03040041 CITY OF CUPERTINO IX
ON RAC�TOR�INFOP,MATION s-
UBUILDING DIVISION PERMIT ^ ,,
BUILDING ADDRESS: PERMIT NO.
10675 GRAPNEL PL SCHAUMANN AIR CONDITIONIN , 03040041
t OWNS 'S AME: PERNm ISSUE DATE
�
I�L ROSARIO EDGARDO M AND R MEHEATING & PLUMBING INC 04/07/2003TR
NE; SANITARY NO. CONOLNO.
(408) 428-0640
ARCHITF.CT(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�OG LICENSED CON'TRACTOR'S DECLARATION O O O O
q� 1 hemby affirm Net 1 am limtucd under provisions of Chapter 9(commencing Job Description
Z widb Somion7000,}�or Division3ofte Busme and Profcuians Codeandmyliceneis
n<6 In fYll fOlces�/f C9r
iq� tisane cLsayL�� .g _7?�n? �-� INSTALL FURNACE ���,�,��®
,F Dam CmhAARCHITECTS ER RRATIO
a rtuoa ria Ih ateaasmbfiaa mrd APR
Ole
Licensed 2003
S OWNER-BUILDER DECLARATION
M1 hemM1y AM,.that l am exempt from the Cmurmorr's License law for the
p0 following mason.(Section 7031.5.Business and PmfeasimsCode:Any city orcounty BUILDING
s'�$ which croperea a permit te construct,site,.improve,demolish.Or mpan any anclaa
F y prim In its issuance.also mquker the applicant for such permiuo Gla a signed aatamnnl
�< that heislicensed pursuant othe provisions ofthe Contrmo'sLiver.LAW(Chapmr9 Sq.Ft. Floor Area $Valuation
Y $ (commencing wit Section 7080)of Division 3 of re Business and Pmfessiam Code)m 3000
.- tet he is exempt aerefrom and am basis for the alleged exemption.Any violation of
Section 7071.5 by any applicant for a permit subjects re Applicant o a civil penalty of A p�.7�7
Out mole than Em hundred dolim(S500). 3 Lti 4 S� bP' 0 0 Occupancy Type
tuownerofampe struc,or myemntende wit wags ualei(Sole rote.Business will I' rework.and the he Conder not intended m Law
do for sate(Sea 7014.Business
and property
wh orm Code:The ns d anon,License law dors or apply lf an riwnu is 301 - ROUGH I�agki IpgRgc[ions
Own employ b,pmvl&d deal such improvements
an ssuch not imwork himelfm through his 303 - ROUGH MECHANICAL
own employees,provided this such Improvements are not intended moffemA for sale.If,
however.the building As improvement issold within one rear ofcompletirim the owner. 304 — ROUGH ELECTRICAL
eJe.�will ban the burden of proving that he did not Wild or improve for purpose of 505 - FINAL ELECTRICAL
D 1.as awls,of re property,am exclusively eonmexthir with licensed contramas to 507 - FINAL PLUMBING
construct the pmject(Sec.704.4.Business and professions Code:)The Commcterk Li" SOB — FINAL MECHANICAL
cone law dors not apply m an owner of property who builds or improves Lemon,and
who contracts for such p viccs with aconsomim(s)licensed pumot nt in the Crintmuors
Lie'.La-
0 1 am exempt under Sm. .B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pcnity of perjury om of ate following dmlentionr.
have and will maimuln a Certificate of Content to Self-insum for Workers Compeer
tion,as provided for by Section 7700 of ate Iaba Code.fm the performance of ate
WO(k for which rli ptirttll I.IfSYca.
❑I have and will maintain Worker's Compensation Insurance.As required by Section
3700 of to labor Cade,for re performance of re work fm Which this permit is issued.
My Workers Compensation Insurance carrier and Policy number art:
Cartier. 0 Policy No.:
CEKHFICATEOF EKEMPnON FROk�K�KERS'—�
COMPENSATION INSURANCE
mils inion need nubs erimpletea Hthe fermis is marine hundred dollara(g100)
or less)
1 sorry that in to performance or the work for which this permit is issued,I shall nm
employ any person in any manner teas m become subject to the Wafker3 Compensation
Laws of California.Dam
Applicmt
NOTICE TO APPLICANT:Ir.after making this Certificate of Exemption,you should
become subject on the Worker's Compensation provisions of the Ichor Code,you must
.J O forthwith comply with such provisions or this remotihal be denotedrevoked.
'-' CONSTRUCTION LENDING AGENCY
I hereby affnm this there ire construction lendingagency for the performance of
IZ t7 the Werk for which this permit is issued(Sec.30D,Civ.C.)
W� Q Lendcrs N.
] z 4ndcr's Address
U 0 1 modify that 1 have read this application and sum ren arc above beinnamion is
U. F term i.I Agree to comply with All city and county ordinances and sum laws misting m
0U building construction.and hereby aurods ralmsenlativm of this city to on=upon to
W ahncme j.diladproperty rte ince.porch es
(We)agree to saw,indemnify and keep harrnleu the City of Cupcnino ageimt
h incotequers. on en costgrin and expemenmit. may in any way accmc against said City
f,z incouequcnce UNDERSTANDS
of this permit.
OP IC R GULATIO ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
Signetumol'Appliant/Contacmr Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum Wilding occupant Rom or handle Imeearaou material
as derned by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Curie.Sermon 23532(e)?
DYu "� All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or futrc building occupant tie equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
strict?le.umdram air contaminants as do/ftncd by the Bey Ada Air Quality Management all new materials for inspection.
DYcn �lS
1 hawread
nice Hnlr&Snreha)aocrdt..25riSls25533 dM534.dI erdsomouddralifrteoWildinngJu mol currently haveA ummL real it a myupoembliily 0 mafy
arc occupant M the
oqulmments which T!n2! eppm.rp whence or a cmufteamo a ter Signature of Applicant Date
owner otalithomind agent cam All roof coverings to be Class "B"or better
CITY OF CUPERTINO
�(a` FURNACE /AC 3
CUPEkTINO PERMIT APPLICATION FORM
APN#
Building Address-
_j
d ress- j J
Owner's Name: Phone#:
2:1 :? -�?�
C tractor: n. License#:
TID 12-23Y
C tact: Ph o e#:
q 0$ X123- C@'9.
App icant/Contractor:
P N i c
Building Permit Info:
Bldg ElectPlumb
Mech
ResidJob-Dential:'on: � /�
Residential: C �C_ _ Commercial:
'Sq-.Ft.—Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
Oaf
Type of Construction: Occupancy
Qty-,if
A is 1 Fee ID Fee Description Fee Group
M
Y Ener BUILIDNG
RN Relocation of Furnace MECHANICAL
OVER A/C Unit> 10,000 cfm MECHANICAL
HAN A/C Units <= 10, 000 cfm MECHANICAL
EPT Rec tlSwitch &Outlets ELECTRICAL
RE Seismic Fee Res BUILIDNG
FEE Elec Permit IssuanceELECTRICAL
FEE Mech Permit Issuance MECHANICALEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
• BUSLIC Business License BUILIDNG
zrs" 3 �
CITY OF CUPERTINO IX
ON RAC�TOR�INFOP,MATION s-
UBUILDING DIVISION PERMIT ^ ,,
BUILDING ADDRESS: PERMIT NO.
10675 GRAPNEL PL SCHAUMANN AIR CONDITIONIN , 03040041
t OWNS 'S AME: PERNm ISSUE DATE
�
I�L ROSARIO EDGARDO M AND R MEHEATING & PLUMBING INC 04/07/2003TR
NE; SANITARY NO. CONOLNO.
(408) 428-0640
ARCHITF.CT(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�OG LICENSED CON'TRACTOR'S DECLARATION O O O O
q� 1 hemby affirm Net 1 am limtucd under provisions of Chapter 9(commencing Job Description
Z widb Somion7000,}�or Division3ofte Busme and Profcuians Codeandmyliceneis
n<6 In fYll fOlces�/f C9r
iq� tisane cLsayL�� .g _7?�n? �-� INSTALL FURNACE ���,�,��®
,F Dam CmhAARCHITECTS ER RRATIO
a rtuoa ria Ih ateaasmbfiaa mrd APR
Ole
Licensed 2003
S OWNER-BUILDER DECLARATION
M1 hemM1y AM,.that l am exempt from the Cmurmorr's License law for the
p0 following mason.(Section 7031.5.Business and PmfeasimsCode:Any city orcounty BUILDING
s'�$ which croperea a permit te construct,site,.improve,demolish.Or mpan any anclaa
F y prim In its issuance.also mquker the applicant for such permiuo Gla a signed aatamnnl
�< that heislicensed pursuant othe provisions ofthe Contrmo'sLiver.LAW(Chapmr9 Sq.Ft. Floor Area $Valuation
Y $ (commencing wit Section 7080)of Division 3 of re Business and Pmfessiam Code)m 3000
.- tet he is exempt aerefrom and am basis for the alleged exemption.Any violation of
Section 7071.5 by any applicant for a permit subjects re Applicant o a civil penalty of A p�.7�7
Out mole than Em hundred dolim(S500). 3 Lti 4 S� bP' 0 0 Occupancy Type
tuownerofampe struc,or myemntende wit wags ualei(Sole rote.Business will I' rework.and the he Conder not intended m Law
do for sate(Sea 7014.Business
and property
wh orm Code:The ns d anon,License law dors or apply lf an riwnu is 301 - ROUGH I�agki IpgRgc[ions
Own employ b,pmvl&d deal such improvements
an ssuch not imwork himelfm through his 303 - ROUGH MECHANICAL
own employees,provided this such Improvements are not intended moffemA for sale.If,
however.the building As improvement issold within one rear ofcompletirim the owner. 304 — ROUGH ELECTRICAL
eJe.�will ban the burden of proving that he did not Wild or improve for purpose of 505 - FINAL ELECTRICAL
D 1.as awls,of re property,am exclusively eonmexthir with licensed contramas to 507 - FINAL PLUMBING
construct the pmject(Sec.704.4.Business and professions Code:)The Commcterk Li" SOB — FINAL MECHANICAL
cone law dors not apply m an owner of property who builds or improves Lemon,and
who contracts for such p viccs with aconsomim(s)licensed pumot nt in the Crintmuors
Lie'.La-
0 1 am exempt under Sm. .B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pcnity of perjury om of ate following dmlentionr.
have and will maimuln a Certificate of Content to Self-insum for Workers Compeer
tion,as provided for by Section 7700 of ate Iaba Code.fm the performance of ate
WO(k for which rli ptirttll I.IfSYca.
❑I have and will maintain Worker's Compensation Insurance.As required by Section
3700 of to labor Cade,for re performance of re work fm Which this permit is issued.
My Workers Compensation Insurance carrier and Policy number art:
Cartier. 0 Policy No.:
CEKHFICATEOF EKEMPnON FROk�K�KERS'—�
COMPENSATION INSURANCE
mils inion need nubs erimpletea Hthe fermis is marine hundred dollara(g100)
or less)
1 sorry that in to performance or the work for which this permit is issued,I shall nm
employ any person in any manner teas m become subject to the Wafker3 Compensation
Laws of California.Dam
Applicmt
NOTICE TO APPLICANT:Ir.after making this Certificate of Exemption,you should
become subject on the Worker's Compensation provisions of the Ichor Code,you must
.J O forthwith comply with such provisions or this remotihal be denotedrevoked.
'-' CONSTRUCTION LENDING AGENCY
I hereby affnm this there ire construction lendingagency for the performance of
IZ t7 the Werk for which this permit is issued(Sec.30D,Civ.C.)
W� Q Lendcrs N.
] z 4ndcr's Address
U 0 1 modify that 1 have read this application and sum ren arc above beinnamion is
U. F term i.I Agree to comply with All city and county ordinances and sum laws misting m
0U building construction.and hereby aurods ralmsenlativm of this city to on=upon to
W ahncme j.diladproperty rte ince.porch es
(We)agree to saw,indemnify and keep harrnleu the City of Cupcnino ageimt
h incotequers. on en costgrin and expemenmit. may in any way accmc against said City
f,z incouequcnce UNDERSTANDS
of this permit.
OP IC R GULATIO ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
Signetumol'Appliant/Contacmr Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum Wilding occupant Rom or handle Imeearaou material
as derned by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Curie.Sermon 23532(e)?
DYu "� All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or futrc building occupant tie equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
strict?le.umdram air contaminants as do/ftncd by the Bey Ada Air Quality Management all new materials for inspection.
DYcn �lS
1 hawread
nice Hnlr&Snreha)aocrdt..25riSls25533 dM534.dI erdsomouddralifrteoWildinngJu mol currently haveA ummL real it a myupoembliily 0 mafy
arc occupant M the
oqulmments which T!n2! eppm.rp whence or a cmufteamo a ter Signature of Applicant Date
owner otalithomind agent cam All roof coverings to be Class "B"or better
CITY OF CUPERTINO
�(a` FURNACE /AC 3
CUPEkTINO PERMIT APPLICATION FORM
APN#
Building Address-
_j
d ress- j J
Owner's Name: Phone#:
2:1 :? -�?�
C tractor: n. License#:
TID 12-23Y
C tact: Ph o e#:
q 0$ X123- C@'9.
App icant/Contractor:
P N i c
Building Permit Info:
Bldg ElectPlumb
Mech
ResidJob-Dential:'on: � /�
Residential: C �C_ _ Commercial:
'Sq-.Ft.—Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
Oaf
Type of Construction: Occupancy
Qty-,if
A is 1 Fee ID Fee Description Fee Group
M
Y Ener BUILIDNG
RN Relocation of Furnace MECHANICAL
OVER A/C Unit> 10,000 cfm MECHANICAL
HAN A/C Units <= 10, 000 cfm MECHANICAL
EPT Rec tlSwitch &Outlets ELECTRICAL
RE Seismic Fee Res BUILIDNG
FEE Elec Permit IssuanceELECTRICAL
FEE Mech Permit Issuance MECHANICALEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
• BUSLIC Business License BUILIDNG
zrs" 3 �