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05110075 CITY OF CUPERTINO ' BUILDING DIVISION PERMIT CONTRACTORANFORMATIQN acSli... ,N. BUILDING ADDRESS: ABC COOLING & HEATING PERMIT NO.05110075 20735 GARDEN PLACE CT OWNER'S NAME: PERMIT ISSUE DATE Alk TIMOTHY TSU 31845 HAYMAN ST. 11 ONE: SANITARY NO. CONTROL NO. (510) 471-8181 ARCHITECTIENGINEER: BUILDING PERMIT INFO LECT UMB MECH F., �� Ala) g// Appp.BI�� EO PLO 0 Z' LICENSED CONfRALTOWS DECLARATION Job Des Cllptlon,� j Ux C I lexby afford Nam rov at I licensed under provisions Of Chapter 9(commencing �� (((j��aaa rl '� �/l a ) 5<i with Section 7")of Division 3 of Ne Business and Profcssidmeede.sed my license is u < in full force andcfta0 REPLACE FURNACE & A/C ,nLicense `Za Lie.a �'5 F p r3- DOW�/O COntD -- 7W ARcxrrECTs DELL ARA--7o—N-7 .0 7� 1005 f I uMcuund my plans shall W used as public records JyU e C Licensed Professional all 021.I am BUILDER DECLARATION �/ 1 hcrehy alum Un 1 1. ucmpt s an Nc Crntrac Cod :A nx Law for Ne p O following moon.(Section 7rD I.S.Business and Pmfeunes Code:Any city or county whim requires a permit to eanswct alter.improve,dcmolW,or repair any uructurt pft5200 that Win LssoaEd ruffmattoims tW spoliate for tech pmmitmicese Lawdsutemcm E€G Natal is liccucd pursuanuo the pmvisiona of the Contractor's License law(Chapter Sq.F[. Floor Area Valuation e (commencing with Section 7000)of Division 3 of the Business and Prefesdans Cole)or i Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of section 7031.5 by any applicant for a permit subjects she applicant ro a civil penally of r Occupancy Type amt mom dean five hundred cellos(S500). ❑I.u owner of the Property,or my suploym with wages as their sole eompewtion, will do she work and the mmctum it not intended proffered ronale(See W64,Business Required Inspections and pmfeWom Code:The Commucts h License law does rot apply m m an pwr of q p property who builds or improves thereon.and wh.dus.e.11.,it himself or tluough his owe employeas,provided Nal such improvements ase rot intended mill red forsale.If. however,the Wilding or impmw:mul is said within ase year of eempretion,the owner- builder will have dr,Wrden of pmomg that he did set Wild or improve for purpose of sale.). ❑1,to owner pf h.property..m c temancly contracting wish licensed cea.m.an construct she project(Sec.7066.Business and Poefesuom Cade:)The Consumes Li- me Law does not apply in an owner of property who Wilds or improves thereon,and who contracts for such projects with a corme duds)licensed pursuant In the Contrsclors License law. ❑1 am uempt undo,Sec .B A P C for this reason Owner Date WORKERS COMPENSATION DECLARATION 1 hereby Nen under perulty of perjury one of the following declarumme 1 ham and will mainain a Cenditcare of Consent to self-intim for Workers Compen- 'car.as provided for by Section 3700 of she labor Code,for the Performance of the wort for which this Permit is iasued. 1 have and will maintain Wthis rs Compcmauon Insurame,as required by Section 3700 of the Inbar Codc,for the performance of Ne work for which this permit is issued. My Worker's cion'tu aua rtin and Policy number am: Carrier. S• `� Irawtnna co —F Policy No.: L 14 LS t 0 Lt CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This section teed notWcompleted if1W permit is for one hurureddollars(SIW) or less) 1 cerdry Not in the"fearsome,of the work for which this Permit is issued.I shall not employ any perxn in any manner an as to become subject in the Workers'Compenration Laws of Califomia Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject in We Workers Compensation provisions of Ne labor Cade,you mud foMwidt comply with such provisions or Nu permit shall W deemed revoked. zCONSTRUCTION LENDING AGENCY [-+ I hemby arrum Nat Jami,.con a..itma.g agcmy for the Premum orme a lYi thc were for which this permit is ended(Sec.3097,Civ.C.) Lender's Name - = Z IE.Z.Adders U C 1 cord(,that I hast read this application and sate shu the aWw mfomrstiun is U.E' cornett 1 agree ta comply with all city and county oNinances and sum laws terming to 0U Wilding construction.and hereby auNorire mprexnutiwa of this city w enter upon the W alunw-mentioned property for inspection purpose. (We) C.to save,indemnify and Fccp harotles the City of Cupertino against liabilities.judgrecna,costs and ex.which may in any way accme against said City U to consequence of the gramdng ofthu permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N N-POINT Issued by: Date ��- �— U b SOURCE REGULATIONS n /3 - N I5�o3 Re-roofs Signature caul Dau HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will dte applicant.,future Wilding occupant note or handle haosoll maurial as defined by dm Cupertino Municipal Cod,Chapter 9.12,and the Hcalth and Safety Alicmjt.Scc❑uon 25532(.)? All roofs shall be inspected prior to any roofing material being installed. Yes 9 — Will Ne applicant or future Wilding occupant usecyuipmentordevices which If a roof is installed without first obtaining an inspection,I agree to remove Emit m7stalom air conuminanu as defined by Ne Bay Arta Air Quality Management all new materials for inspection. District? ❑Yes No I have read the hvaNrwsmaem,ls requi,emenuum3erClepter G95 of Nc Calik' ME Healthgt Safely Cock,Sections25505,25533 and 25534.1 understand thaifthe Wilding does trot cuncolly hast a¢rant dead,it a my resPawbility b notify the occupant or she requiremcns which must pdorm dmxE of.Ocrdree of Occupan Signature of Applicant Date l/ I s o5 All roof coverings to be Class "B"or better owner or admad><a • Dam. Community Development r' 10300 Torre Avenue aS Cupertino CA 95014 Telephone(408) 777-3228 CITY OP Fax(408) 777-3333 OUPEkTINO Buildin De artment JOB ADDRESS: PERMIT #O S`� G Z s a��3S GAP( OWNER'S NAME: PHONE # GENERAL CONTRACTOR: a I FAX # I am not using any subcontractors: 116 - $3 /1hs 5 Signature ate Please check applicable subcontractors and complete the followin 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 Owner Contractor Signature Date 10/28/03 CITY OF CUPERTINO azb FURNACE/ACCITY OF CUPERTINO PERMIT APPLICATION FORM APN# Date: Building Address: ctiL cQa w / 2-0 -7-3--S e1111— Owner's�TI ame: . Phone#: l 973 - 9/o 4-k Contractor: ^9� License #:7? 38.3 Contact: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: a cc '7c) G 3 :�r6L. Residential . — Commercial ❑ For Residential Installations: Attic ❑ 151 floor ®' 2"a floor❑ Adhere to min set back requirement a For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Prct: j Type of Construction: Occupancy group: Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 clip MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfrn 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