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04040134CITY OF CUPERTINO�3- BUILDING .,•s`�%?.m'se-p**. '�F ;' CONTRACTORIINFORMATIONI , DIVISION PERMIT Buu.Dwcnnnarss: A PERFECT CLIMATE PERMIT N"04040134 OWNER'S NAME: PERMIT ISSUE DATE AMOTZ MAIMON 10570 5 DEANZA BLVD 04/21/2004 ONE: SANITARY NO. CONTROL NO. (408) 861-9545 AlCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELF.Cf PLUMB MECH 0 0 0 0 LICENSEDCONTRACTOR'SDECLARATION 1 he y (firm that 1 am Iittnse0 under pnov'"ons of Chale or commencing lob Description p wimsection I of Division 3 of NC Business an ressinns Code, and my license is int r.um me EPLACE FURNACE & ADD A/C C s Lic.X '!Q Da Cuntre � / A CHITECrS DEC 1 I u flan my plans shall W used es pub m rtcards Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 71131.5, Business and Pmfcv,i.ns Code: Any city or county which requires a permit to construct, alter. impmve, demolish, or repair any structure74 2 prior In its issuance, also requires the applicant for such Permit to file a signed stawmenl Inas he is licensed pursuant o the Provi&ions Of the Contractor's Liccno law(CUeP¢r9 %\Sq Ft. Floor Area Valuation (commencing with Section 7")of Division of the Business and Professions CaJc)or L i Nat he is exempt therefrom and the basis for Ina alleged exemption. Any vmlotion or Section 7031.5 by any applicant for a permit subjects she applicant to a civil Penally orCSO foe —"o Occupancy P Y Type not meta than hundred dollars ($5W). i ❑ I, as owner of the pmperty, Of my emPloycu with wage& as their wle comPensadon, will do the work, and the swdum is not intended or offered for sdc (Scc.7Uad, Business goad Professions Code: The Coruscates Limnse law does not apply to an owner or peparywhoboildsorirnmorwsmere.....dwhodocamehwmkhimulfardmW,hhis(/ �J(�./ f/H�R�eqq4ie ns t• ns l/ Own employees, provided that such improvements gore not intended or offered for ate. If. 11 however, the building as improvement is sold within one Kar of completion, he owner. builder will have the burden of purring that he did not build or Improve for purpose of (p(J/ sale.). El I, as owner of property, gore exclusively contracting with licensed ennugonort toconsu / ct sense a the Project (sec. 7044, Busowner of gond property or improves who lens Code) The Contractor's ford Geos law dues notch apply to an owner of property who and, _ who cantata for such projects with a contractors) licensed pursuant m the CrnlnnoM1 r sed p Committees License law. ❑ 1 am eaempl under Sec. . B & P C for this rcuon Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby aRan under penally of perjury one of Ne following dectaralions I hats and will maintain a Certificate of Content to self -insure for Workers Container - "tion, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as m4uimd by Scctinn 3110 of the labor Code, for the red ...... r the work for which this permit is issued. My Work sCmmproo.d tlnsunna carrier end Policy number am: Cacti - li o.: &VICI ICI CERTIFICATED E.E FAOM WORKERS' COMPENSAT 11NSURANCE (This scctlnn necJ nal be comPlemd if the Permit is Lorene M1undred dotter, (gIrXO ,r Isla.) I certify Nat in the performance of me work for which this Permit is issued, I Nall not employ any person in any manner sr u On became subject to the Workers Compensation Laws of California. Data Applicant NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Worker's Cam remotion provisions or the Lahor Code, you must forthwith comply with such provisions or this Permit shall be deemed revoked. CONSTRUCT] ON LENDING AGENCY , I reactor, ofrim that mere is a eoutructim, leading agency fm the pco urmancc ur the work for which this permit is issued (Stn. 3097, Civ. C.) Leader's Name Lender'&Address 1 certify mal l have read this application and stoic that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to buildingconstruction.iro,end herebyaddition rroursenutivssof Oil City to enter upon the Novcmcntioncd property for insPccoon pufwses. (We) agree Io save, indemnify and the City of Cupertino against liabilities ,judgmc Is casts endeapcnsc ich mayin as' way accmc against mid City •� / in conogueneca he granting arm's omit. APPLICA DF,RSTANOS D WILL COM LYS' TFi ALL ON DINT SOU62ATIONS. Issued by: Date Re -roofs Type of Roof Si" Wrco p ontnnor Dam HAZARDOUS M DISCLOSURE Z. me applicant or future building occupant store or handle hanNaus mucosal u defined by the Cupertino Mun 'pal GUdC. Chapter 9. 12, and the Health and Safety ode, section 35532p)1 ❑Yea N. All roofs shall be inspected prior to an roofing material beim p p y g g installed. Will If a roof is installed without first obtainingan inspection, I agree to remove P g thea applicant re t pP g omupoat use equipment or devices which Or Uganda., .1, common deftn d by the Bay Arca Air Quality Management all new materials for inspection. 'strict? ❑ Yes Ihawreadmcla alumsma Is requirements under Chapter 6.95 of the Cali for. ria Health gr SafetyC rk, scemm 25505,35533 ad 25534.1 understand that if the building does nor cuaenrly h a nant that iI is my nsihility m notify rhe encu ant .()he Mftmquimmcnt t mu mctpniormi arae race m.¢mrae. Signature of Applicant Date Iffl All roof coverings to be Class "B" or better o me a.mo see avant Drat I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information ��/Contractor Signature Date 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 ��/Contractor Signature Date CITY O UPERTINO CITY OF CUPERTINO FURNACE/AC n PERMIT APPLICATION FORM APN # Date 2� Building Address: BREMFURN Owner's ame: Phone --, YYILb A/C Unit> 10,000 cfm Contyyct r.� Phon �/_ /r (foil/ `lJs Licer�s�s3 Contact: :� q Phone:^ ,b , 1�7s� C/ la D(�/ CupertinBusiness Li ense #: Building Permit Info: Rec tl, Switch & Outlets ELECTRICAL b / Bldg ElElect Cid Plumb ElMech BUILDING Job Description: �cC3 OvLd Qa) A� L Residential 0Commercial ❑ EPERMTTFEE For Residential Installations: ❑ ❑ ❑ ELECTRICAL Attic 1" floor 2nd floor Mech Permit Issuance dhere to min set back requirement El PPERMTTFEE or Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ PLUMBING Structural Calculations required for new installation El Bldg Permit Fees New installation Planning Approval Required ❑ BPLANCHK Cost of Project: Type of Construction: Occupancy group: 2Stra71 q92- I Business Licens Strapped' pped ❑ On Platform Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement 2 Qty. if Annli4hla FPP Tr) FPB De.,crintion Fee GrouD 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 EPERMTTFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMTTFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC I Business Licens BUILDING CP � v I 4 _,,; C