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04030225Metz 00 _Z wF 0� olio ;pt �pC seat�V y.2 > fFc 6 ^ Z V yC UC OF FD U< ' CITY OF CUPERTINO BUILDING DIVISION PERMIT CQNTRACTORJINFORMATION. si.'f-^--uaifaGr a'UILDINGADDRESS: VALLEY HEATING & COOLING PERMITNO04030225 10365 FARALLONE DR OWNER'S NAME: PERMIT ISUEDATE GRACE YEN 1171 N 4 NE SANITARY NO. CONTROL NO. (408)294-6290 ARCHITECT/ENGINEER: BUILDING PERM IT INFO BLDG ELECT PLUMB MECH 0 0 0 0 SDECons of CON LICENSEDCONTRd under 1 hereby ,)firm that 1 am under provisions of Chapter 9 (commencing ft p Job Descri ttf"'�I1 �5` G�1F��® with Section ]IXIB) of Division Jaf the Business and Professions Code.antl my lice•.e is f Bu in fullfa�ep defy«L Licm Lie.g b'S'Yo RPLACE FURNACE (80000 K) MAY 19 2004 i - f--9�r-r_ � , .CAis.Z Dam Coruaa'tor r A CHITECT'SDECIJIRgT'IOON I n rsund my Alam ¢hall W used a p mcnfds BUILDING Licensed Professional OWNER -BUILDER DECLARATION I hcmby alnrtn that 1go (ram ale License Law for the 1..Bumpy Profession Code: Any city m county following lease. (Scion 7031.5. Business and Con _ , dimmi sig any nmctuon which rtyuima permit I.re eenswct alley. improve, herein W, ore issuance. a th ,Joe its6l ensearso RI{alrhe do appeisima of (ofOn suchCot permpmol' to et . Law (Cl statement Ihnhc Ls littmN pursuamuntho pro visions of um COnuumr'alieemx law(LT,Mer9 Sq. Ft. Floor Area Valuation (commencingwithSection ]) Division )the Business and Preficamor Code) or I that ha isexempt therefrom and On board for the alleged exemption. Anyviolation of NZ0j]DBer00 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not moon Nan For, hundred dollars (SSW). I,aownuof Nepmp ay.mmyunplornwithwaguatheirmlecompenndon, Required Inspections will do Ne work, and Iha slmnux u nal intended or offered formle se, 70 a, Busirrss and Professions Code: The Committees License Law does not apply to an Owner of property who hoods or improv thereon, and who does rostrums himself or through his own employ.. provided that such improvements art not intended oro@red for Its IL however, the building Or fmpmumuni is sold within One year of completion, Ne owner. builder will ban the burden of proving that he did not Wild Or improve for purpose of salt.). ❑ h an Owner of the property, am exclusively contracting with licensed contractors to construct the projon (Sec. 70x4. Business and Profusions Code:) The Conlrmmri V- ocme law docs not apply in an owner of property who Wilds or improv thereon, and who contnus for such projects with a conttacmr(s) licensed pursuant in the Contractor Litems Law. I am a empr under Sec. . B k P C (o Nis rtsson Owner Dale WORKER'S COMPENSATION DECLARATION ereby aRrtn under penalty of perjury ane of the following doeboalions: 1 have and will maintain a CeniOtvm of Consent to self -imam for Worker's Compen- sation. as provided for by Section 3700 or the labor Code. ter the perfomnoe of On work for which Of, permit is issued. ❑ 1 have and will maintain Worker's Compensation Imuran«, an required by Section 3700 Crum labor Code. for da performance Crone work for which Nu permit is issued. My Workers Compensation Insuta«e carrier and Policy number are: cam' e `//o /( CERTIFICATE OF EM OM WORKERS'��/sy COMPENSATION INSURANCE This section good nor W completed irtfe permit is (mons hundred dollars (SIM) or leu) 1 certify mat in the performance of the work for which this permit u issued. I shall not employ any Person in my mamrerx as to become subject is the Workers Compensation Laws Cf California. Date Ap,licaal NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with men provisions or Nis permit shall W deemed renkcd. CONSTRUCTION AGENCY is a c OsumiLENDING I hcmbyich thi Inst erre is s ed (Suchen lending agency far the perfurman c of ' the work for which this Permit is issued (Soc. 109'!, Civ. C.) Lender's Nvnc L emicri Addrtss I certify that I have read this application and sate that the above information is comicL I agree to comply with all city and county ordinances and sum laws reining to building construction, and hereby mthorize Minesenutiv of this city to cnmr upon the shove -mentioned pmpeny for inspection pugw,es. ( Wc) agree Move. indemnify and keep humless the City of CUIC111 00 gainst j liabiliuu,judgmcnu, costs and narcoses; which may in my way scene against said City in consequence of the Starting of this Permit ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOU REGULATION . Re -roofs Type of Roof a✓ �, azure OfAliflicantICOulonstioF Data HAZARDOUS MATERIALS DISCLOSURE Will the applicant ar future Wilding ..Part I.. or haMlc hanardsus material as defined by the Cupertino Municipal Cade. Chapter 9.11, and the Health and Safely otic. Sectionz255320)?Yeas roofs shall be inspected prior to any roofing material being installed. _41",All If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building Occupant use equipment or devices which mit hazardous air contaminants as &fund by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes --ONO I have lead the hanadnus materials requirements under Clupmr6.95 of ted Calif u. ria Hegill Safety Cedc,S«vrns 25505,15537 tend 2553. l undcrsuM lhartux, Wilding does not currently haw a mnanl diva it H my rnponsibility in notify the occupant of the requirements Nth mug be Ipiormissuareoo(a Cembcam of Q�' Ne�y. Signature of Applicant Date o All roof coverings to be Class "B" or better me .. agent Date 17, 1Jd CITY OF UPERTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS r b 3 qI_ a 19 A LL0n/O D9. PERMIT G U 72 D- OWNER'S NAME: PHONE # Cabinets & Millwork Z go GENERAL CONTRACTOR e �_ FAX # Cement Finishing i I am not using any subcontractors: Sk C✓L � "- Signature Date Please check applicable subcontractors and complete the following information: 9�01/contractor Signature '-�77/ ?0� Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing )/ Heating IL Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 9�01/contractor Signature '-�77/ ?0� Date 9 e CITY OF CUPERTINO 461- FURNACE/ACC17Y OF CUPERTINO PERMIT APPLICATION FORM APN # / Date",3 `7 Building Ad ress' 7OV5 Fyg94d,!>jE / 1UPS BREMFURN Owneg's Name: ^ , I �7 �a eN Ph ne - #: &-7 - gra 9 Con ractor: r Phone: l%A/tP � s�ov1«� t ��.'-1�z9� License ;J5 6)'2(? Contact: Phone: A657— eYOf 90 Cupertino Business License #: , Q -,! i2 MECHANICAL Building Per it Into - Rec tl, Switch & Outlets Bldg ❑ Elect ❑ dumb Mech Job !ti K 4- BUILDING Resid tial mercial ❑ Elec Permit Issuance For Residential I st lations: MPERMITFEE Attic ❑ 1" floor .2nd floor ❑ MECHANICAL Adhere to min set back requirement E] Plumbing Permit Issue For Commercial Installations: BPERMFEE Replacement same weight ❑ Additional weight (structural calcs) ❑ ---- Structural Calculations required for new installation ❑ Plan Check Fee New installation Planning Approval Required ❑ BUSLIC C?tof I? jecti Type of Construction cupancy/ oup no Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Re lacement;u Qt . if nlicable Fee ID Fee Descrintion Fee C;rnnn BENERGY Ener BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL 1 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 7z- S i