04080210 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION `,
BUILDING ADDRESS: ASCO SERVICE INC PERMITND04080210
OWNER'S NAME: PERMITISSUEDATE
JAN
ONE: SANITARY O. CONTROL NO,
ARCHmscr/ENGINEER: BUILDING PERMIT INFO
IMN
ELECT PLUMB MECH
app LICENSED CONTRACTOR'S DECLARATION JobDescri t n
W 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing p
�iu, with Section 7")of Division 3 drum Busineuand Professions Code,and my license is
in roll r .m rep.p -718SC(n REPLACE FURNACE/DUCT SEP 2004
n i Li¢nx laza G Llc.N
�Fp Dain^7 LL-e��ToS DELL C7 S'L /CG_
ARCHITECTS DECLARATION
Stu ticrstanJmyplansaM1allh used nrds
;Sd0 ON BUILDING
ay Li<cnxd Professional
<3 OWNER-exempt fr m the Commences
0 I hereby.('firm Not 1 1. exempt from the Contras Co License Any a Law for the
p O which m rtasna(Sedan 9(131.5.Business and ve.derons Como:Any city Or county
which rt9uires a permit re construct,thL alar,improve,h Perlia or repair any swam.
FZi tpoor in hat hoiucensed cans also requires thovisioranf for mchpermi'roc.m.rile a Signed Statement
�S (commenia withSecond7 )orDiviomnfNcConuacossandcnsclaonsCod¢r9 Sq.Ft. Floor Area Valuation
t-ro (commencing with Section 7")or Division)of NC Businmaand Professions Code)or
to $ that he is exempt thucfrom and th,hash for the alleged eaempto.Any violation of
Section 7031.5 by any applicant for permit wbjeots the applicant o a civil penalty of 39)B5141"er00 Occupancy Type
not mere than five hundred dollars(55(10).
1,as owner of ft Property,or my employees with wages as their sole compensation,
will do the work.and the structure is not intended or offered for We(Sec.7044,Business
and Professions Code:The Cnnuacmrs License Law does Out apply as an owner of Required Inspections ,
property who Wilda or im promo thereon,and who dos such work himself or through his
own employees,provided that uch improvements are not intended aro@nd forsau.IL
however.the building or improvement is sold within on year of completion,the owner
builder will have the burden of proving Nat he did not build or improve for purpose of
sale.).
❑1,as owner oft¢propeny,am exclusively contracting with licensed contrxors to
construct the project(Sec.9044,Business and Professions Code:)Tho Con racmts W-
cmc Law does..,apply ro an owner of property who builds or impmvm thereon,and
who concocts for such projects with a contractor(s)licensed pursuant o the Con=toe$
License law.
❑1 am exempt under Sec. .B&P C for this reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain aCertfic.0 of Consent o self-insure for Workcr'sCompcn-
sation,a provided for by Section 3700 of du labor Cade,for the performance of the
.,it for which this permit is issued.
1 have and will maintain Worker's Compensation Insurma,as required by Section
9BOofthelabor Cudafm Ne performanceof work farwhich Nis permit isissue..
My Work(eY.(s Compematirs
an Insuna nolo and
be
Policy number me
:
Ct miro SfAri F' /J Pancy No.:00V9q-ke-2o,9
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CTTu section rued not Mcomplcud if the permit is fmonchundnd dollars(SIM)
or kss.)
1 tenor,Nat in the perr....of the.,it for which this pooh a issued.I shall not
employ any person in any manner mu7gbccorOcyubd'ec(t IM Workcn'Compctwdon
tawsca CafiPornia�N D=r
Applicant h:II
NOTICE
DOA 1 :1,of r ing this visions of of E Labor
Toa you should
become scoop a Worh lum pcwtion provisions of the rued! Cram,you mum
.,O foMwithcomplY with such pmvisinns or this permit snail sac dccmrA revoked.
'Z IZ) CONSTRUCTION LENDING AGENCY
'rt Ihereby affirm that there is a construction lending agency for the performance of
a Y the.,it for which this permit is issued(Sec.3897,Civ.CJ
Qlender's Name
,z Lender's Add.
U C) 1 anify that 1 have mad this application and some that the about m1frmuiun is
U. P COMM I agra to comply wit all city and county ordinances and sue laws misting to
0 U building construction,and hereby summon representatives;of this city to enter upon the
W alcove-mcmumcd properly for impaction purposes.
(We)agree 10 save,indemnify and keep harmloss the City of Cupertino against
nFw y Liabilities,judgments,costs and expenses which may in any way aceto against mid City .
V z APPLICeof the RNof h
ANTUNPESTADS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -
SOUR EGU T10y8.
0-2 D F
Si more fApprcanvCySlraemr Dam Re-roofs
t HALAROOUS MATERIALS DISCLOSURE Type of Roof
Will the app t ant m forme building ocupant stare m IurWle hanrdous material
az defined by tk Cupertino Municipal Code.Chapter 9,12,and the Health and Safety
ode,Scc25532(.)?
yea �No All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant of future building excuiontuse equipment ordeviaewhich If a roof is installed without first obtaining an inspection,I agree to remove
loc
mit hararaaus air contaminants u defined by the Bay Arca Air Quality Managcmcn( all new materials for inspection.
i stria?
❑Yes eN.l have mad the hxn than,materials¢taro ores underChapter 6.95of@c Cmirm.ia Health&SafetyCale,Sections 25505,25533 and 25534.[understand that lithe buildingoea no}curtcndy ham a tenant that it is my responsibility w notify the acupant or the
a, nuimmosccof.Cerulmmm OtryofAppl'cant Dale
r amhorirca a cm t� Dme All roof coverings to be Class "B"or better
CITY OF CUPERTINO o o
All
am,� FURNACE/AC
�UPERTINO PERMIT APPLICATION FORM
APN # Y /2 Date: ^
5 2 �
Building Address: _
/ 7/ ll0�� • r A� yJG w 1
Owner's e: ' 1 Phon !/ / 7'
ice* Y";Gi -
Contractor: Phone: License #:
AS o
Contact: Phone: Cupertino Business License #:
ZS'SS
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description:
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1" floor 0 2nd floor❑
dhere to min set back requirement❑
or Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning A royal Re uired ❑
Construction: Occupancy group:
Cost of Project: y 9 0 Type of Cons p Y P
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN eocation 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
X MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Pemut Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
S v
( 33v
Community Development
10300 Torre Avenue
Cupertino CA 95014
• Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPERTINO
Building Department
JOB ADDRESS: PERMIT # Zl0
( ( 7 / 3 P0GL0A
�F�Y �tiL w � 0q, V C7
OWNER'S NAME: O�,4 ,..i = A PHONE # c;,B ge,44
GENERAL CONTRACTOR AS[ o SQL✓/c FAX # g C 8
I am not using any subcontractors: 0-2 q-- a q
Signatur 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
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
O_2 p
/Contra or S' ature Date