03050137 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTORS 4RMATIO�I
BUIL DING ADDRESS: SCHAUMANN AIR CONDITIONING PERMITN003050137
q7 KT7.TJTWQr)T) AIT
owNER•S NAME: HEATING & PLUMBING . INC P°"'dE°n8/2003
NANCY H
ONE: (408) 428-0640 SANITARY NO. CONTROL NO.
ARCHITECTYENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 l�
_Oo
LICENSED CONfRACTOWSDECLARATION JobDescri tion
u+ I Icn,by affirm that 1 am licumed under previsions of Chapter 9(commencing p
O� withSection 7")of Division 3 of Ute Business and Professor.Cock,and my license is ILP
DUIi mld�ran,e�nd rr« g -7ao v REPLACE FURNACE
Ossa - � Conuanrar
ARCHITECTS DECLARATION LUN 3 3 2003
U I uMerstand my plans shall he used as public mentos JUN J L
n
G Licensed Prefessinnal
OWNER-BUILDER DECLARATION BUILDING
I If1 g�'pg�
1 hcmhy affirm Nam la ®1J LLP gMal 1 exempt from the Cionnomfs Lironu w for the
00 following moon.(Scotian 7031.S.Business and professions Code:Any city or county
K$ which myuires a Permit to cnnvmct,slur,improve,demolish.in tepalr any situation,
z prior to its issuance.also requires the applicant rorsuch permit to file a signed statement
iS`e thatMislicensedpurmantintheprovisionsoftheConvacrofsLicenscLaw(Chapter9 Sq.Ft. Floor Area $3Nt(y®tion
yl-$ (commencing with Section 7000)of Division 3 of the Business and Profession Code)or
Q that ha is exempt therefrom and the baso for the alleged eumpdw.Any violation of
Secdon 7031.5 by any applicant for a permit ubjecu the applicant in a civil penalty of 3�I)l�Itr1�Pl O O OCCU
not mom than live hundred dollars(M). panty Type
❑L,as owncr of the pmpwy,m my employcu with wagu m J kmde wmp melon.
will do he workand theswmum is not imendedoroflered forade(See.7044.Business -
and Profession Code:The Camrastmes License Law does ret apply m an owner of 3 0 3 - ROUGH &s
property who buildsor improves thereon.and who doessueh work himselfor through his JL4
ownemployau,pmvidc atsttchimpmms uamnatinuM conflicted forssle.If. 3O4 - ROUGH ELECTRICAL
however,the building or improvement is sold within moon,year of completion,the owner-
builder will base the burden of proving that he did not build or improve for purpose of 505 - FINAL ELECTRICAL
gra.). 507 - FINAL PLUMBING
1,u awnr of the PropertSce.70y,,B uness and contractingfesswith licensed dmacurers i-
convect the project(alts to aq Business and Profession Code:)The ws Use bh Ind SOS - FINAL MECHANICAL
who Law does not app1Y a an owner of property who builds or improve Commences and
whom Law. for each prejcan with acamranoy(,)limed pursuantmase Conu«loM1
License law.
0 I am exempt under Sec. ,B d:P C for this mason
1371W',
ner Dau
WORKERS COMPENSATION DECLARATION
1 hereby affirm under proudly of perjury one of the following deeumti no,
I haw and will maintain a Certificate ofComant m salt-insum fa woo sCompcn-
on,ss provided for by Section 3700 of the Labor Code,for the performance of the
rk for which this permit is issued.
1 bare and will maintain Wrkces Compensation Insurance,u required by Section
of due Labor Code,for the perfrni of the work for which this Permit is noted.
Workcfs Cnmpemeuon Insumo«tamer and Policy number ate:
rier. eSTRTF PuIicyN..:QQJQrD1 Zoos,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
or itis.)
(This section need wt hecompleted if the permit is per am ohundred dollars(SIM)
I unify that in the performance of the work for which this permit is issued,I Nall out
employ any Peron in any the Workeri Compcnation
LawsofClifomiaaPDate
NOTICE TO-APPLICANT:IL after making this Cenificam of Facmp nm you should
become subject in the Wonmr s Compensation provision of the labor Cade,you mum
.J z forthwith comply with such pmvisiona in this permit shall k deemed mwkcd.
z O CONSTRUCTION LENDING AGENCY
P1 kmby WE-that Nem is a romuumiom lending agcmy for the performance of
fir Ne work for which this permit Is issued(S..3M,Civ.C.)
QLanders Name
=z Undeh Add.
U Q 1 certify that 1 have read this application and sum that the,bow information is
"F correct.1 agree to comply wit all city and county ordinances and sure laws misting in
O U building convection,and hereby authorimtepreunutives of this city to troy upon the
[Ll ahovc-mantiuneopmpertt and expenses
purposes
(we)agmen gran,indemnify and keep harmless the City of Cupertino against /S
y
liatolithajou,nomiss.case,andlepcnnd keep
mryinanyway eCity rueagainst oag City /
V z in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGUL NS. t
Re-roofs
lgnume of ApplicantlConu«tor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will f applicant or forum Wilding occupant nom in handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.13,and do Health and Safety
otic.ClY.25533 (,)? / All roofs shall be inspected prior to any roofing material being installed.
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
it hazardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
District'
❑Yu
Ihawn,ad JxhvaNrms 25305.sn,quimd255u,1u Chapter 6.95 orthcWilding
nuHcalI haw may Lonhar CNon 35erials 25533 sod under
Chaptnothar if Jc Wilding
dos not currently have a tenant that it u my resp roihiliry m notily the occupant of the
require which muss pro Issuanc of Ccnifcau of Occupancy. -
��— � / S- ZT-,Q7 Signature of Applicant Date
Ownr or nthinved agent Dam All roof coverings to be Class"B"or better
r.
CITY OF CUPERTINO 03 S ` � 3 7
FURNACE/AC
OF
CUPEkTINO PERMIT APPLICATION FORM
APN# f O Date:
i
Building Address: v
Owns Name: Phone#:
� Z
Contractor: Phone: /—?pp_ fy6-0 ,33 License#:
OO
C9nt� Phone: Cupertino Business License#:
Building Permit'Info:
Bldg ❑ Elect Plumb ❑ M(
ch
Description:
Residential Commercial ❑
For Residential Instaations:
Attic Ells`floor 'm 2nd 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 of Project: Type of Construction: Occup y cup;�
ao yi�y /
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Flo ea:
New Location ❑ Replacement
A l Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
f 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
EPERMITFEE ` Elec Permit Issuance ELECTRICAL
NIPERMTTFEE Mech Permit Issuance AMEVCHANICAL
• PPERMTTFEE PlumbingPermit Issue BPERMFEE Bld Permit Fees BPLANCHK Plan Check Fee BUSLIC Business License