05120013 CITY OF CUPERTINO Q /"�7,�r� �-v�
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BUILDING DIVISION PER MIT � � kryW rag q
BUILDING ADDRESS: A PERFECT CLIMATE FEEMIT NO.05120013
1127 HUNTERSTQN PT.
OWNER'S NAME: PERMIT ISSUE DATE
JIM DUPORT 10570 S DEANZA BLVD 12/02/2005
NE SANITARY NO. CONTROL NO.
(408) , 861-9545
ARCHITECrfENGINEER: BVPERMITINFO
-REDO ELECT
PLUMB MECH '
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LICENSED CONTACTORS DECLARATION Job Description
I 1 thereby affirm Nat 1 aro Accessed under provisions of Chapter 9(ammtncing P
+'
infuluamneMaf
with Section 7000)of Division 7 of the Business aM Pro(cuWm Code,and my license is g� a REPLACE FURNACE & ADD A/C
t 5 License a +' o Lt..P
i` Date Con '
sig AR f1ECr9 DECIDELL.e TION
X I understand my plans shall be and a public records
l
• Licensed Professional
b�r OWNER-BUILDER(mmDECLARATION
55 1 hereby Nu 1 m etempt Tram the Contractors Licrne Law for Nc
O O following rueon. con,a 7 ander Business and ve.de oli Cade:My city of county
which its SW s permit a coir s[be uer,improve,demolish.t or ePeiathemae $10040
paler W its issuers,also equina pm applicant for such Permit W Ole Reigned, aw(naumcnt
F�o
that ho is Ii[cnscd putsuw W the provisions of tie Conuecefe Iueva law(CMPer 9 Sq.Ft.Floor Area Valuation
!{ a (commenting with Sudan 7000)of Division 7 of that Business and Proessiov Code)or
! that he is eaempt therefrom and the basis for the alleged esealPdm MY violation of
Session 7071.3 by any applicant for a permit subjects We applicant to•civil penalty of p Occupancy Type
.1 mart than Bw hundred dollen($700).
❑Lasowneroflhe property,army amloyenwith waSess,Ne4elecompeumba,
will do the week and rte macue is Out intended at offered foredo(Sm.7014,Busiav Required Inspections
and Profession.Coen:The Commences Liccee dem sun desat"Ply W N owner of 9 P
property who builds M bnpmwa thenen,and who does[Yell work hlmeif m ilmaph his
Own employees,provided Ne such improvements are mitinanded moffered for Wa If.
however,the Wilding or Improvement is said within olm year Ofampletion.the owner.
holder win haw the Waster of proving that he did not build a improve fa purport of
tale.).
❑1.as owns of the property.ora conclusively conaauing with named mnuamars to
mnsruct the project(Sea 7014,Budnem and Professions Code:)The Conmctor's Li-
cove law doss am apply W an awns of propenywho Wilds or impmws mean,and,
who contracts for such pmjecm with a eonu mer(s)licensed punuant W Lilt Contractoes
License Law.
❑IuneaereptunderSee .B&PC fa N4 mswv
Owner Dam
WORKER'S COMPENSATION DECLARATION
I Mmby.W.under peeWty of perjury am of Ne following(edsousb ce
1hemandw0I mdnuinacenir=wofca nimself-invertfaWarke/sCampm-
aatlon.a provided for by Section 7700 of tie labor Cade,for na pedannance of that
work for which Mia permit is issued.
❑Irian and will mdnWn Wohte,CompevWan Insurarna,use mquieed by Section
3700.f the labor Code,for Ne perfamsnee of Ne wnuk fa which lhu Permit m WOOL
MyW Compenumon btsasuce turner and Polity number e:
caric' Pailcy No.:
CE TIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cries malar aos not W canpleud lithe permit Is faom WodaddaOan($100)
or mss.)
1 cenify that In the performance Of one wprt fa which this permit is issued.I shall na
employ any eno,alna•l1a'lq!gpa�ell WhsubjatmlM�CampcnaatWn
Laws of C•. __dl I Lf�d A
Applicant�2 A
NanCETOAPPIj'tC : I., making Nu nilam of Fiempdon.yw dWUW
become subject W no Warkeh Compensation provision of the labor Code,you mon
z forthwith comply with such provisions or Nu permit shall Ise deemed revoked.
zCONSTRUCTION LENDING AGENCY
r1 Washy alnm Nu Lie.its construction lending agency fa the Performance of
a tie work fa which cids pewit is issued(Stu.3097,Ci,C.)
1 Q lender's Name
O,z Lenders Address
V 0 I ardfy that 1 haw lead this application and was Nu tine show information is
IL U corned.I agree W comply with all city and county ordinueem and same law relating W
0 Wildingconstruction.and hemby aunods epmenowns of this City he calm upon tiro
move-mcMaled propcny for inspection Purposes.
pyo (We)agent W an,indemnify and keep humlev Ne City of Cupertino agdvt
lti cn liabilities.judgment,cow and expenses which may In any way same agalna aid City
U,`z in consequence of the gunning of this Permit /'L 2,— 6�_
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AIS.NON-POINT Issued by:9 Date
SOURCE REGULATIONS.
Re-roofs
Signuue of ApplismUCanuana Die Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will rte applicant or future Wilding aaupantnoro or handle baadov maerial
as,dcflnsd by the Cuperoro Municipal Cade.Chapter 9.12,and tle Health and Safety
use,S.W.25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yue o
Will de applicant or filum Wilding Occupant um equipment or devices Mich If a roof is installed without first obtaining an inspection,I agree to remove
mit hvaednv dr antaminanu dcflmd by Ne Bay Area Air Quilty Mmnsgcment all new materials for inspection.
Qw ctT
❑Yue
I haw mad the assurance materials equieements under Chapter 6.95 of the Califon
rte Health&Safety Cade,Sections 27707,77737 and 71534.1 thdelusud Nat if the Wilding
data not C.110Y ban a enam.that it I my MiGodhilitY in notify its aWmat Of Ne
requiemewwhich mwWmatpdorWissuance ofacadr.,.afOccupancy. Signature of Applicant Date
Owner or authorited agent Dae All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014 .
Telephone(408)777-3228
aCO Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
1 V)--1- �•,-�t S" / ZDo7
OWNER'S NAME: al— PHONE # — ?34 —
GENERAL CONTRACTOR 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
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
T'
Owner/Contractor Signature Date
CITY OF CUPERTINO
FURNACE/AC Z
6 j
CUPEkTINO PERMIT APPLICATION FORM
APN# 3 /2 Z/ o (/ Date:
6
Building Address:
l l a'1 14.
Owner's Name: Phone
y-40�-
Contractor: License #:
Contact: Cupertino Business License #:
11,
Building Permit Info:
Bldg ❑ Elect LAY Plumb ❑ Mech Yd
Job DescriptionICxG'C'.Wt. >rAdd6(c—
Residential
LResidential U/ Commercial ❑
For Reid ntial Installations:
Attic M 1ST floor El2"d floor❑ /
Adhere to min set back requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost ofroject: Type of Construction: Occupancy oup:
Strapped ❑ On Platform IK Bonded ❑ q.Ft. Floor ea:
New Location Replacement
Qty, if
Applicable Fee ID Fee Description Fee Group
BENERGY aRecptl,
BUILDING
BREMFURN MECHANICAL
BREMACOVER > 1Q000 cfm MECHANICAL
BREMAIItFIAN <= 10, 000 cfm MECHANICAL
BREMRECEPT itch & Outlets ELECTRICAL
BSEISMICRE e 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 B. BUILDING