04040101 r CITY OF CUPERTINO ' �>
BUILDING DIVISION PERMIT CONTRACTORANI+ORMATION '
BUILDING ADDRESS: AAA FURNACE & AIR CONDITIO Y'04040101
27Q2 ('01,11MBITS A17
OWNER'S NAME: PERMIT ISSUE DATE
CAROL MILL
IF
NE: SANITARY O OL NO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDGEL.ECI' PLUMB MECH
0 0 0 0
u0, LICENSED CONTRACTOR'S DECLARATION - - -
in�� I hereby affirm that I am licensed under provisions of Chapter 9(commencing lob Description
with gectian]llfg7 of Division Sof BC Businaaarid Profcssinm Cade,end myliccnse is 1!"' rtlyy�Wra pp
infullfncemrdcffen. INSTALL A/C Aµ„-°��
pLl: License Clan Lic.N
Dace Convector
ARCHITECTS DECLARATION ALG -P004
1 understand my plans shall tic unit uas public records
h.G 3 Licensed Pmfcssionel
OWNER-BUILDER DECLARATION IYI�II
1 hereby affirm that 1 em exempt from the Canta"ore License law far the
O o following reason.(Section 703 1.5,Business and Profasioes Cade:Any city or county
m E which dopones a permit to consumer,alter.improve,demolish.or repair any structure
pd.,to its issuance,elsu requires Ne applicom fcairmh Permit to file a signed su enu m
toBar he is licensed ppernittoBcforeign.ofthe Cianutur'sBrevelaw(Chapar9 Sq.FL Floor Area Valuation
z
J!5 (commencing exec with S"afted,on and
gu Division r the
the eg elnC9 and Profeon.Any vi Code)of
Bass W is exempt theafrmn and the basis for Ih dl.gcd exemption.Any violation of
Section 7031.5 by any eppliant for a permit subjects the applicator to s civil penalty of 3 96yNg'fI"er0 0 Occupancy Type
not mote Nan five hundred dollars(2500).
❑I,az owner of the property ar my employees with wages as their sale compensation,
will do the work end thestructure is not inandcd or offned far sa4(Sec.7044,Bud.
and Professions Code:The Contractors License law dos trot apply ben owner of Required Inspections
prope coy w ho builds or improves thereon.and who docs inch work himself or through his
own employees,provided Not such improvements are not intended oralremd for sale.IL
however,the building or improvement is sold within ane year of completion,the owner-
builder will low the Wrden of proving that he did not Wild or improve for purpose of
silt.).
❑1.u Owner of the property,am CscluslV.ly Contracting with licensed conesctors to
construct the project(See.7044.Business and Professions Code:)The Contracbrh U.
ccsve law data not apply to an owner of property who Wilds or impraws Berson,and
who contracts for such projects witb a corms etor(s)licensed pursuant o the Comnctor's
Liras,law.
❑l son caempa uadvf Sea. .B&P C far this mool
n'
O mer Cr- ✓""`.^^ria- D 4'/IO—Oi
WORKER'S COMPENSATION DECOON
1 hereby afnmr under mardly of perjury arc of Be following decimations:
( I haw and will maintain a Catarina Consent of Conseno self-insure for Worker's mpe
Con-
non,as provided for by Section 3770 of the labor Code.for the performance of the
7307M
ok for which this permit is ismad.
1 haw and will maintain Worker's Compensation Insurance,as reyvir.d by Section
of the labor Code,for the perforce manof the work for which this permit is issued.
y Workers Compensation Inauuna carrier and Policy number are:
rtier. Policy No.:
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(This senior need not W couridmd Brie .it Is faraa hundred dolurs(SIM)
or icss.)
I artily that in the performance of the work for which this Permit Is Wood,I shall not
employ any person in any discover as to become abject to tire,Workeri Compeaation
taws of Califomia Dau
AppLcanl
NOTICE TO APPLICANT'.If.after making this Cent ficate of Exemption,you should
Wcome subject to the Workers Compensation provisions of dM labor Cade,you must
J Z fothwith comply with such provisions or this permit anon be domed revoked.
ZO CONSTRUCTION LENDING AGENCY
F' Ihereby affirm Bu them is a construction lending agency for the perfurmanaof
a > Be work for which this permit is issued(Sec.3(19].Civ.C.)
Izl A Lcolm'e Nem.
CL LnWcr's Address
U O 1 certify Bat I haw read this application and sate that the aWw information is
It. P cone".1.8ree tm comply wit all city and county ordinances and state laws relating to
building conA
traction,and hereby aWmm minasemadws of this city to enter upon im
U above-mentioned propcny for inspection purpaua
a ///
(We)agra s.cost,inde
mnify., and kap harmless Be City of Cupertino id City
U Z in
o,cosuand espaw_swhicA may in any way attmc egainstsaiO City
U Z m carve ANT of UNDERSTANDS
of this permit.
'—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREG CATIONS.
y C� �_ Re-roofs
5 numf u
oApplicagConumr s Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building oeul a st store or handle hatgaous material
as;defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
_gEhLCodc.58uw 25532(a)? -` ,S tr All roofs shall be inspected prior to any roofing material being installed.
❑Ya N
Win the scant or future Wilding t use a t or deices which If a roof is installed without first obtaining an inspection,I agree to remove
PP B acupan yuipmcn
mit M1a'mrdnus air contaminants az JcnncJ by the Bay Area Air Quality Management all new materials for inspection.
District?
Oyer
1 haw mad Be hararBws macro s regaircments under Chapin 6.95 of dre Cali far.
ria Health&Safety Coo,Sections 25505.25533 and 25534.1 undcrsurM that Box Wilding
does n urten I haw a anam.that'"is my responsibility to rarity IW Occupant of the
(tquirt enawhi[hmaLlA'm"pljofbLasudnaOfaCe(riflC,NafDCCY Signature Of Applicant Dale
Owner ser aamari><a stem / D,b All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
1' rte' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building De artment
JOB ADDRESS; V 2 I �O 2 Co lu , bus ✓e PERMIT# 0 Z)
OWNER'S NAMES Caro\ N t l PHONE # a 5-57—
GENERAL
3GENERAL 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
,V Heating A4 A 1 u rvt aC e
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
lF Tile
Owner,/'C�tztr' r Signature Date
Community Development Department
! Building Division
City of Cupertino
10300 Torre Avenue
® CITY OF
Telephone: (408)777-3228
CU PE�TINO Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval'shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed,a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
J
Homeowner's Name: ) /
Job Site Address: ��og r/Y
Roofing Company Name: ,f/r✓I I/ OtJaq
AA12phcanYs Signature: Date _9=)$1__0 y
Greg eel
Building Official
Revised 1/30/03
CITY OF CUPERTINO I
FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN # 3 I B. b Date:- ( (a 2- Doo
Building Address:
21r7o2 Co(� 1s Ave-
Owner's
-ve .Owner's Name: Phone #:
C a ,-a I M I ler 25-5- / 3/ S-�
Contractor: I-- Phone: License#: /
A A A "r 0-CQ, w /a �c a °13- -4-71 7
Contact: Phone: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description:
Residential ❑/ Commercial ❑
For Residential Installations:
Attic ❑ I�` floor 2"d floor❑
Adhere to
in set back requirement
or Commercial Installations:
eplacement same weight ❑ Additional weight (structural talcs) ❑ _
Structural Calculations required for new installation ❑
New installation Planning A royal Required ❑
Cost of Project:<14 S 7a, o,3Type of Constructio / Occ ancy oupr,�
Strapped ❑ On Platform ❑ Bonded Sq.Ft. a:
New Location ❑ Replacement ❑
Qty. if
A c b 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 Recptl, 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 Licens BUILDING