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03100051CITY OF CUPER'1'INO3°r BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: ATLAS HEATING PERMIT No 03100051 .,NEWS NAME: PETER SHOW 155 SAN LAZARO AVE PERMIT ISSUE DATE PHONE: (408) 739-0516 SANITARY NO, CONTROLNO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION v Job Description 1 Wrcby alarm that 1 am liwnsed ander I� a y q.pty aommenming with Section 70(a)) of Division 3of NC Ba.inmxa cNa dmyliccnscis in Liceoupi`ys d` `N��% L'K.N Contract _ U;�NACE & A/C ��7�� EF0 ALTS DECLARATION 1 W ar �� H s shall ud as pubic records understand my planse 2 3 2004 Licensed Prnfc.scomal OWNER DECLARATION �1� I am cscmpt tram the Cordrmmor'a License Law for the 1 hereby affirm m exempt �p NY`Otl o'hat followingmaxims. Permian 703 1.5, Business and mu Code: city of county o�V/ ING de h,orAny mquircs improve, demolish, nr repair any s0wmr0 permit re cnnumn, alar, nt forsu prior issuance. reyuims the for suchFermi uofIe asigned snmmem priorto sl Sq. FL Floor Area Valuation esedpalso thus inion o me cwns�JpursuanttothcprovisionsofthecommcmrindProflaw(Chopmr9 with genion ](arid Division or the Business and vi Calc) or r on. Any thn he is eaemp therefrom and the basis for dm alleged exemption. Any vinlmion of bar he is b 3 5614017.00 APN Number Occupancy Type Section 7031.5 by any applicant for a permit ubjects the applicant 10 a civil penalty of not more Nan five hundred dollars ($50)). 0 I, az owner of the property, m my employms with wages a their sole eompena.tion, 3 0 1 _ ROUGHA TTM727iQ[i will do the work, and the shmeure is not intended or offered for sale (Sec.]014. Business and Professions Codc: The Contractor's License Law docs not apply to an owner of if tl1TLB tf1S properly who builds or improvca thereon. and who does such work himself or his (P-CCtIOn$ 303 — ROUGH M CRANI AL hemployees, provided that such improvements we not intended or offered for sale. If. 304 — ROUGH ELECTRICAL owever, the building or improvement is sold within one you of completion, the owner. builder will have the burden of proving that he did not build or improve for purpose of 505 — FINAL ELECTRICAL ale.). 507 — FINAL PLUMBING ❑ L as owner of rhe pfopeny, am exclusively ebitnning with licensed contractors to construct the project (See.70n4, Business and Professions Code:)The Contractor's LL 508 — FINAL MECHANICAL rue law doe. not apply to an owner or property who Wilds or improves thereon. and. who contracts for such pmjtcB with a eomnetor(H licensed pursuant to the Contractor's License Law. tJ I am exempt under Sec. B & P C for this motion wr Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of pe jury one of the following declarations- ClI hale and will maintain a Ccnirica d of Consent to self -insure for Worici sCompen- satlon, as provided for by Section 37W of the tabor Codc, for the performance of the work for which this permit is issued. 1 have and will maintain Worker's Compenaztinn Insurance, as respired by Section 3 or the labor Cade. for the pertinence or be work for which this permit is issued. My Workker•I C��mpens1aIio/n and Policy number am aln�xurvnce /5'g � cartiq{M✓rPolicy No.: S CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE mtu seeaiw wed not W completed if the permit is formed hundred dollars ($loth or Icss.) 1 certify but in the performonec of the work for which this permit is issued, l shall not employ any person in any Commit so az to Weomc subject o the Workers Compenaadon Laws of California. Date Applicant NOTICE TO APPLICANT: If. after making this Condicem of Exemption, you should become subject to the worker s Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall W deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirms that there is a constmevimn lending agency for the performance of be work for which this comfit is issued (Sea. 3097. Civ. C.) Lender's Name lender's Add. I certify that I have read this application and state that the abuse information is mORCm. 1 agree to comply with all city and county ordinances and state laws relating to building Construction, and hereby nnthorim represcntadves of This city to enter upon the a sive mentioned property (or inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against fribilities.ju igmcnts,eosls and capensu which may in any way Berme againslaaid City in cnnseyuenee of the granting of this permit. APPLICANT NT APPLICANT ON RSTANOS AN ILL COA LY WITH ALL NON -POINT Issued by: Date IOd . • ld�% Re -roofs Type of Roof 3 Signamrcof ApplicenUCoa1xCmr ° Date HAZARDOUS MATERIALS DISCLOSURE Will be applicant or fuwrc building occupant store or handle haralloas material ' a dcBned by dte Cupertino Municipal Code. Chapter 9.13, and the Hcalb and Safety O,inW 25532P :_ \ No All roofs shall be inspected prior to any roofing material being installed. WoYea If a roof is installed without first obtaining an inspection, I agree to remove the. plicamorfwurcbuildingwcupanroucyuipmrmorCcviceswhlcb emit hv.ardnas airimminanls az Jcf ncd by the Bay Arca Air Qwlify Managcmcm all new materials for inspection. Dirricil Yea No 1 have mad the haaardous materials requirements under Cbapmr 6.95 of be Califon nia Health & Safety Cole, Sections 25505, 25533 and 25534.1 understand Nal if the Wilding Ctrs not currently have a amount. that it u my respomibility N noufy the omeupant of the retimmorentrwni pa. do L ri detectors erdreateoracupmry. Signature of Applicant Date Ist All roof coverings to be Class "B" or better 0wner or ,Bret eat Date '.i 10:''07/2003 00:25 Su. CITY Of CUPEVINO 5105363262 LEGALITIES INK CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM yto PAGE 01 Qty. if Applicable Fee ID Fee Descriotion Fee Groun 7 Date: / Building Address:` // BUILDING Owner's Name: 0 Phone #: 5 5 U 2 �j Contr or: Phone: License.g: zp�� 'e7 6 BREMACOVER Contact` Phone Cupertino $usess License #: 1 BREIvIAIR.HAN Building Permit Info: MECHANICAL 1� BldgEl Elect Plumb 13 Mech Job Description:, -9.0, Or o U ELECTRICAL Gt c!c/ G 3.. C, Ten i - BSEISMICRE Residential Commercial ❑ BUILDING ForidentialInstallations: EPERMITFEE '\tticLJ 1" floor EJ 2" floor. ❑ ELECTRICAL Adhere to min set back requirement 0 MPERMFCFEE PPERMTTFEE For Commercial Installations: MECHANICAL PLUMBING Replacement same weight ❑ .Additional weight (structural calcs) ❑ BPERMFEE Structural Calculations required for new installation BUILDING New installation Planning Approval Required ❑ BPLANCHK Cost of Project: Type of Construction: Occupancy group: 64X,?. &rD BUSLIC Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Arca: New Location ❑ Replacement ❑ Qty. if Applicable Fee ID Fee Descriotion Fee Groun 7 I BENERGY I Energy BUILDING BRE_MFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfm MECHANICAL 1 BREIvIAIR.HAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING / EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFCFEE PPERMTTFEE Mech Permit Issuance Plumbing Permit Issue MECHANICAL PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUELDrNG