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05030028
CITY OF CUPERTINO ( BUILDING DIVISION PERMIT 4CONTRACTOR,INFORMATION �`+'s BUILDING ADDRESS: A PERFECT CLIMATE PERMIT NQ,5030028 776 CARNTRR- DR OWNER'S NAME: PERMIT,SUE DATE ONE: SANITARY CONTROL NO. ARCHTIEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH I� LOZp LICENSED CON'TRACTOR'S DECLARATION Co I Worthy afBmt that I am IicemW under provisions of Chapmr 9(commencing Job Description i6 withSation 7%,O)Of Division 3 of.Business and Professions Code.and my license is A<6In rUl rOfCt indt L -ou, uscowaria YE.C-ad Lic.a 7a+31S� REPLACE FURNACE, ADD A/C Z F n Dam Com.clor ')' ARCHITEECTS DECLARATION U I unMrstnnd my Plans shall used u public 3 GL; Licensed Professional OWNER-BUILDER DECLARATION .�<f 1 berchy affirm that 1 am exempt from the Contractors License Law for the 00 following mason.Section 7!131.5,Business and Profewiens Code:Any city or county $ which requires a Permit to construct,alter,improve,demolish,or repair any suunme prior in its issuance.also requires Ik applicam forwch permit to rile a signed sutement h�'< think is licensed pursuant o tic provisions of the Contractor's Lianm Law(Chapter 9 Sq. Ft. Floor Area re/ auation oll--0 (commencing with Section 7")of Division 3 of the Business and Professions Code)Or w. $ that he Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a Permit sanccu the applicator to a civil penalty of 3-�� �� COQ cupaney Type not mos:than five hundred della.(5500). ❑1,as Owner of dao propenY•a mY employees with wages u their sole compenation, will M are work,and thcstruaure is not intended in offered for ale(Sec.7014,Business and Proreuiom Code:The Contractors License law does nut apply to an owner of Required Inspections propeny who builds orim news tbemon,and who doessuch wort himself orthrough his Own employees,provided shot such improvements are netimanded or offered Formic.it, however,Ne building or improvement is sold within one year of completion.the Owner- Wilder will have the Wrdcn of proving that he did tint Wild or improve for purpose of salt.). ❑1.as owner of tM prophecy,am exclusively concocting with licensed comsacmrs to Construct the project(Sec.7061.Business and Professions Code)"DO Convactori U cense law docs not apply to an owner of property who builds or improves daemon,and . who contracts for such projects with a convacter(s)licensed pursuant to the Contractors License law. ❑I am exempt under Seo. ,B&PC for this reason Owner Dam WORK ER'S COMPENSATION DECLARATION - 1 hereby affirm under penalty of injury one of the following declarations: T haw and will mainuin a Cenifam efC...L to mlf-insum Por W(XkCr's Compdm 137W den.as provided for by Section 37M of the labor Cads,for the performance of the rk for which this permit is issued. I have and will maintain Workers Compensation Insurance,as"Cited by S C ion ofthe labor Code,for the pciformarec of the work for which this permit is issued. yWorkersC mpenxa6. 1. tone C. C and Policy mark,rsier:Njg a ) TION Na: aQ' t 1943 CERTIFICATE OF (FMP7lON FROM WORKERS' COMPE SATION INSURANCE Thissection need not tecompleted if the permit is feronc hundred Mlle.(5100) or less.) I certify tha in the performance of the work for which this Permit If issued,l shall not employ any pawn in any mannerw ax to become subject to the Worked Compensation Laws of Califamix Dam Applicant NOTICE TO APPLICANT:If,after making this Ccnifcate of Exemption,you should become subject to the Workcri Compensation provisions of the labor Codd,you must .JO rayl comply with such provisions or this Permit shall W domed mvokd. Z" CONSTRUCTION LENDING AGENCY Ihereby effort that there is a comquctimn lending agency for the Performance Of fY the work for which this permit is issued(S.C.3097,Civ.C.) fz1 QLender's Name D a.z lender's Address U C) I aniry,that I have read this application and sum that the allow information is U. F correct.l agree to comply with all city and county ordinances and sic a laws relating to 0 building construction,and hereby authorim mpresenutiws of this city to enter upon the r above-mentioned pm,,oty for Inspection purposes. e).,.I.save,indemnify and keep ty or Co,ohno F'r4jj IiabilidesWjudgmenu.costs and expenses which may in my way nsee=against sand City U in consequence of the granting of this permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date E 'G ATIONS 3 >Gv� Re-roofs Signarert of App i.VConlracmr Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding OCCupant nom or handle hisOmmus material as defined by the Cupertino Municipal Code,Chapter 9. 2,and the Health and Safety Code,Section 25532(.)? All roofs shall be inspected nor to an roofing material bei. ❑Yea p p Y g g installed. Will the applicant or future Wilding occupant esu equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit harmdous air conuminans.dcfned by the Bay Arta Air Quality Management all new materials for inspection. ,avno, 1 // ❑Yes VNu I have read the h.odous mamrisla rtquiremenu under Chapmr695 of the Califm nix Hcalth&Safcty Cade.Sections 25505.25533 a.125536.1umle.und therifthd Wilding dots not currently haw a tenon,that it u my responsibility to notify dac Occupant M the item a Mmmnat mptiprmi aananracdnireatepraaanyr. Signature of Applicant Date sones or amhorited age t o,te O All roof coverings to be Class "B" or better Community Development 10300 Torre Avenue H / Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRESS: PERMIT # ©S-0 o 0 2-.7 /07762 G L OWNER'S NAME: PHONE #(70'7) 3/5 42L7 GENERAL CONTRACTCV FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followinginformation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical iix� 7-2-5152 Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 3�aJ�c� Owner/Contractor Signatur Date OSfl3 0oZ � CITY OF CUPERTINO 11 ,e FURNACE/AC Cm or UPEkj1N0 PERMIT APPLICATION FORM ., - APN # Date: 375- 32- d Building Address: Owner's Name: Phone #: C cto Phone: License#: 1/09) d'(nl— 95 5 '7. 3/56 Contact: // Phone: Cupertino Business License #:_ k.U�- Building Permit Info: _ Bldg ❑ Elect -Plumb ❑ Mech Job Description: Residential ..Cohmercial ❑ _. For esidentialInstallations: ttiVt floor ❑ 2"d floor❑i�dhcrc to min set back requirement❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ — Cost of Projec - Type of Construction: Occupancy group: 1 '700 Strapped ❑ On Platform ❑ Bonded ElSq.Ft. Floor Area: New Location ❑ Re lacementj;al` Qty. if A licable 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 cfin 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