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05060138 - CITY OF CUPERTINO a BUILDING DIVISION PERMIT �kc0NTRACtTftINFORMATION BUIMi LDINGADURESS: BEST HEATING & AIR SYSTEMS PERMIT NO.05060138 •OWNER'S NAME: PERMIT ISSUE DATE GEORGE WAGNER NE: SANITARY NO. CONTROL NO. (408) 247-4328 !!HFIECTIENGINCER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Coin LICENSED CONTRACTOR'S DECLARATION .lob Description w FC 1 hereby affirm Nal 1 am licensed under provisions of Chapter 9(commencing ZW with Scction7")of Division 3ofthe Busincssand Profeasiomeode.and my license is n« infllfomeand`if 3�y-33 ADD ASC j,2y Lieense Claza Lie.9 le ^=w Date Contractor ARCHITECTS DECLARATION /^ $(pq' q �'�� j as u 1 understand my plans shall W used as public rtemds c. c.U yNyt C. Licensed Professional `rs5 OWNER-BUILDER DECLARATION 9y 1 hereby affirm That I am exempt from the Contractor's License Law for the Sul O o fallowing mason.(Section)(131.5,Basions aM FORWum Code:Any city or county Su X m which requires a permit to conswet,alter,impmw.demolish.or mpair any stmeture `l i9^'^ prior tons issuance,also mquims the applicant for such PermiOo rile a signed statement 5�< that hpursuant In,is licensed pursuano the provisions of the ContractoLice r's nse Law(Chaplcs 9 Sq. Ft. Floor Area Valuati n mmFo (commencing with Section)000)of Division 3o the Business and Profcasios Codc)w Ii t--ilk i $ Our he is esempt thetefrmn and IW basis for Ne alleged exemption.Any violation of Section 7031,5 by any applicant for a permit subjects the applicant to a civil Penalty of 3&219110*10cI00 w U MWc8pancyType not more Om five hundred dollars(SSW). I,ss owner of she pmpeny,or my employcn with wage u the'v sole compensation, will do the work and the structure is not intended m offered fertile(Sec.7044,Business and Professiom Code:The Conuactor't Licetse law dor tort apply to an owrter of Required Inspections proper,who Wilds or improves Nemon,and who deessuch work himselfor Omugh his own employees,provided Our such improvements are not intended or offered for sale.If, however,due Wilding or improvement is sold within oto year of completion,the owner, Wilder will have the Wrden of proving that he did not Wild or improw for purpose of sale.). ❑ I.as owner of the propcny,am excht ively contracting with licensed contractors to constmet the project(Sec.)Om,Business and Profesdons Cade:)The Contractor's Li- cense law does not apply m an owner of progeny no Wilds or improve thereon,and who contracts for such projec 'th a eontnmor(s Zd'pursuamm ontnaoit saw. ❑lame pt under Sec. .BAPCf this awn Owner ER'S OMPENSATION DECLARATI I hereby affre under penalty of perjury one of Ne following declarations: C-1 haw and will maintain a Certificate of Consent to self-imine for Worker's -N--as provided for by Section 3700 of the Labor Code.far the perf amanen of the work for which this permit is issued. I haw and will maintain Worker's Compensation Inturanco,as mquirtd by Section 39W of the Litter Code.for the performance of Ne work for which this permit is issued. My Worker's Compensation Insurance caner and Policy number am: Cartier. Policy No, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ' (This section nod not W completed if tW Iennil is fnrone hundrtd dollars(5100) or let,.) I cenify that in the performance of the work for which Nis penis is issued.I shall not crnploy any person in any mannrrulo� O Jsubject to tM wortrnt Compcvadon Law of Cali(pm'a.Dalei Z _� K Applicam /.Do. _ _-- NOTICE TO APPLICANT:IL after making this Contrition of Exemption,you should Wooten subject to IW Worli Compensation previsions of the Labor Codc,you must .JO forthwith comply with such provisions Or this Pcrmi t shall W dccmcd remkcd. z in CONSTRUCTION LENDING AGENCY [-w I hcmby aRrm into dura is a comuuction lending agm e,for the pcda maraca of G'> the work for which this permit is issued(Sec.3097,Civ.C.) W Q LmderS Name =z Lender's Addmaa V Q 1 cenify Nat I have mad this application and state Net the above iws no is W U bounce I agree construction,comply with all city and coumy mnvest Of and su¢law r uixotg m S Q V above-metionewd hertbyauNonpr rtpmscnutiws of this City toorter Cion tW r W above-mentioned agree progeny for imnify an koct,h. (We)agree m saw,indemnify and treD harmless w City of,agents City Fa ta/1 liabiliue,ludgments,costa ind expetucs which mryin any wyaccme againstsaiO City t_)2 ineonsequenccdfthegribrom oflhis permit. ^' APPLICANT UNDERS SAND WILL O,e MPLY WITH ALL NON-POINT Issued by: Date SOURCE L s Y�ZJ Sigam ,1imm ort for / Date Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof / Will the applicant or fumm Wilding occupant store or handle hvaAous mamnal az dc0ncd by the Cupc)mno Municipal Code.Chapter 9.12,and the Health and Safety We.Seetien 2ss3, , All roofs shall be inspected prior to any roofing material being installed. OY willthe applicant r fuum building occupant use cquipmcm or devices which If a roof is installed without first obtaining an inspection,I agree to remove it harardnas air conuminans as defined by the Bay Arta Air Quality Management all new materials for inspection. xr' ? Yes I have orad the haav 'us materials requirements under Chapter 6.95 of Be Califon not Hcallb k Safety Code,Sec' 235(15.25533 125534.1 undcmandthdifthe Wilding docs nor cu �i7zdagcre,� haw a n Nat ii u my apo Wily to notify the necupwt Of the mgaimmc u bcaOrtucerti0nteerOcapan Signa[ureofApplicant Date D� All roof coverings to be Class"B"or better CITY OF CUPERTINO Sub FURNACE/ACOrb 3� CUPEkTINO PERMIT APPLICATION FORM APN # � 2 Z/ v (D DateZ-0: /^ / v Building Address: (l/ D .5fii,P.L< 7�Soi`1 Ow�aer's Name Phone,#: Ma /- C ractor: � s S License Co7t t: Cupe i Business License #: U .0 w �o Buildin emit I rn o: Bldg ❑ Elect Plumb ❑ Mech Job scriptio • All? A�lc- Residential A, Commercial ❑ For Residential Installations: Attic ❑ 1' floor 2"d floor❑ Adhere to min set back requirement❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural cafes) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required Cost of Pro• VC_ Type of Construction: Occupancy group: Strapped U On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy I BUILDING BREMFURN Relocation of Furnace . MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIR14AN A/C Units<- 10, 000 clin 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 L 6- f � � ° . Z3 -- .. --. Community Development `f 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building De artment JOB ADDRESS: PERMIT# 8Jt-,� 2 OWNER'S NAMEIPHONE # GENERAL CONTRACTOR I FAX # /fig I am not using any subcontractorsS— i tore ate Please check applicable subcontractors and complete the followinginformation: 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/C tractor Signature 0ate +.', •'3., - - Community Development - - 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 , CITY OF 'Fax(408) 777-3333 ,15UPEkTINO Buildin De artment JOB ADDRESS: PERMIT# OWNER'S NAME: ��,Q�� t v9C� C.� '" PHONE # eR53— GENERAL CONTRACTOR: _ FAX# /�83�`� I am not using any subcontractors: '�� ;' 4X7,10 5 Signature 'Date Please check applicable subcontractors and complete the following ' ormation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical _ Excavation Fencing n Flooring: Carpeting �. ® Linoleum'/"Woody Glass / Glazing Heating Insplation % Landscaping Lathing Masonry Ornamental Sheet Metal j Painting/ Wallpaper " Paving Plastering Plumbing Roofing. Septic Tank Sheet Metal Sheet Rock i Tile t Owner/Co'n'tractor Signature " .Date