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04110022 CITY OF CUPERTINO BUILDING DIVISION PERMIT � CONTRACTOR Z,.'FURMATION BUILDING ADDRESS: PERMIT NO. - 04110022 0 N R AM PERMIT ISSUE DATE NE: SANITARY OC N0. ARCHITEC,rENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH _ .. 0 0 0 0 y00 LICENSED CONTRACTOR'S DECLARATION lob Description w❑ 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing p i W wiOSc Jon poi Divirmd3o(dm Butl use d o(essiunaC e.sod mylicenwis �p {Is1s1tt Ipg�"�a�pµ]��y������ n<a in full, rad CBCCL �1 b�UC l- S � � REPLACE FURNACE & D CONTRACTOR: MARSHAL A -N OOLING ARCHITECTS DECL RrT T �7 lis rsanJ plans sh usedas uMi Otho - 'I zoo - LL� Liccnwd' ;tensional Nnv 9 zoo l OWNER-BUILDER DECLARATION 3 1 trrchy affirm Nal 1 am exempt from the Conranors License law for the 00 ing mason.(Section](D 1.5,Business and Professions COO:Any city or county m which rtquires a permit to construct,alter,improve,demolish,nr repair any atructum ' Fly prior to its issuance.also rtquires the applicant forsuch permit to flc a signed summons < this he is licensed putwant to the provisions Of the Comruwr's License Law(chapter 9 Sq.Ft.Floor Area 'alua�o�1100 gi--° (commencing wish Section 7")of Division 3 of Oc Businca and Professions Code)ur , y that he h exempt themfmm and the basis for de Weged exemption Any violation of Semon]031.5 by any applicant for apvmit subjects the applicant to a civil penalty of APN Number Occupancy Type not mom than firs hundred dollar(S50)). ❑Las owner Ortho property,or my employees with wage u theh sole rompenatun. 32635037 . 0A will do the work.and Nesttunure is nolimended orOOered for also(seeT0a4,Business Required Inspections and Professions Code:The Contractor,Lt..taw dors not apply to to owner of q p property who builds orimprova thereon,and who doessuch work himselfor through his - own employees,provldcd that wen improvements are notimended oroRemA for ale.If. however,the building or improvement is sold within one year of completion,the owner- Wilder.wiB have the burden of proving that he did not build or improve for purpose Or sal'.) ❑1,u owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.]t%4,Business and Professions Code:)The Contractor's Li- toe Law does not apply to an owner of property who Wilds or improv¢thereon,and who contracts for such projects with a contacwr(s)licensed pursuant m she Contnaoes l,mense taw. I am exempt under Sec. .B&P C for this mason s Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby aRtmt under penalty of perjury apse of the following dmlarationsi 1 have and will maintain a Certificate of Comms to self-insure for WorkersCompen- ration,as provided for by Section 3]00 or the Labor Code,for the perfommnce of the _ work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as required by Section 3]00 of Tabor Code.far the pcRormance of the for which this perosis is issued My o ompemation lnsunna came and Put tie Pali CERTIFlCATE OF EXEM FIt6 WORKERS' COMPENS NiNSURANCE rlTusecuon need mol bC completed lithe permit is toronc h indmddollars($100) or less) 1 certify Nm in Ne ptrfurmance of the work for which this permit is issued,I shall not employ anypersol r('mannerw as to Wcomew jccuo Je Workers'Compensation Laws of Calif. ... . a — - App l an NOT A LICANT:If..[let making this Ccnifca¢of Exemption,you should / y pec bj m the Worker's Compcmmion provisions of the La Wr Cndc,you most .J,Z fo iib comply with such provisions Or this permit Shall W deemed revoked. / Z'O CONSTRUCTION LENDING AGENCY F-'^ Ihemby affirm Nat them is a construction lending agency for tM performance of / x tW work for which Nis permit is issued(Sec.3097,Civ.C.) Landers Name / = Z Lenin's Address U 0 1 certify that I bars mad this application and state Nat the shout information is f" correct.I agree to comply with all city and county ordinances and state laws relating to DU building consuetion,and hereby authome representatives of this city to enter upon the r abovomenlioncd property for inspection purposes (We)agree to save,indemnify and keep barmless the City of Cupertinoagainst FN liabilities.judgments,costs and cnpcmo which may in anyway accrue against aid Cty U Z inconsequence Ofthe Banbngofthispermit. - ^ AP ICANT UNDERSTANDS AND WILL CO LY WITH ALL NON-POINT Issued by: Date / 5 C R ULATIDNS. Re-roofs ''GAlso—mof'Applpl-icantiConuacmr �� Date / HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle havardoue material as defined by the Cupertino Munic' Cock.arlpmr 9.12 and the Health and Safety Code,EotYon 25532(,)± All roofs shall be inspected prior to any roofing material being installed. Will the infcam or future building t mete e w mat or dc.iea whim If a roof is installed without firs[obtaining an inspection,I agree[o remove pp 6 occupan y p mit W.dou,air cmnuminan6 as dcfmcd by the Bay Area Air Quality Management all new materials for inspection. D suits? 0 Yes 1 have mal the hmardnus materialarequiremems untler Chapter 6.95 of the Califor- nis Hea di&Safety Code,Sections 25X15.25533 and 25534.1 understood used ifthe Wilding does rat currents have a errant,that i'H my mapomih" our,the aavP.,of the mgaim rt.w mmslW tp o missawcca Ce worOce e. Signature of Applicant Date f All roof coverings to be Class "B"or better u@orircd agcm am ' r Community Development ' 10300 Torre Avenue ✓' Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building Department JOB A RESS: PERM# i5©5/ v�i✓c E D�//OO Z Z OWNER'S N Z p PHONV # yo,? 23 7- ,21 W GENERAL CONTRACTOR:,-jt-6,j p n sr c FAX# I am not using any subcontractors: Signature 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 4(0 7 Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile ei Contractor Signature Date CITY OF CUPERTINO -Z'2 lig FURNACE/AC T kAPN—# 037 PE(�TINO PERMIT APPLICATION FORM Date: Building Address: Owner's Name�j, d ` hone #: To v� c1� Contractotl0 Phone: �j License #: Contact: ` Phone: Cupertino Business License#: �✓ Joti d s L v 3ra3-�l/v Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Descr w t 6' Residential Commercial ❑ 1 For Residential Installations: Attic ❑ 1" floor ❑ 2nd floor❑ dhere to min set back requirement❑ or Commercial Installations: eplacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ \ New insta tion Pl in A r uired ❑ Cost of�r ect: /Type of Construct oi—� Occup cy up: Strapped ❑ On Platform ❑ Bonded Sq.Ft. Floo New Location ❑ R laceme� Q1Y• f A 1•c 1 Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfin 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 MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BTZLIC Business License BUILDING