03080090 CITY OF CUPER'I'INO -
BUILDING DIVISION PERMIT .�aCONTRACT�ORvINFRMATION :_
BUILDING ADDRESS: UNITED AIR COMFORT PERMIT No,3080090
OWNER'S NAME: 5819 N ANDREWS WAY PERMIT MILE DATE
NL (408) 771-8967 SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
+00 LICENSED CONTRACTOR'S DECLARATION IobD On�7 O O
'w 1 hereby affirm that 1 am liamcd under Dmv' ons or Cha W19 mincing B
i<6 with Section 10048 of Division 3 of the Business an Xfcsy a licensi • ^�E®
I
full fame ani if
Sq. lneenaecl �"e' Lie. rQ+ e ACE A/C (5 TON)
�w Date Contractor AUG 2 2 2003
ARCHITECTS DECLARATION
acd� I understand my plans shall he used as public records
H Licensed P
mfcesipnil
_0 OWNER-BUILDER DECLARATION BVe�
ILD'NG
2a y 1 hereby affirm that I am exempt from the Contractor's License Law for the
C20 o following reason.(Section 7031.5,Business and Prulestlntu Cale:Any city or county
<m� which requires a Permit to construct,alter,improve,demolish,or repair any evucwm
prions its issuance also requires the applicant forsuch permit to r1ritogned.owemem
iso that he is licensed pursuanthathe provisionsoftheCommetur'sLicense law(Chapters) Sq. Ft. Floor Area Valuation
LI- (eommencingwith Section 703D)of Division 3ofthe Businmand Pmrcssions CnJc)ur
$ that W is exempt therefrom and the basis for the alleged exemption.Any violation of 35925045 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Numberccu ane OType
not more than five hundred dollars(M). P Y YP
1,as owner or the ptopeny,or my empluyem with wages as their sole compensation,
will do the works,and the stmaum is not intended at ofrcmd for sale(Sec.7014,Business 301 RO
—
and Pmfcwiom Code:The Convoctori License Law docs not apply to in owner of �Ections
property who builds or improves thereon,and who doessuch work himsclfor through his 303 — ROUGH UOH M CHANIC.'AL
Own employees,provided that such improvements arc not intended or offered for sale.If. 3O4 — ROUGH ELECTRICAL
however,the building or improvement is sold within one year of completion.Ne owner
builder will have the burden of proving that Or did not Wild or improve for purpose of 505 — FINAL ELECTRICAL
sain).
1,as owner of the propcny.am exclusively convecting with licensed contractors to 507 - FINAL PLUMBING
Construct the pmjcct(Sec.7Ba4.Business and Profession rude:)The Comencl•r's Li. 508 — FINAL MECHANICAL
erose Law docs not apply to an owner of property who Wilds or improves themon,and
who contracts for such projects with a contractorb)licensed pursuant o the Contractor's
License Law.
❑ Iarnescmptunder See. ,B&PCfmthisresson
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certi6cam of Consent ro self-insure for Worker's Compcn- '
sation,as provided for by Section 3700 or the labor Code.for the perfm tare.of the
work for which this permit is issued.
�1 I have and will maintain Worker's Compensation Insurance,as required by Section
P00 of the L i horCale,for Ne performance of the work for which this permit is issued.
My Wor er and Policy her am:
Gan er: Compensation II n cc comPolicy No.:9 b9 ZR 91
CERTIFICATE OF E%EMP ION FROM WORKERS'
COMPENSATION INSURANCE
(This section bead not becompleted Box Permit is far one hundred dollars(tial)
of lest.)
1 certify than in the performance of the work for which this permit is issued,I shall not
employ any tanker in any manner s r is to hccome subject o the Worken'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should
become subject in one Workers Compensation previsions of(be Labor Chile.you must
.J O forthwith comply with such provisions or this permit shall he deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
n 1 Wmby affirm that Nem is a coentosetinn lending agency for the performance of
C4 the work for which this permit is issued(Sec.3097.Civ,C.)
W Leorcr's Name
C' Landers Address
I
U Q certify this 1 have read this yapplication and suet the the about ors hilatiun is
Lf. U bonding 1 Agree m comply with all city and county ordinances and cute laws relating to
�U abovengcon..d construction, hereby authorisseprescnunivrs of this city mcnurupon the
perty
G ahovc(Wemoto)a cd to adve for inspection an keep cs. ,`,�g7fy'r7r/' //
(We)agree to save,indemnity and kora harmless the City of Cupcnmo against ��--v�a/v
F N Iia biitics,judgmen costs end wPe chmayi ywayacconagainstuid City
U Z in conseywncc dSrynnin nI���Zit
'—' APPLIC NT S N LL N P INT Issued by: Dat
SOURC
&gnamrc of AppbcanUConvactor�d� Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding Occupant store or handle hararduus material
as defined by the Cupeniw Municipal Code,Chapter 9.12,and the health and Safety -
COJC,Sccdon 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑1cs
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
_mit M1aaardnes air conmminants as defined by the Bay Arca Air Quality Minagermot all new materials for inspection.
District?
❑Yes lam"
1have mail thch mMtmsmamrialsmqulmmenuuntkr Chaprer6.95ofthe Carrot.
niaHwlth&SafctyC41c,Becomes 25505.;433 and 25514.I undersand that if tW Wilding
deet not curmntl a none ll
s yrespons stytonsfilydr,mcu tof the
myuimmc aw t pnr�eU Signature of Applicant
�� Date
Owner or authorized agent D,a, All roof coverings to be Class "B"or better
CITY OF CUPERTINO
i K- FURNACE /AC o3 62 60
' CUPER,TiNO PERMIT APPLICATION FORM
APN# /, /O 3
Building Address: `�
2-
Owner's
Owner's Name: Phone#:
Contractor: G%%6y License#: 75759
Contact: g Phone#�--�-� �&116703- Z G53
Applicant/Eent#aGw
�Z3 Z
Building Permit Info:
Bldg Elect Plumb Mech
Job Description:
Residential: Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation: 3G
Type of Construction: Occupancy Group:
Qty. if
A licable Fee ID Fee Description Fee Group
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
t BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
EPERMITFE Elec Permit Issuance ELECTRICAL
Gh MPERMIT E. Mech Permit Issuance MECHANICAL
i PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG
� a
cI -
BUILDING of cuPET
BURACTMINFORMATIOM ,.
ILDG DIVISIONSION PERMIT , gON
BUILDING ADDRESS: PERMIT.
10279 JUDY AVE 2070090
"ER'S NAME:
'!IKE WARREN APPLICA o f fl DAT,E2 0 0 2
i
Is I PHONE: SAA•ITARYVN/O./ 1O CONTROL NO.
C z Z ARCHITEC(ENGINEER:
FOO BUILDING PERMIT INFO
<U BLDG ELECT PLUMB MECH
S�i LICENSED COcensed mile,
p DECLARATION Job Description
Z_O loony O)ifflfthen1amlifineBunderprovisionsofChapter9(commecense ADD 499 SQ. FT. p
mt_-u with Section]1100)of DivisionJof the Business wd Professions Code.and my license
;x75 i,in milrarteand effect. ADDITION OF ACCESSORY, DEMO EXISTING
m u< License Class Lic.a
'�p� Date cmunscour
CHITECrS DECLARATION SHOP BLDG
i rs uu❑as public records
i'S O O n cs,iowl
9, O 'NER5BUILDER ss DECLARATION `�[ /
r a r 1 by uIT her 1 um exempt from the Contractor's License Law for the
< following a Litman 703 L.5.Business and Professions Code:Any city or county
�3eszF O rommecem ' alter,improve.❑emolixh,or rtpair any structure
pnmtoan,uamee,,al,ortq applicant fmsuch pe.miuo File asigm4nnemm
or tM1a,he is encm'i ificrtfroni and igmu of Ne Conwcmrs Limnu law(Chaper 9 Sq.
-•Ft:•F1oor.Ar�nj - --...- ----'-
_ which p �ulrn'�Divisi of3 C nB inesUv nP few(CMpterw -�F's: .•" ,t s anon
l ......... ... ....
requires a con to consumer.
Net he is licensed puriuvntte the pros
( •
(commencing Sora 7oo0)a i-._.. , c gv,;.s-.c�y_. .lhe basis for the alloyed beingioaiAny violation ofSomm M315 byof not mare than five hundred eoRaf,essoo). 37 5' ,YP�flnb@r . . Occupancy Type
❑1,as owner of the property,or my employees with writes as their sole compensation.
-'will;dd the work;;and the structur<is not moinded"orOffered for sale'(Sec:'7044;-
Bosoms'end Prefes,im,Codc:The Contract.',License Law clots our apply to an 1 - ired InspecticnsT':-St PM:
owner of pommy who builds or improve,thereon,and who does such work himself 102 - PIERS
m through his own employee,..prewom that such improvements me not imended or
offered for sale.If,however,tro Wilding o.improvement is sola within One ar o ---------. . _.—_.-.-__—-
103 LIFER- ' - -..... - -
comPlcuan.Nc ownenbuildcr win have the buNcn of proving doer M did nm bund or ..•,f?G':>?: \..T .:_\k'
improve for purpose of sale.). 104 — REBAR ..
-. ----
❑I:esownerofthe property am acrosmelycot i g m l,cenmdecomum to - 5- ANCHOR--BOLTS --._ ... _. .
newer the pro+em(Stt 7044.Business andP r an,Coda)The commeo., 106 - SEWER & WATER l ' >�• L I:., -.__.
License Law ams not apply to an owner of property who builds or improves thereon i��
ata who cm,tmns.mr auch.pro3«1win, .cam tr(s),IimmAA pursuant m m . 202.--_.__UNDERFLOOR._PLUMBING
Conuanors License Law. .-r__.____.
❑le larder « " 6&pet ,h'srtuon 203 - UNDERFLOOR,,MECHANICAL
'im7 DZ' 204 - UNDERFLOOR FRAME
ER MP o! uRAnoN 205 - UNDERFLOOR INSULATION
-Ih ramrmrrder,penmtyorp<juryooennhefoRnwingaeelamrnn,: 301 - ROUGH PLUMBING
f .1 ❑ 1 ha t rid will riminton, n CeelRda¢of Con ent'ia mvnnmrc for Worker', 302 - TUB tit OR SHOWER ..
compo ton:-a,-pm ded for by-sect naonrme Laron eta ran he 303 - ROUGH MECHANICAL
performance of the work for which this permit is issued,
r. 01n ape llmnihmnWadcriCuinp nonminnd,i q abYskov 304 - ROUGH ELECTRICAL
3700 of rhe Gro.Cade,for the performance of the'w6rk foro-which this Permit is 3 05 - FRAME
Is e4 My WmI wz Compensation insurance Gamer and Polity munber Are
306 - HOLDOWNS _
Garner °4. 4 Lt S s _
1 FRWt _ INSUIJATIONLi CTIFlCA710NOFEXEMPTIONM
',COMPENSATION INSURANCE _
6bri scoodnaed nm be coinplcied if the permit is for one hundod dollars _,.. . 3O9 EXTERIOR LATH qa• t )) 3;'•-'—'_ .._... _.,
Is 100)o I ).
�(2 a1<trt ry�+t�m perm
or In rk mr.wnicn m,permit- _ __._... 3.1.0._..__INTERIOR-LATH__„
swill memviY ny'pc n r Snne so olrEgppe b, n a ,' 311 - SCRATCH
Compo t laws f
-wpp r - 313 - ROOF NAIL
_._.
" ^? 1 eat m ng c,laeueaeEeem should 501 - FINAL ELECTRICAli• ENERGY "
Z bee ub3em Ile Wark<nC pensario pro n,of the
Labor Code youmust
OO Tann m o hh6chp m II Ice t:nRxd Wm ked _ 502 - FINAL PLUMBING ENERG
"ICONSTRUCTIONLENDING AGENCY � � � - '- 503' FINAL- MECHANICAL ENE GY;7-i
a > '' 1 n mby M.th t m ,s a c sawn on len d'ngagency for.he pert nuance "
W sucd(stt309] Cv.c) 504 - FINAL BUILDING ENERGY T
,.�. of Jae kion hbh thspe t si.9
w p
Und
D Z" Lanae ,Aadrca, "- -" -505-- - - FINAL ELECTRIC --
U0 O. 506 - GAS. TEST ioi AL (/..
. Ic mfy thair has ve dth ppi oto nev mNtNe above information ts ^
E pct+ g m< ply w„nall city,and ntyordinance,nae awe laws relating 507 — FINAL PLUMBING
O [) is pule gro t ao the by' Nso prcu at esofthiscity10enterupon 508 - FINAL MECHANICAL
the abo t once property ro t comp tyroI.
H px,a (We)agice't6mmodemnify,aall, phariNess'dA! jFy"ofCupenino�gainst 509 - FINAL GRADE
y Laba ties,judgments,costs ❑ penes wh h may n any w y ecce ge st said
U Caty consequence of Meg ung of Ns permu _" S 1 O I N NG / .(
f APPY.ICA.NT UNDERS NDS ly\D WILL.COMPLY N'j'1'jf ALL OV ON`r o'
/ 11
ce a llCAs Issued baa j-0 -
I RKS Date
,gnat f A IicanUC ower t :+- •-. _.
....u .,., e-
<. vise , HA7Jv k1$MATERIALS D15CLOSURE':5 ''�:, Re-roofs
i!d I de applicant 6i Noma,bualdidjOcca
8 pant sere 2 nd the Hazardous materiel. ,
C di: by N55320d nope pal Cpdc Ch pm 9.12 end J, Health an material safety Type of Reof _. .,
Code:S ton 25531a)lT5 •"` t
❑Yc, _ \ 'Std. 5 1, 'I
.
rr, All roofs shall be inspected.prior to.any roofing.matenal,bemg installed..__
�(cvi W11 th appLcpmo f t le.ng map tuse yAml it Quality
u de anal wench If a roof is installed without first obtaining an inspection;159h2e,to remove
vsh?..Z arr collum ¢ dein. d,e Ray Arca Air Qud ty Men'gemen,
" all new materials for inspection_ Applicant understands and will cam 1 with
�f irf7Ys - t r r . _ �.... - _ EY._ __-
,I H v� 1a ihe•'Hevrdo maaeneis'rt I r all non-point so ce r lations.„, , ._
q nm un¢unde)Chap a 695 or'the I
CAN m Health'&Safety Cod arm 75505 25533 and 25534A undersand roar
(the b 11 i g dot' of carte dY h a mnem that t y rtspom b I ry toy reify
.. .. _.. .
mcupe t f N equ rcmcn h ch st be m t p o to 4,uancd a Cc facet of -
upancy.
4r
.. '_ $3g-star fAppI W, ... . ....... .. ._ .
o __7d-.7 .. .. _. Date'- ... . _.-.
,,;:- o,, •,e All roof coverings to be Class "B"or better'
FFICE