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03090129CITY OF CUPERTINO BUILDING DIVISION PERMIT INTORMATION ,CONTRACTOR BUILDING ADDRESS: A PERFECT CLIMATE PE"n"903090129 OWNER'S NAME: 10570 S DEANZA BLVD PERMIT ISSUE DATA HE (408) 861-9545 SANITARY N0. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I hereby 9 Job Description p affirm Ihet I am licensed under provisions or Chapter (commencing wish Seniors 7IXk17 of Division J of the OusinuwM Profcssiom Cndc, and my license is L enseClassull to= erme'' Class REPLACE FURNACE Qy 7 Date Contractor Date. T'S DELL ARCHITECT'S DECLARATION / W... 1 understand my plain shall W used a public records O O 3 Licensed Pndemional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from Ne Contractor's License Law for the following mason. (Section 8171.5, Business and Professions Code: Any city or county whichmyuires a pmmil m construct, alter, improvx, demolish, or repair any xuucure 2400 prior hr its issuance. also trquires the applicant for such perreil to rile a signed statement that he is licensed pursuant In the pmvisinsu of the Contrutori License Law (Chapter 9 Sq, Ft. Floor Area Valuation (commencing with Section 7") of Division J of the Business and Professions Code) or that he is exempt Ocmfrom and Ne basis for the alleged ascription, Any violation of 3 1629067.00 .APN Number ' ' OccupancyType Section 7071.5 by any applicant for a permit subjects the applicant to a civil penally of -' not more than five hundred dollars ($500). .. - - -- - - ❑ 1, as owner of the property, or my employees with wages as their sole compensation. will do the work, and theancmm is not intended or offered for sale (Sec. Business 3 01 _ ROUGH ctlons and Professions Code: The Comnnofs License Law does not apply to in owner of , property who builds or imprnws thereon, and who Joessuch work himselfor through his 303 - ROUGH M CHANT .T own employees, provided that such improvements arc not intended or offered for aale.If, 304 — ROUGH ELECTRICAL however, Ne building or improvement is sold within one year of completion, the owner. builder will have the burden of proving that he did not build or improve for purpose of 505 - FINAL ELECTRICAL sakJ. 507 FINAL PLUMBING KlimaNcomi ue(Secarty,. emiusi.dPmtractingwaejcenedem.umrs t Business508 _ FINAL MECHANICAL erne law docs not apply to an owner of property who Wilds or improves themon, and who contracts for such pmjecu with a contractor(s) licensed pursuant to the Coomctoi s License Law. ❑Ieme cm under See. _.B&PCT rthis Dw Data V WORKE 'SC MPENSATIO RATIO _ -" 1 hemby uRrm under penalty of perjury one of to following declamations: - Ihaveandwillmainuina Cenficate of Christ., to .1 What. for Worker. Co.,.. _ - .alum, az provided for by Section 37M of the IaWr Code, fur the performance of the .. work for which Nis permit is issued. . . 1 have and will maintain Worker's Compensation Insurance. as required by Section 7700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Ordnance carrier and Policy number em: Canner. Polity No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not W completed if the permit 0 parent, hundred dollars ($Im)) less.) I codify Nat in the performance of the work for which this Permit is issued. 1 shall not employ any person in any manner in a in become subject to the Workers'Compensation Laws of California. Dew Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the worker's Compensation provisions of de Labor Code. you most forthwith comply with such provisions or this permit shall W deemed invoked. CONSTRUCTION LENDING AGENCY I hereby off rm that there is • construction lending agency for the performance of Or, work for which this permit Is issued (Sec. 3097, Civ. C.) Lender's Name I<nda's Address I certify that 1 have read this application and sate that the shove information is ' comet. I agree to comply with all city and county onlinances and state laws minting to building construction, and hereby aothorice reprcmnutives of this city to enter upon the ahow-mentioned property for impection purposes. (We) agree to qve, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way acme against mid City in eor the granting of 'his Permit, APPLICANT UNDERSTANDSAND WILL COMPLY WITH ALL NoP INT Issued by: Date SOU r ULATIO . Re-roofs Type of Roof nature of ApplicantiCamract r0 HAZARDOUS MATERIALS CLOSURE Will 0. applicant ser future building occupant store or handle hazardous material m defined by the Cupertino Municipal Coda Chapter 9.12, and the Health and Safety Code, section zssrnan ❑res �a All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building eccupantuse equipment ordevices which I hanorbous air Commidants u defined by the Bay Area Air Quality Management all new materials for inspection. oict7 ❑Yes Y. I haw mad the haaardous maarielsrequimmcnu under Chapwr695 of Ne Califno- nia Health&Safety Code. Soeuods 25505.25573 and 25534.1 understand dust if the Wilding does not currently how a ¢hent, that it ts my responsihiliry m notify the occupant of the mquim w hott W m ne=ficald ofpFcalcancy. Signature of Applicant Date / All roof coverings to be Class "B" or better Ch, crorawuorircJagc l „e • a, - CRY Of CUPERTINO CITY OF CUPERTINO b3 127 FURNACE/AC PERMIT APPLICATION FORM APN # , Date: Building Address: ��11 63s d ton n Z2/r Q,AREMFURN Owner's Name: nt i Phone #: -4,4/4-29)0q- , 4 -39) 0q. v s c� e �� A/C Unit > 10,000 cfm Con acto : / Phone: _ Contractor: License #: Contact: Phone: Cupertino Business License #: ingPt Info: Rec tl, Switch & Outlets rIdgElect ❑ Plumb ❑ Mech ❑ Job bescr tion: BUILDING EPERMITFEE Elec Permit Issuance t ential ( ' Commercial ❑ MPERMITFEE For Re idential InL llations: LJ ❑ MECHANICAL Attic l't floor 2nd floor Plumbing Permit Issue Adhere to min set back requirement ❑ BPERMFEE For Commercial Installations: Additional weight (structural calcs) ❑ BUILDING Replacement same weight ❑ ❑ Plan Check Fee Structural Calculations required for new installation BUSLIC New installation Planning Appr val Re uired BUILDING Cost Project? " Type of Construbti Occupancy group: Strap ed ❑ Cjn Platform ❑ Bonded a Sq.Ft. Floor Area: New oration ❑ Re lac J Qty. i£ e t wtAl Pi A m Fee De.ccrintion Fee Groun - ENERGY Energy BUILDING Q,AREMFURN 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 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 ,7t (v -I.