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CITY OF CUPERTINO
CONTRACTOR INFORMATION
-
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
0480 :Emy?�RTA-1- ACV
CONDITIONED AIR
PERMIT"'.03060128
OWNER'S NAME:
1701 LITTLE ORCHARD ;ST
""TO9718/2003
l
NE:
(408)291-2220
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O
LICENSED CON RACIOR'S DECLARATION
I hereby 1 licensed Chapter 9
Job Description
afli,m that am under provisions of (Commencing
ith Section )g10)of Division Sof dm Bu' and Pro esdslpSCode.andery5ccucis
m rml Torso I veto ' L�1, �(p�
License Claaa omN�Q
Date
REPLACE A/C FINALE..®
RCHITEC'S UZ AR ION
1 understand my plans shall be used ss puhlmc records
J U L 1 0 2003
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affmn that 1 am exempt from the Contractor's License Law for the
d
following masa.. (Section 7031.5, Bness usianProfessions Crum: Any city or county
U
BU'LDIN^
which requires a permit to comtmcl. almr, improve, demolish, Or repairmystructure
prior to its issuance. also roquiros the applicant for such permit m Me a signed statement
that he is licensed pursum,to the provisions of the Common's License Law (Chapter 9
Sq. Ft. Floor Area $1N�t Sion
(commencing with Section 7(k00) of Division 3 of thc Business and Professions Cad=) or
Nal he ts exempt Oterefrom and the basis for the alleged exemption. My violation of
Section 7031.5 by mry applicant fm a Permit subjects the applicant to a civil Penalty of
3 gkHHi 8Iil&5er 0 0
Occupancy Type
our more than Ove hundred dollars (115()(D.
❑ I. as owner oftAe property, or my employees with wages M their sole compensation,
will do the work, and theatmctum is notinended oro@red foesal0(Sec. 7(FM, Business
_
and Professions Code: The Ci m sane, License Law does not apply in in owncr of
UODS
progeny who builds., improves thereon, md.h. doesa.h work himself. their his
3 0 3 - ROUGH 3L�
awn employees. provided that such improvements are n.timanded in offered funk. If.
304 — ROUGH ELECTRICAL
however. the building or improvement is sold within am year of completion, Nown
e er-
budder will have the burden of proving that he did not Mild ar Improve for purpose of
501 — FINAL ELECTRICAL ENERGY
gam.).
502 - FINAL PLUMBING ENERGY
❑ 1. u owner or the property. . Business s and contractingfituwith licensed mminerrs to
construct to project (Sec. n, u-
Wi Code:) The vea
503 — FINAL MECHANICAL ENERGY
not n a werofand property who themona
apply man
ecowho wcenseddaorimproves thereon,and
505 - FINAL ELECTRICAL
conwdoes
r such witha cofpropeny
who contracts for such projects with a contrumr(s) licensed pursuant b the Contractors
Lt.= Law.
507 - FINAL PLUMBING
❑ lamesemptander See ,Bd:PCIerthisreaden
508 - FINAL MECHANICAL
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby inn order penalty of perjury am: of the following decimations:
1 have and will maintain a Certificate te of Conto self -insure f. Workers Compon.
mi.n. as provided for by Section 3700 of the tabor Code, for the purkne.m. of the
work for which this permit is issued.\
1 hove and will maintain Workers Compensation Insurance, as requimd by Section
3700 of due tabor Code. for the Performance of the work farwhich this permit is issued.
My Workers Compensation Insunue aria number am:
rn�d�Ppgliry
Carrier. 1N
CERTIFICATE EXEM N FROM WORKERS'
FROM
PE
COMPENSATION
COMPENSATION INSURANCE
(Thusection road set hccomplcmd ifmhe Permit isforonc hundred dollen: (SIM)
or Mss.)
1 comfy dust in the performance of the work for which this pconil is issued, I shall not
employ any person in my mariner m u an become subjal m lM W.keri Compensation
Laws of califomia. Data
Applicant
NOTICE TO APPLICANT: If. after making this Cmuricam of Exemption, you should
become subject to tic Wodcrh Compensation provisions of the Labor Code, you most
foMwith Comply with such provisions or this permit shall be deemed revoked,
CONSTRUCTION LENDING AGENCY
I hereby arrum that them is a construction lending agency for the Performance of
dto work for which this permit is issued (Sec. 3097, Co. C.)
tenders Name
tenders Address
1 certify that I have rad this application and auu that the above information is
come'. I agree to comply with all city and county onlinances and stare laws totaling 10
building concoction, and hereby aumborim represnmives of this City to enter upon the
shove-mcndom d property for inspection pur osses
(We) agree ssranve. indemnify keep humless the City of Cupcnina against
liabilities, judgments, costs and expenses which may in any way sccom against said City
h
m consequence of the germing of this permit
per
f
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
1`/
Issued by: Date
SOURCE REGULATIONS.
t lA
Re -roofs
`ammo
S AppbanVC ammurr Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will due applicant or future building occupant store or hands, hazardous material
as dcOncd by the Cupertino Municipal Cade. Chapter 9.13, and the Health and Safety
ode. 0Ys Section 35332(a)? Ya
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding Occupant sae ui
p W proem or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
g P
it hazardous air contemin!rtu (rood by the Bay Asa m
Air Quality Management
all new materials for inspection.
iudct? \�XNp
❑ Yes
1 have mad the hmaNnus materials tequimmcnts under Chapkr6.95.f the Califon
nu"cilth6SofctYC.4.5wmi.m MMS.M533"M534.1undersundlhaiftM building
does not currently hale a tenant Nat it as my reapmenhilily b notify the occupant of the
requirements which muss be at in issuance of. ccrtifiamo Occupan
:/ /1/LDI�Wj f .917- ��` `b
Signature of Applicant Date
All roof coverings to be Class 'B" or better
Gwen! ser ... Wrizm.g= Date
D
CRY OF
CUPERTINO
CITY OF CUPERTINO D j � 6 O/
FURNACE/AC
PERMIT APPLICATION FORM
APN #
Date:
3
rue urou
BUILDING
BREMFURN
Building Address: I ^ LAv M PteL' 7` I A �L
�
MECHANICAL
Owner's Name:
c �Sl/�-- s_
Phone #:
'z200
Contractor: � Phone-
License #:
Contact: Phone:
1
Cupertino Business License #:
Building Permit Info:
Rec tl, Switch & Outlets
Bld ❑ Ele lumb
Mech
Job Description: i
f
EPERMTTFEE
Residential Commercial ❑
ELECTRICAL
For Residential Installations:
Attic ❑ ls` floor ❑ 2"d floor ❑
Mech Permit Issuance
MECHANICAL
I PPERMTTFEE
BPERMFEE
Adhere to min set back requirement[]
PLUMBING
BUILDING
For Commercial Installations:
Plan Check Fee
Replacement same weight ❑ Additional weight (structural calcs) ❑
BUSLIC
Structural Calculations required for new installation ❑
BUILDING
New installation Planning Approval Required ❑
-
o Type of Construction:
Cost of Project: ` 00:5,.
Occupancy ou�
Strapped ❑ On Platfo onded ❑
Sq.Ft. Floor Area:
New Location ❑ Re laceme
•. _..%.iii_
FrP m
ree n
BENERGY
Ener
rue urou
BUILDING
BREMFURN
Relocation of Furnace
MECHANICAL
BREMACOVER
A/C Uni[ > 10,000 cfm
MECHANICAL
BREMAIRHAN
A/C Units <= 10, 000 cfm
MECHANICAL
BREMRECEPT
Rec tl, Switch & Outlets
ELECTRICAL
BSEISMICRE
Seismic Fee Res
BUILDING
EPERMTTFEE
Elec Permit Issuance
ELECTRICAL
MPERMTTFEE
Mech Permit Issuance
MECHANICAL
I PPERMTTFEE
BPERMFEE
Plumbin Permit Issue
Bld Permit Fees
PLUMBING
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING