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04070137
'CITY OF CUPERTINO '` %^ BUILDING DIVISION PERMIT ?.zCONTItACTOR INFOI2MATTON ' hii-+7. '.53."40,mA ifs;XVW BUILDING ADDRESS: A PERFECT CLIMATE PERMITNO.04070137 OWNER'S NAME: PERMIT ISUEDATE LYNN CARTER NE: SANITARY NO. CONTROL NO. 408 861-9545 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH _oo LICENSED CONTRACTOR'S DECLARATION Job Description V� u I hereby affirm that 1 am licensed under previsions of Chaper 9(commencing with Section 7000)of DIAmion 31trilm Business and Pmfecduna Cade..dmy license is in rata ramex 23� REPLACE FURNACE & ADD A/C jb� LicMae Cl s Lie.# �—p Da O Cantonar V ARCHITECT'S DECLARATIOt A a—n I understand my plans shall W used as public records �� 9 <004;G G Licensed Professional OWNER-BUILDER DECLARATION f I hereby affirm that 1 am exempt form the Commcmr's License Law for the ®� i 00 allowing reason.(Section 7131.5,Business and Profusions Calc:Any city or county S� which requires a permit to rnnstruct,alter.Impmve,demolish.or repair any suuctum priorhs is;ssuance,also=lot s the applicant forsuch permit to Glc a signed statement 2F Natheislicensed pursuant tothe pmvislonsofthe ComractorsLicsnsclaw(Chapmr9 Sq. Ft. Floor Area Valuation pNa (commeocingwiNs dm7000)o(DivWon3oftWBusinmand Profusions Code)M 59 Out W i exempt therefrom and the bask for dm alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of g��fh6er 0 0 Occupancy Type not mom On five hundred dollars(5500). as owner of Ne property,or my employcu with wages to their Sole canpcnssdon. willdodmwort.andthea.Ctrm is not intended or offered firand.(See 7041,Business Required Inspections and Profeaions Code:The Contractor'License Law does not apply m in owner of q P property who buildsor improm discon.and whodeessuch wart himselforduough his Own employees,provided Nat such improvements art natimmndcd Or Offemd for sale.If. however.IN building or improvement is sold within ON year of COMPIMOn,Ne owner builder will haus the burden of proving that he did inti Wild mhappen,for puryose Of axle.). I,as Owner of the property.am exclusively contracting with licensed convectors to comuuct the pmjen(Sec.7000,Business and Pmfe.Gom Code:)The Contratm's Li- ceme Law does not apply m art owner of property who Wilds or improm thereon,and, who contracts for such projects with o comoactor(s)licensed pursuant to the Conuacwfs License law. O 1 am exempt under Sec. .B&P C for Nk rwon Owner -'� z WORKER'S COMPENSATION DECLARATION c , 1 hereby affirm under penalty of Perjury rete of the following declarations: 1 have and will maintain a CeNOeate of Conscnt to self-inmm for Wa luce,comPen- sation,a provided for by Section 3700 of the Labor Code,for the Perfannanes Of IW work for which this permit is issued. se and will maintain Worker's Compensation Inmrance,u required by Section 700 of the labor Code,for Ne performance of the work for which this permit is Hand. My Worker's Com ensation lophis ce carrier and Policy numhe,art: Camlcr. icy No.: al CERTI CATE OF EXEM ON FROM ORKERS' COMPENSATION INSURANCE miksaIt.reoil wt W completed ifdmPermit isform.hundred Mllars(SIM) or les.) I certify Nat in the performance of the work for which this Permit is issued.I shall nut employ any person in any manncrso is;b become subject to the Workers'Compensation Laws of Califomia.Date Applicant NOTICE TO APPLICANT:If,after making Nis CcniGnte of Exemption,you should Wcomc hincet to the Workers Compensztion pmvisions Of be labor Code,you mesa forthwith Comply with Such provisions or this permit shall W decreed resited. z'—' CONSTRUCTION LENDING AGENCY 4 l hereby affum that Here is a construction lending agency for the Performance of rG 7 the work for which this permit is issued(Sec.3097,Co.C.) I[7 Lemaces Name z Emden.AJd. V 0 1 certify that 1 have read this application and sure that the above information is D.f"' comma I agree 10 comply with all city MO county ordinances and sum laws mlating to O C.7 building convection,and hereby authorise representatives;of this city in enter upon due W aWve-memioned property for Inspection purposes. (Wm)agree to an.indemnify and keep harmless the City Of CupcNno against iliabilidex.judgmcnts,costs and expenses which may in any way acetum against said City V z in consequence of the Granting of this pernit. r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-P01 Issued by: e lUR LATI S. Z Re-roofs Signatureof Aliplopertizontractor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupaotstore or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety lDisukt? le,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. Will Otc applicant future building occupant tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hvafdri.air conn inants u dchned by the Bay Area Air Quality Management all new materials for inspection. ❑Yes rIhavcread thchar banal 5.15ds 5uimmcnts34.1 u CNsusid O50fda Califon Health&SafetyCode,Sections 25505.25533 and 255ld.l undcrssnd Naifda:W;IJing u not c tit hoes a¢oars.Nat it k my responsibility mnotifytheoccupantofNca;re a met poor missrmmoneenic or erpaney.� D 'g ature o Applicant Dale ownnmarmrri.<daFers D,a All roof coverings to be Class "B"or better e Community Development 10300 Torre Avenue Cupertino CA 95014 " Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building Department JOB ADDRESS: � PERMIT # ©I p p r7 6137 OWNER'S NAME: IPHONE # Ud -9546- GENERAL CONTRA OR FAX # _ C/ I am not using any subcontractors: -7)Z2-/6 Signature Date Please check applicable subcontractors and complete the following information: 21 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 -, CITY OF CUPERTINO FURNACE4 /AC UPEkTINO PERMIT APPLICATION FORM APN # T17 / 6l(// _/'�O 2 Date: —7 ,z- Building Address: OT3 2D Owner's Name: o Phone#: 0--253- -2�(n2 Contractor: Phone: License #: Contact: Phone: Cupertino Business License #: Building Pennit Info: Bldg ❑ Elect ❑� Plumb ❑ Mech ❑/ Job Description: Residential Eq— ' Comm tial ❑ For Residential Installations: Attic ❑ 1S1 floor ❑ 2°d floor❑ Adhere to min setback requirement❑ or Commercial Installations: eplacement same wei Additional weight (structural talcs) ❑ Structural Calculat s required or rte installation ❑ New installatio tannin A r val Re fired ❑ Cost of Proj t: T e of Construction: Occu ncy up� Strapped On Platform Bonded ❑ Sq.Ft. Floor Area: New Locati ❑ e lacement ❑ Qty. if A e Fee ID Fee Description Fee Group BENERGY Energy BUILDING 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 BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Pemtit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING $/7bl. V�