [-. N I hereby aRrm that then is a construction lending agency for the Performance of lYi the work for which this Permit is issued(Sec.3097.Ci,C.) 1 Q Lender's Name 7 ,Z Lender's Address V O I cenify the T have lead this application and sato that the show information is LL Pconed 1 agree in comply with all city and county ordirumea and sue laws relating to V building conswction,and hereby authonn mpresenutises of this city in enter upon me 4S1 above-mentioned property for inspexien purposes. F n. (We)agree to save,indemnify and keep hamias the City of CupMmAo against fq Liabilities.judgments,costa and espcmm which may in my way secmc against mid City in of doe ranting of V ? APPLICANT`UNDERSTANDS AnND WILL COMPLY WITH ALL NON-POINT Issued by: Date 9,?" SOURCE R GUE CATIONS. ( ,//V�UL_q./.I MY"1 Ii Re-roofs Signal or ApplicanU tractor Date H RDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant orfuture Wilding Occupant more or handle tuamilous Malone e xfined by the Cupenino Municipal Cox.Chapter 9,13,and Ne Health and Safety ode.Section 25532(x)? Yes All roofs shall be inspected prior to any roofing material being installed. ❑ Will the applicant or furore build becupanl me equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it M.dous air conuminanu u ncd by the Bay Arca Air Quality Management all new materials for inspection. Distrix? ❑Yea IhavcmadthelmnNrwsma nalsmquiremenuunxrChapwr6.95of0uCalifor- nia Hraith h SgctyCox.Sectiom 25505,25533 and25531.1 unxntand 0wif the building dem not currently haw a nemant,that it As my romeMihility m nuufy the occupant OF me mquimmrm; to must W met p' miss c9ofa Certificate of0crvp Signature of Applicant Date own ra.. ..ctlagcnt Y S! Date All roof coverings to be Class "B"or better CITY OF CUPERTINO a BUILDING DIVISION PER C0N:'TRACTQRINI+'0RMf1TI0N _ Bu1LDINGADDRESS: CONDITIONED AIR PERMITN0.03050107 92 CANTFIRIXInOD MR OWNER'S NAME: 1701 LITTLE ORCHARD ST2/2003 J ME: (408 2 91-2220 SANITARY NO. CONTROL NO. ARCHOECTrIENGINEER: BUILDING PERMD INFO BLDG ELECT PLUMB MECH ioo LICENSED CONTRACTOR'S DECLARATION I� T hereey rfim, v t l am lia fieonscd under Prelim.Prelim.of Chapter 9 mcomp-Acing Job Description wise$cctiont of saof a'ncas mfrs m,Code.and my license is , N mmurerceande oC 51�p REPLACE FURNACE & A/C k v2 z License Clam -Fp Dow Corer mr £S AR erl E RATION I C� I�!M•+�anJ my plans shall le use uMic records a U W lwsv y A 0� Licensed professional NOV 1 0 �] OW NER200v1BUILDER DECLARATION 1 i fI family aRrm that 1 am ucmpt from the COm acmh License Law for the po followingmurn.(SAMi 7131.5.Business and Pmrcimns Code:Any city of county <m 8 which requires a permit m en.L alter,improve,demolish,or repairmysvucture uzi Prim m its im......1.require the applicant for such Permit o file a signed suumem BUIYAw < that he is li<cnuJ Putwanum tie provisions of Ne Crntncmr's Liccnsc law(Chaper9 .Sq, Ft. Floor Area n 2F0 (commencing with Section 7")of Division 3 Of the Business and Professions Cnle)or s '59 Nat W is eacmps tMmfmm and the bete for the alleged eaempslon.Any violation of Section 7031.5 by any applicant for a permit subjecu the applicant o a civil penalty of 3$$hI B10rAheC 0 0 Oeeu ane Type not more man five hundred dollen(350(y. p y yp ❑1,as owner of me .,0,At my cmplryee with wags As their sol.Cron,astlan. ,,p g��--tpp�t�T[�f]� 'S will do lie work.and the atmomm is not intendMi or olfated formic(Sec.7001,Busimas UGH SQC� Ctions and Pmfeuiom Code:The Contrum/s License law doe not apply b an owner of propcnywh.builds orimpr.ves Narcan,and whoduessuch work himulforthmugh his 303 - ROUGH' M CHAN CAL employees.provided lost such impmanocom...Iint.rwwnroBerwfmsam.If. 304 - ROUGH ELECTRICAL however me building of imp snvemenI is sed within orc yea of compledun,th.owner- . builder will have the burden of proving that x did not build or improve for purpose of 505 — FINAL ELECTRICAL ml'.)' 507 - FINAL PLUMBING ❑L u owner of the progeny,,mum.And contracting with:)Thic d con.acmrs to mmwn theprojectpply to an weer of andny who Wit" Coximpr C.demon,u- 508 - FINAL MECHANICAL come law dam not b an owner of p emot.who builds or improves thereon,and, who nse Lace for such pmkeu with a crnvacnorts)licensed punuam to the ConuacmM1 License law. El I am excmpo..it.,Sec. .B&P C for Nis moron Owner Dat WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of Perjury One of Ne following declarations; I have and will maintain a Cenificam of Consent m selGinmrc for WorkeesCompen- 73700.1fth, on,u provided for by Section 37M of th.labor Code,for the performance of the k for which this pemnit is issued. 1 have and will maintain Worke!s Compinsmon Insurance,at r.gaired by Section tabor Cede.for the Kd.rmanee of theryfis for which this permit is issued. Worker's pe alio/ Imunnee cavi e ry ther. �r dicy No.:no nl CERTIFICATE OF EXEMPTION FROM WORKERS)_�1•`]Y1�1-1 COMPENSATION INSURANCE (This section need not becomplcied if the permit is intent,hundred dmllan(SIM) M­less.) 1 comfy that In to performance of the work for which this permit is issued.1 shall not employ any prom.i.my manner An as m Imu mr subject m the Wimlor.Compensadon Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making this Ccnifica c of En.mpsion,you should become subject to the Worker's Compensation provisions of the Labor Code,you must .J O foMwuh comply with such prnmvm viAmis or this Permit Ise deemed reked. Z' CONSTRUCTION LENDING AGENCY [-. N I hereby aRrm that then is a construction lending agency for the Performance of lYi the work for which this Permit is issued(Sec.3097.Ci,C.) 1 Q Lender's Name 7 ,Z Lender's Address V O I cenify the T have lead this application and sato that the show information is LL Pconed 1 agree in comply with all city and county ordirumea and sue laws relating to V building conswction,and hereby authonn mpresenutises of this city in enter upon me 4S1 above-mentioned property for inspexien purposes. F n. (We)agree to save,indemnify and keep hamias the City of CupMmAo against fq Liabilities.judgments,costa and espcmm which may in my way secmc against mid City in of doe ranting of V ? APPLICANT`UNDERSTANDS AnND WILL COMPLY WITH ALL NON-POINT Issued by: Date 9,?" SOURCE R GUE CATIONS. ( ,//V�UL_q./.I MY"1 Ii Re-roofs Signal or ApplicanU tractor Date H RDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant orfuture Wilding Occupant more or handle tuamilous Malone e xfined by the Cupenino Municipal Cox.Chapter 9,13,and Ne Health and Safety ode.Section 25532(x)? Yes All roofs shall be inspected prior to any roofing material being installed. ❑ Will the applicant or furore build becupanl me equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it M.dous air conuminanu u ncd by the Bay Arca Air Quality Management all new materials for inspection. Distrix? ❑Yea IhavcmadthelmnNrwsma nalsmquiremenuunxrChapwr6.95of0uCalifor- nia Hraith h SgctyCox.Sectiom 25505,25533 and25531.1 unxntand 0wif the building dem not currently haw a nemant,that it As my romeMihility m nuufy the occupant OF me mquimmrm; to must W met p' miss c9ofa Certificate of0crvp Signature of Applicant Date own ra.. ..ctlagcnt Y S! Date All roof coverings to be Class "B"or better �J CITY OF CUPERTINO 0 FURNACE/AC o 3 S CUPEKTINO PERMIT APPLICATION FORM APN # Date: 2�Z."�J � (0 ( °t 3 Building Address: �ZZ Owner's Name: Phone#: Contractor: Phone: )� License#: qa, �i .2220LI Lt S 1 ( -"- Contact: Phone: Cupertino Busi ess License#: 233 ff Building Permit Info- Bldg ❑ Elect P1m Mec Job Description: ;. /] ; n - n �) C Residential `= 4 Commercial"1❑ /'� For Resioential Installations: Attic I" floor ❑ 2"d floor❑ Adhere to min set back requirement❑ • For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation-Plannm A rovah e uired ❑ Cost of Pr ' ct 1 1 •1S-0 Type of Construction: / Occup cy grou Strappe ❑ —` -4a rm Bonded El / Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Grou BENERGY Ener BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING e BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING �J CITY OF CUPERTINO 0 FURNACE/AC o 3 S CUPEKTINO PERMIT APPLICATION FORM APN # Date: 2�Z."�J � (0 ( °t 3 Building Address: �ZZ Owner's Name: Phone#: Contractor: Phone: )� License#: qa, �i .2220LI Lt S 1 ( -"- Contact: Phone: Cupertino Busi ess License#: 233 ff Building Permit Info- Bldg ❑ Elect P1m Mec Job Description: ;. /] ; n - n �) C Residential `= 4 Commercial"1❑ /'� For Resioential Installations: Attic I" floor ❑ 2"d floor❑ Adhere to min set back requirement❑ • For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation-Plannm A rovah e uired ❑ Cost of Pr ' ct 1 1 •1S-0 Type of Construction: / Occup cy grou Strappe ❑ —` -4a rm Bonded El / Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Grou BENERGY Ener BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING e BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING