03080037 CITY OF CUPERTINOF+
BUILDING DIVISION PERMIT �CONTRACTOWINFORMATION
BUILDING ADDRESS: KESTER HEATING AND AIR CON EaMITN°03080037
t OWNER'S NAME: 4351 GLENPARK DR PERMIT ISSUE DATE
NANCY
"E (408) 265-1103 SANITARY NO. CONTROL NO.
ARCHITECT[ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
Zoo LICENSED CONTRACTOR'S DECLARATION lob Description
U 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing p
with Section7H )or Division)ofthe Busi orad Pmrmiom Codo,stdmyliccnmis
mfull fme,ppndeffen. gf(ob ADD A/C
d ? Lkensa CMs C.-2n Lk.N
a t- DamConvenor
ARCHITEC'SD AUG 13
E I understand my plana shall W used u uhl+e rcrnNs 2003
)LOU
Licensed Professional
OWNER-BUILDER DECLARATION IO II B�II ®�Npq�
<F I hereby affirm that I am exempt from Ne Contractors License Law for the BN9 L
COO following reason.(Section 7031.5,Business and Professions Cale:Any city of county
$ which requires a permit to construct.alter,improve,demolish.,repair any swnum
.Za prior to its issuance,also requires the applicant(Or such permit to file a signed Statement
p0 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
}E (commencing with Section 7")of Division 3 of the Business and Professions Code)ur
$
at he Is exempt therefrom and the bmis for the alleged exemption.Any vMidimn of 35716114 . 00
Section 7031.5 by any applicant for a permit ubjects Ne applicant to a civil penalty of APN Number Occupancy Type
not mom Nan five hundred dollars(5500).
❑1.xammrofthe pmpeny,ormycmployem with wageautheirsrle compensation,
will do Ne work and Ne sw,ure is not intended oroQertd fertile(Sec.704.Business —
and ProThns
fessions Code: e Contractor's License Law donot appy m to owner or 303 — ROUGH CHAN I AL ns
property who builds or improves thereon,and whodeessuch work himselfor through his
own employcm,provided that such improvements am not intended nr offered for sale.If. 304 - ROUGH ELECTRICAL
however,to building or improvement Is sold within one year of completion,the owner
bui lder will have Ne burden of proving Net he did not build or improve for purpose of 501 - FINAL ELECTRICAL ENERGY
sale')' 502 - FINAL PLUMBING ENERGY
❑1.as owner of the pmpeny,am exclusively contracting with licensed Cro lfatma to 503 - FINAL MECHANICAL ENERGY
contract the pmjcci ISec.7044.Business and Prafeasions Code:)The Conuacbrs Li
Come law does not apply to an owner of p,pesy who builds or impmws Macon.and. 505 — FINAL ELECTRICAL
who contracts for such projects with a contractor(s)licensed pursuant m the Contractors
License Law. 507 - FINAL PLUMBING
❑I am exempt under Sec. ,B&PCIm Npreasun 508 - FINAL MECHANICAL
1037.0)
ner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affrtm under Nulty of perjury one of Bte following declarations:
1 have and will maintain a Ccnificam of Consent to self-imum for Wortrrs Compen-
ion,of provided for by Section 37M or the Lob,Code,far the perfmmaae of the
rk for which this pcnnil is issued.
1 have and will maintain Workers Compensation Insurance,as required by Section
!mf the Labor Code.for Ne performance of the work forwhich this permit la Issued,
Worker's Cnm ensaIII Imumnceeartic��n��nggd Polley n��um�l'm�'�ra��m�12 me - 1 NP�YRSB<Y No.0 1
CERTIFICATE OF ( PI70N FR WORKERS'
COMPENSATION INSURANCE
(This.actin need not be competed if tbe permit is foronc hundreA dollar(3100)
Ices.)
1 certify Nat in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as at become subject to the Workers'Compensation
Laws of C.Iiforo..Data
Applicant
NOTICE TO APPLICANT:IL after making this Cer ,iream of Exemption,you should
become subject.the Worker's Compensation previsions of the Labor Code,you most
.JO forthwith comply with such provisions or this permit shall w deemedvo
reked.
z ti CONSTRUCTION LENDING AGENCY
Fr IherebyaffirmNatMoreisaconsimedinrlendingagencyl'ortheperforanceor
FY> the work fur which this p,mlt is issued(Sec.3097,Civ.C.)
U1 Q Under',Nauru
z Lander:Address
U 0 1 aNfy that I have read this application end state thn Nc sbnve information is
L-' toren.l agree to comply with all city and county ondounces and sum laws relating to
DU building construction.and hereby authodne representatives of this city to enter upon the
G
(We)agree to save,indemnify and kith hay in an @e City of against
id City
N liabilities,judgments.costs nond expenses which may in any way accrue egelnA said City G
U z, in consayucnec ofthcg rating of this permit.
" APPLICANT UNDE TANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR LAT+ S.
(/ �( g-U-a Re-roofs
Sin re ofAl¢^aMCont sur c Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or ratio.building Occupant at..or handle haaNuus material
as defined by the Cupertino Municipal,Code,Chapter 9.12,and the Health and Safety
ode,Section 25333(e)?
Yes
All roofs shall be inspected prior to any roofing material being installed.
❑
Will the applicant or future building occupani um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air Contaminants as me l by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yea
1 have real the hmanl"usmamrialsrequirements under Chapter 6.95 of Ne Califon
ria Hardt&Safety Code,Sections 25505,25533 and 25534.1 understand that if dm building
does notcurrently h a mount.Nat it is my rmponchility to notify the Occupant of the
mead owhich oat bemet poor to Issuance off CaurmakeofOccupercy. Signature of Applicant Date
-II All roof coverings to be Class"B" or better
er faction. a m Date
CITY OF CUPERTINO
�0 mgJ F URNACE/AC v3 CIT 0
11,? " 3
�UPERTINO PERMIT APPLICATION FORM
APN # .:� / f Date:
I -) 1 -03
Building Address:
VO 4- 1?iMa-,,J A e—r
Owner's Name: Phone#:
Contractor: Phone: a $ License#:
4- 55A1160
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elec Plumb Mech
Job Description:
A a
Residential tom' Commercial ❑
For d tial Ins llations:
Atti 15, floor2"d floor❑
4dhere to min set back requirement[]
IFFor Commercial Installations:
Replacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation
New installation Planning Approval Required ❑
Cost of Pr ' t: _Type of Constructi Occupancy
Strapped On Platform Bonded ElSq.Ft. Floor
New Locationo'll Replacement ❑
Qty. if
App c e 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 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 BUILDING
ago . 7 7