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03100170t I Q Z r CITY OF CUP,R,rINO BUILDING DIVISION PERMIT aCONTRACT012,INFORMATION� BUILDING ADDRESS: 1683 CASTI.FTON RT ALLIED AIRE SERVICE INC PERMIT N003100170 OWNER'S NAME: 661 SINCLAIR FRONTAGE RD PERMITISUEDATE BAILEY JOHN 0 AND ALVADA J 23 2003 NE: (408) 934-8844 SANITARY NO, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR DECLARATION o Job Description al I am d am&, provisions of Chipter 9 (rommen,mg 1 hereby affirm mIia an With Section 7000)ofDivision3of me Busincssand Professions COde,and m licensers m sen mads erre pp License Cl s REPLACE FURNACE & ADD ASC p ��QL M xMO Cmair _ Convaclor b 1 ARCHnECCS DETION I understand my plans shall he used as pVhllerectna, I'1 11 NOV / `! 2003 C Licensed Prefcssimmi OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law fur the �)tt �n �� U following reason. (Section ]131.5. Business and Professions Calc: Any city Or county IC u x u which requires a Permit to construct, alter, improve, demolish, or repair any structure S34 Prior m its occanee, al.su requires the applicant for such Permit u Glc a signed statement Sq. Ft. Floor Area that be islicensed pursuant mthe pm.ixmnsofthe Contractor's License Law (Chaplcr9 Valuation (commencing with Sampan 7000) of Division 3 ofthe Busincssand Professions Cak)0 35618066.00 Oak he is exempt therefrom and On beau for the alleged exemption. Any vialmion of Section ?031.5 by any applicant for a permit svbjecttthe applicant to a civil Penalty of APN Number Pane Occupancy Type Y YP not more than five hundred units,, ($50 o). ❑ Las owner attire propero , Or my dmployc. with wag.. their sole compensation. will do the work, and the structure is not intended or offered for sale (See. 7044, Rustiness Required Inspections and Professions Code: The Comment's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his Own employe., pmvided that such improvements are not intended or offered for sale. If. however, the building or improvement is sold within one year of completion, the owner. builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 h as owner of the propcny, am exclusively contracting with licensed cantnetom to construct the pmjecl (Sec. 7044, Basincss and Profcdxions Cade:) The Contractor's Li- . cense Law docs not apply to an owner of property who builds or improves thereon, and . who consumers for such projects with a eontrim or(s) licensed pursuant o Ik Contractor's License law. [31 am exempt under Sec. B A P C for this reason Owner Date WORKERS COMPENSATION DECLARATION I hereby affirm under Penalty of pe jury one of the fallowing declarations: 1 hoe and will maintain a Cenificme of Cogent to self-i.mc for Warkcrs Cumpcm nation, as provided for by Section 37M of the labor Code, for the prourim nce of the work for which this Permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, u required by Section )700 afore Labor Code. for the Performance of me work for which this Permit is issued. MYY`\Wor.k[9[ts�ComPensation Insurance eanicr and Policy number art: CarMY '• k 14TL �U an Policy . o00 - CERTIFI ATE OF EXEM PTIO MWORKERS' COMPENSATION INSURANCE (This xenon need not M COMPlned if the Irrmil is far one hundred dollars (SI W) or less.) 1 certify Our in the urrom ance of IM work rut which this Pcrmil is issued, 1 shall not employ any person in any manner so as to become subject to the WorkersCompensation Laws of California. Data Applicant NOTICE TO APPLICANT: If, aftermakingthis Certificate of Exemption, you should become subject to the Worker's Compensation provisions Of the labor Calc, you must fmmwilh comply with such Provisions or this permit shill IN, deemed revoked. CONSTRUCTION LENDING AGENCY 1 herby affirm mal mere is a conslracrum lending agency for Inc performance of the work for which this permit is issued (Sec. 3097, Ci, C.) Lender's Name Lender's Address 1 certify that 1 have moa oris ncaaun and dints sen nabove information is building I agree to comply with all city and county ordinances f andd Cott laws refiling m building conswNpn.and herebyection ivcs o!NisCity Ioenter upon the annve-mentioncd Propcny for inspection Purposes. Purposes. (We) agree to v indemnify and keep totemic. the City or Cupertino against liabilities,-udgments.c and es which may is any way see= against mid City in inn tie cc d(the ntin Of sPcrmit. APP CA UND S COMPLY WITH ALL NON -POINT / Q Issued by: Date / 7 U SO RC EGU S. Re -roofs Type Of Roof 3 03 wuirc of ApplicandComreaor Date HAZARDOUS MATERIALS DISCLOSURE Will Or applicant or future building Occupant arum or handle harudous material az defined by the Cupenum Municipal Code, Chapter 9.13, and the Health and Safety dc, Section 35532(a)? C3 Yea lkNu All roofs shall be inspected prior to an roofing material being P P Y g g installed. If a roof is installed without first obtaining an inspection, I agree to remove Will mea scant or mmrc building t use equipment or devices whim nn g by In, B it hazardous air contaminants . JclincJ by the Bay Arca Air Quality Management all new materials for inspection. Dorm ❑Ye,No I have read the haraNnus m ,mals requirements under Chapter 6,95 of me Cali for Iia Heal afmyC See)S.3S533and35534.1undersundmmifrMbuiimng 'al J<v ncar Wtly as testant iI is y r .iniliry les nadfy me acuPw of dr Mgll m file s C for Itl lssuNCCO CCIIIfiLdIC nfQ YP0n1 . Signature of Applicant Date G o3 All roof coverings to be Class "B" or better wnd,Or dagcnl avhoriy as =zp 8 G d-� MY OF CUPERTINO CITY OF CUPERTINO o 3 � 0 C>/ 7o FURNACE/AC PERMIT APPLICATION FORM APN # p ft7 Date: �^ -) ;L2 Building AddresM (jl f i MECHANICAL Owner's NyIIle: Phone #: I L.(" - BREMAIRRAN Contract Phone: L -LI Z �; = 4-D t 9 34 - �f License #: ar0003� Contact: - Phone: Cupertino Business License #: ELECTRICAL BSEISMICRE Building Permit'Info: BUILDING Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: ��! ✓� eJ1{ Residential ❑ ommercial ❑ MECHANICAL For Residential Installations: Attic ❑ 1" floor ❑ 2nd floor ❑ Plumbing Permit Issue Adhere to min set back requirement ❑ BPERMFEE For Commercial Installations: BUILDING Replacement same weight ❑ Additional weight (structural calcs) ❑ Plan Check Fee Structural Calculations required for new installation ❑ BUSLIC New Inst lation Planning A rov a uired ❑ BUILDING Cost of ectf-Type of Construction Occupancy group: Strappe ❑ n Platform ❑ Bonded ❑ Sq.Ft. Floor Area: ❑ New Location Re lacemek/u QtlAda Auo fable Fee ID Fee Descrintion Fee Gronn BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRRAN A/C Units <= 10, 000 cfm MECHANICAL 1 BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMTI'FEE Elec Permit Issuance ELECTRICAL MPERMTI'FEE Mech Permit Issuance MECHANICAL PPERMTTFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING Z c I