03120001 cUrY cur CUPCRTINo SW" 9
BUILDING DIVISION PERMIT WNTRACTOWNFORMATION '
t
BUILDING ADDRESS: AAA FURNACE & AIR CONDITIO 1`nUO03120001
22888 CRICKET HILL RD
ERS NAME: PERMIT ISSUE DATE
JDROANEEL GAOSH 1712 STONE AVE 12/0 2003
ONE: SANITARY NO. CONTROL NO.
(408) 293-4717
ARCIUTEL IENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ioo
LICENSED CON-PRACTOR'S DECLARATION '
1 rad 70 amrm their am fiaeBu i n ss ndPronmx ons Coder 9(commencing Job Description
�6E With$cnion]aN)7 of Division]of NC Business and Pmfcssi.ns Code.and my license is
?�N in full fnreeand of FURNACE p1A�n
p adz Liccnu Class" _ (=Lica
iF� Dam TS DE �
ARCHITECTS cimosecor
ARCI !
1 understand my plans shall W used a public records
PAY
,a vs
Y12o Licensed Professional 2004
OWNER-BUILDER DECLARATION w
a Se 1 hereby affirm that I am exempt from the C'ontractor's License Law for the s,>.ar�,
00
following reason.(Seed..7031.5,Business and Pmressions Code:Any city ar county h!s L®
``e m which requires a permit to construct,alter,improve,demolish,m repair any structure -�O O 0
So poor to its issuance.also requires the applicant forsuch Permit file a signcdstatcmcnt
< that he is licensed pursuant to the provisions.nM1e Contractors uanse Law(Chapter 9 Sq. Ft. Floor Area Valuation
2.a (commencing with Section 7")of Division 3 oftbe Businessand Professions Cadc)or
i Nat he u exempt Merchant and She basis rot dire alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than rive hundred dollars(SSW). �' Occupancy Type
❑I,a owner of the properly,or my employees with wages as thou sole compensation,
will EO the work.and dm stricture is not intended molfcred torsade(Sec.]044,Business
and Pmressions Code:The Contractors Liam Law dates not apply to an owner of Required Inspections
property who builds or improves thenen,and who d IS such work himselfor through his
Own employers,provided that such improvements are not intended or offered for sale.If.
however.Ne building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving Nn he did not Wild or improve for purpose lir
sale.).
❑1,as owner of the property,am exclusively convzeting with licensed contractors to
construct She pmject(Sec.7044,Business and Pmreaions Code)The Contractor's Li .
cent law docs not apply to an owner or properly who Wilds or imprmes thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to die Convectors
License Law.
❑ 1 am exempt under Sec. B 6 P C for this roman
Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following Occlusions:
1 have and will maintain a Certificate of Comnao self-insure for Worker's Coni
cation,as provided for by Section J]OB.f the Labor Cndc,for the performance of the
work for which this permit is issued.
Q I have and will maintain Worker's Compensation Insurance,a required by Section
37OO of the labor Code.for the performance of the work for which this permit is issued.
My WmkSr r.Compensation Inwrance carrier and Policy mordbSM are:
Cartier: :'/e.�G ✓✓11 Policy Nu.yj rrls
CERTIFICA �OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not tecomdcod!room permit is formic hundred dollars($I00) -
ar Icss.)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner w a in become subject o the Wormos Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,at making this Cenifiatc of Exemption,you should
become subject to the Worker's Compensation previsions of Ne labor CMe,you must
Ofimthwilt comply with such provisions or this permit sha11 W deemed rivaled.
Z CONSTRUCTION LENDING AGENCY
I hereby affirm Nat Vert is a construction lending gency for performance Of
ya ? Ne work for which this permit is issued(Sec.3097,Civ.C.)
lender's Name
7 Lenders Address
J p 1 tt.try Nat 1 have read this application and sure that the shove tar mmatitn is
F connect.1 agree to comply with all city and county oNinances and state laws relating to
.JU building eonsucmn,and hereby amhmia representatives of this city to enter Open the
h
a awomnc
endiud properly for inspection pm,mes.
(We)agree to save,indemnify and keep harmless Or City o(Cuper ino against
UZliabilities,judgments,orthe costs and expenses which may inany way accrue against Said City
U z in cnnses, @e granting exthis permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
OUR E EGULATIONS.
/ /�"%O�
YOUR
—� Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will no applicant or future building Occupant store or handle hasmdoux material
defined by the Cupertnino Municipal,Code.Chapter 9.12.and the Health and Safety
d..
sec25532(aAll roofs shall be inspected prior to an roofing material bei.
El Yes P P Y g g installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.nit harardnus air conaminama as defined by the Bay Arca Air Quality Management all new materials for inspection.
Gooier,
❑Yes is
I haw.W the hmaNi smamrialsmquimmenksunder Chapmffi95of1 cCalifon
nix HealNKSafety Ctvde.SecdonsnY)5.25533and25534.1undersandthatif Ne Wilding
does not currently haw a¢amt Out it IS my respmiihilry to modify the occupant of the
require _orfs w/hich must In met poor or issuance ora Ccnifieate of a-- ---cy. Signature of Applicant Date
0 a brio—A�ner cur auNorise�ent Dam - All roof coverings to be Class "B" or better
wIF e
t
aMGQ�. CITY OF CUPERTINO
FURNACE/AC
0000/
CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN# � J� � Date:
� -� O
Building Address:
d
Owner's Name: one#:
Contractor: 4,64t, Phone: License#:
- // 'J6 opf 9
Contact: Phone: Cupertino Business License #:
_
jZ 57.3
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech
Job Description:
®D o U
Reside tial ❑ Commercial ❑
For Residential Installations:
Attic ❑ 1" floor ❑ 2°1 floor❑
Adhere to min set back requirement E]
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation PlanningARZr2val Required ❑
Costo roj t: ` Type of Construction: Occupancy group:
Strapp I Id ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty.
A I 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
MPERMII'FEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING