The URL can be used to link to this page

05020086 CITY OF CUPERTINO *R�E�a. Ns t+m" �°': '�-.. %x'• •*"' ' BUILDING DIVISION PERMIT CONTRACT WINFORMATIONK BUILDING ADDRESS: A PERFECT CLIMATE PERMITN9J5020086 'I n34S DPMPqTFR AV OWNER'S NAME: PERMIT ISSUE DATE Ak ED YASAKI 10570 S DEANZA BLVD 02 /14 /2005 ONE: SANITARY NO. CONTROL NO. 408) 861-9545 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 �Op LICENSED CONTRACTOR'S DECLARATION Job Description 1 bmcby affirm that 1 am licensed under provisions of Chapter 9(commencing P with Section 7(M)of Division 5 of the Business and Profeasiuru Code,and my license is �,d, in full force and fecty Lien.M ,qz Insenx lase `3 REPLACE FURNACE & ADD A/C n F o DareCumracmr Q Fry ARCHDECTS DECLARATION nU I understand my plans shall he used u public records it C t; Licceed Pmfcsvo al OWNER-BUILDER DECLARATION . <Z 1 hereby r,. that I am exempt from the Conuanoh License Law for[be no following mason.(Secduo 713 L5,Business and Professions Code:Any city,or county x m which require a permit to construct,alter,improve,demolish,or repairany structure FZi prior to its issuance,also requires the applicant for such permit to rile a signed statementshat he u licensed pursuant to the provisions of the Commcwr's llcon}e Law(Chapter,9 Sq. Ft. Floor Area Valuation ¢_a (commencing with Section 7")of Division Sof the Business and Professions Calc)or 3 that he Or exempt therefrom and the buss far the alleged exemption.My violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofPN/1Qf5%ep ane 0 Occas Type oat roam than rive hundred dollar,(5.5M). Occupancy YP I,u owner of the property,or my employees with wages as their role corepmallon, will do Ne work.and the structure is not intended or offered for sale(Sec.7060,Business and Professcsiou Cade:The Comsactori License Law does not apply Or an owner of Required Inspections propenywW builds or improve thereon.and who doessuch work himselfor through his GWL Own employee,provided thusuch improvements are not intended at offered forsak.If, 1 howaw,the building or improvement is sold within one year of eompledon,the owner- builder will have the Widen of proving thal W did trot build or improve for purpose of I,as owner of Ne propeny am exclusively contracting with licensed Cunamm In T(/ construct the project(Sec.70",Business and Profession Code:)The Conbacon s Li. / cnsre few does oat apply in an owner or property who Wilds or improves thetean,and who contracts for such pmjecu with a conwetor(s)licensed purwant to the Contractor's v� License U- 0 I am exempt under Sec. .B!P C for this mason Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 haw and will maintain a Certificate of Consent in self-insure for Worh<rsCompcn- 7031..W tion,as provided for by Section 7700 of the labor Code.for the performance of the ork for which this permit is Issued. 1 have and will maintain Workces Compensation Insurance,as inquired by Section of the Labor Code,for the performance of the work for which this permit is issued. yWorkersCn pensation Insurance carrier and Policy n m r artier. Policy No.: m.l P CERTIFICATE EXEMPTION PROMWORK RS' COMPENSATION INSURANCE (Thu section need not W completed if the permit is formic hundred dollars(SIM) less.) I cenifv that in the performance of the work for which this permit is issued.I shall not employ any peimn in any manner to as;to Wcume sasucet to then Wcrkeri Compensation Laws of California.Date Applicant NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should become subject to Nen worker's Compatsation provisions of Ne LaMr Cade,you must .,O foMwith comply with such provisions or this pcfmimm hat]he deemed revoked. Z^ CONSTRUCTION LENDING AGENCY (—tom IWinby affirm that there is a construction lending agency l'or the performance or E Ne work for which his permit is issued(Sec.3097,Civ.C.) QLender's Name = Z Lender's Add. C)Q I certify that 1 have read this city and county and part that the aW cl interposition mtsuun to / jy U coned I agree m comply with all city and county otarm of and she laws relating a C)U above meconstruction.tioneand heinbYauthurimmpeunhtives of this city in enter upon lW W ehovc(We)agree to ve for demnify an keep es. gy ci.j.agree m Cove,indemnify and high hay a.an the City of against against N in fits,CostsandOf this emiich may in any sv+Y accmc against said City V z in camignenee of the Granting of this permit. l ^ APPLICANT DE STANDS AND WILL COMPLY WITH ALL N -PO Issued by: Date 2 �)/ J REG A NS. Re-roofs$Igmaire at Applicani/Ceruacmr V Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or!mune building uccopan stem or M1andlc hazmdous material az defined by the Cupertino Municipal Code.Chapter 9.12.and the Hcahh and Safety Cale.Section 255320)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes No Will the applicant or future Wilding occupam sae equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove pr Qu :mit District? us air contaminant{u defined by de Bay Arco Air Quality Management all new materials for inspection. Disuin? eW1h ❑Yes No I have read the hanardnus materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 255(15.25533 and 25536.1 understand that if the Wilding docs not c ti ve r¢nam I n my mspansibility to noury do aceta t nfjhc myvtfClgprasw h ,uslmel ssuanccof Cenre¢orOc Y"- ( Signature of Applicant Date \I..n ,PJL y` All roof coverings to be Class "B"or better Ownerlor authorized o6rn't part x - Community Development 10300 Torre Avenue Cupertino CA 9 014 Telephone(408)777-3228 CITY OF Fax(408) 777-3333 �UPERTINO Building De artment . JOB ADDRESS:/r7 5 �� PERMIT #�Z 00 emps OWNER'S NAME: Ed PHONE # #W) -257 . 65'70 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: e� Signature Date Please check applicable subcontractors and complete the following ' ormation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical 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 Owner/Contractor Signature Date 4 Community Development 10300 Torre Avenue v 4 Cupertino CA 95014 Telephone(408) 777-3228 L� ' CITY OF Fax(408) 777-3333 �UPE(�TINO Building Department JOB ADDRESS:/O 5 f PERMIT #W,„, 0� 00 CY G • OWNER'S NAME: EC/ l c PHONE # 409) 0?57 • S5"Jo GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following ' ormation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing aV7 Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating y.� _Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal - Sheet Rock e / Tile - Owner/Contractor,Signature ` Date �`•T_.. a '" CITY OF CUPERTINO FURNACE/AC a oa SUPERTINO PERMIT APPLICATION FORM APN # Date: - Building Address: /03 s74)e- Owner's Name: Phone #: CSd (� oP) X57 5570 Con n/ L Phone: License#: Contact: Phone: Cupertino Business License #: Building Permit Info: --- _ -- Bldg ❑ Elect Plumb ❑ Mech Job Description: Residential !_Commercial ❑ _ For Residential Installations: ttic ❑ 1s` floor ❑ 2"d floor❑ dhere 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 Re uired ❑ Cost of Project: Type of Construction: Occupancy group: - - - � 9 � - Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Re lacemen Qty. if Applicable, Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Re location of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfln 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