04040154CITY OF CUPE10INO:^3K>:an.�"r'si
BUILDING DIVISION PERMIT
r CON1IiM-WOR INF RMATION °.
BUILDING ADDRESS:
SCHAIIMANN AIR CONDITIONING
PERMIT NO04040154
OWNER'S NAME:
PERMIT ISSUE DATE
DAVID MADDOCK
JNE:
SANITARY NO. CONTROL NO.
(408)428-0640
ARCHITECIDENGINEER:
BUILDING PERMIT INFO
BLDGELELT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
]pb Description
1 hereby affirm Nal 1 em licensed under provisions of Chapter 9 recommencing
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with Section 700X)) it Division 3 of Ne Business and Pmfe..imn Coda, end my license is
u«oxc and tri. t. 7t9D3
REPLACE FURNACE
Lie 0
Date Con0amir alpinnin
_
ARCHITECTS DECLARATI N
1 understand my plans shall W used as public records
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EXP,
Licensed Professional
OWNER -BUILDER DECLARATION
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1 hereby ofrirm that 1 am exempt from the Contractor's License Law Our the
following mason. (Sce0un 703 1.5, Business and Prufcssions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any atrunurt
prior m its issuance. alsu requires the applicant for such permit to rile a signed statement
that he is licensed pursuant in the provisions of the Contractors License law(Chaptci 9
Sq. Ft. Floor Area —
—LlIli0
(commencing with Section 70l of Division 3 of the Business and Professions Cole) or
that he is exempt thctefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of
360PNefirB)8er00
Occupancy Type
P Y YP
not more Nan five hundred deli... ($500).
❑ I. as owner of the property, or my employees with wages As their sole mmpro m0en,
will do Bee work, and the structure is not intended or offered for sale (Sec. 7W,
Required Inspections
and Professions Code: The Contactors Uri os, Law dos not apply to an owner of
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property who builds or improves Hereon, and who does such work himself or through his
own employees, provided that such Improvements are not intended or offered for sale. It.
however. Ne building or improvement is sold within one you of completion, the owner.
builder will have the burden of proving Nat M did not Wild or improve for purpose of
talo.).
❑ 1, as owner of the property, am exclusively contracting wit licensed comments to
consumer the project (Sec. 7014, Business and Professions Code:) The Comenctor'a L6
cense law does not apply to an owner of property who Wilda or improves thereon, and ,
who contracts for such projects with a eoniaator(s) licensed pursuant o the Contnemta
License Law.
❑ l un exempt under Sec. ,B&PC for Nis Oman
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby 4MM under penalty of perjury one of one following dalvatiom:
1 have and will maintain a Cenificate or Consent m sel6insure fm Workers Comptes
ion, u provided for by Section of the Labor Code. for the Performance of the
rk for which this permit is issued.
IC31151
I have andwill maintain Workers Compensation Insurance, Ax required by Sectio0
of Ne labor Cade, for Ne performance of tre work for which this permit is issued.
Mind
Weakers�CrynLeosation Insunac cartiu end Policy nmberrtier.
_ p—(—� Policy No.: t % � 31�
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(This secthm need not W completed HOW permit is fir one hundrod dallan (5100)
or less.)
1 eenify that in the performance of the work for which this Permit is issued, 1 shall not
employ any person in any manner so As m become subjecOo the Workers' Compensation
Laws of Californ4. Date
Applicant
NOTICE TO APPLICANT: If, after making to, Cenilicate of Exemption, you should
become subject to the Worker's Compensation previsions of IW labor Code, you most
forthwith comply with such provisions or this permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby oflLm that there is a construction lending agency for the Performance of
to work for which this permit B issued (Sec. 3097, Civ. C.)
Undoes Name
Lenders Add..
I eenify that 1 have read this application and auto that the above information Is
correct. I agree to comply with all city and county ordinances and slate laws relating to
building construction, and hereby sunbathe representatives of Nis city to enter upon Ne
ahovomentioned property for inspection purposes.
(we) agree m taro, indemnify And Idea, humlcas the City of Cupenino against
liabilities, judgments, costs and expenses which may in any way memo against said City
in consequence of the grami ng of this Fenn it.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date�&2/J)/�
SOURC LATIO/�_
Re -roofs
Type of Roof
lg awre of Applicen✓ColusetorDate
HAZARDOUS M R LS DISCLOSURE
Will Ne applicantofmurc bull' upart store or handle h,.doua ..led.]
az defined by the Cupertino Municipal o , Chaps( 9.11, and the Health and Safety
ode. semen 25532(a)?
All roofs shall be inspected to any roofing material being installed.
❑Yea u
N
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant r r un building occupant um equipment or devices which
I, basardon air conmminann as defined by tW Bay Arca Air Quality Management
all new materials for inspection.
strimm
❑ Yea
I have mad the harantacrawrials requirements under Chapter 6.95 ofthc Califon
ria Heolth&Safety Code, Saumu 25305.25533 end 25534.1undcrnand that iftW Wilding
/1
Ones not currently haw a snam, that it is my maponsibility to nobly Ne nccuFant of the
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Mquimm hien must be met prior N issuance or, cenircam of cup�T
Signature Of Applicant ate
— y L31
All of verings to be Class °B" or better
Owner tar authorized m Date'
a
• aClOF
�UPERTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
202:0
PERMIT #
0 l,i (� S
OWNER'S NAME: d
PHO
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
e. /C •actor Signature
2�1
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass/ Glazing
Heating
O Um m 41a, i Ob ---k
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
e. /C •actor Signature
2�1
Date
0
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a
arwo
CUPEI�TINO
CITY OF CUPERTINO
FURINACE /AC S"�
PERMIT APPLICATION FORM
APN # /
Date:
Building Address:
Ci
20
Relocation of Furnace
Phone k
ker'same:
88
License #:
lna
MECHANICAL
tact:
Phone #•
MECHANICAL
Nei 2 3 o
Applicant/Contractor:
ELECTRICAL
o /h.�
Building Permit Info:
Bldg Elect Plumb Mech
Job Description: (�
Residential:
Commercial:
Sq.Ft. Floor Area:
$/Sq.Ft.:
Architect/Engineer:
Valua
Elec Permit Issuance
ELECTRICAL
Type of Construction:
Occu ancy Group
_.
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KZ—
Qr. if
An litghle
PA. M
BENERGY
Ener
•BUILIDNG
BREMFURN
Relocation 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
BUILIDNG
EPERMITFEE
Elec Permit Issuance
ELECTRICAL
MPERMTTFEE
Mech Permit Issuance
MECHANICAL
PPERMITFEE
Plumbing Permit Issue
PLUMBING
BPERMFEE
Bldg Permit Fees
BUILIDNG
BPLANCHK
Plan Check Fee
BUILIDNG
BUSLIC
Business License
BUILIDNG
-I- zS -2-?3
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