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03080019 CITY OF CUPER'I'1N0 Ruu,Dlrvc DIVISION PERMITCONTRACTOR INFORMATION' BUILDING ADDRESS: A PERFECT CLIMATE PERMIT NOO 3 O 80019 OWNER'S NAME: 10570 S DEANZA BLVD PERMIT LSSUE DATE Aft MARSHALL CHARLSIE 2003 ONE: (408) 861-9545 SANITARY NO, CONTROL NO. ARCHITEC tENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 100 LICENSED CONTRACTOR'S DECLARATION C7 O O O i'r❑ 1 hereby affirm that 1 am licxnsed under provisions of Chapmr 9(commencing Job Description aW with Scaion]IX10)ND' ision3nfmc Busincxs and PmfcssionsCMc, ndm liccnu is Lfull fcanume and of S ADD A/C ® �ppp /� -F O Da¢ Canmumr ea ril[1�� be ty A HITECTS DECLARAT f manJ my plansshall W used as public rc nNs AUG 14 2003 7aD e 0 LkcnseJ Pmfcssional x 3 OWNER-BUILDER DECLARATION a y I hereby affirm that I um exempt from the Contractors License Lew for the ren n'rs rr��fs� 00 following mason.(Section 703 1.5,Business and Professions Code:Any city or county B�a/U u o my e 2� which requires a permit of construct,altar.improve,demmuh,or repair any strvnurc $3794 Z prior m its issuance,also requirestW rm applicant for such peit to Fit.signed examinexaminantmcnf ii G that he is licensed pursuant to the provisions or the ContractoriLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation 1- (commencing with Section 7000)of Division 3 of the Business and Professions Code)Or i thnt he i,exempt CcrtRom and the basis for the alleged cxcmption.Any violation of 35923013 . 00 s«sun?031.5 by a by Applicant for aprtnitsnbjemxm[avplican,toacivil penalty of ane APN Number Occupancy Type not more thin five hundred dollars($50(f). p y yp ❑I.ns owner Of the property,rrAn,cmploycca with wages as their sola compensation, will do the work,and me structure is not intended or offered for sale(Sec.7044,Bus and Professions Code:The Conlncrnrs License Law does not apply to an owner of 3 O 3 — ROUGH �f s property who builds at improves Boon,and who doessach work himself or through his L own employ=.provided that such impmKmenu art no,intended or offered for sale.Jr. 304 — ROUGH ELECTRICAL however,the building or improvement is sold within one year of completion.the owner builder will have the burden of proving that he did not build or improve for purpose of 505 - FINAL ELECTRI CAL sale.). 507 - FINAL PLUMBING ❑1,as owner of the property,,B exclusively confessions with licensed contractors i. conte,La the project(Sec.704q Business and Professions Code:)The Contractor's Li SOB — FINAL MECHANICAL cense law coca not apply loan owner of property who Wildsbs improves Centra.and who contracts for such projects with n convumr(s)licensed purauam to Ce Contractors Lk[nsc Law. ❑I am exempt under See. ,B&PC for this Mason Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one Of the following declarations: I have and will maintain a Cenificam of Conant to self.inscre for Workers Cumpen. ,alio.,As provided for by Section 3700 or On Labor Cade,fm the performance of the oh for which Ci,permit is issued. have and will maintain Worker's Compensation Insurance,as required by section 37 of Ce Labor Code,for the performance of the work for which For permit is issued. My mocrs C.mp[ns torn Insunf¢c carticr and Policy num c Cam, tory No.: � CERTIFI=OFEh ON FROM WORKERS' COMPENSATI INSURANCE (Ibis section need not W cmnplemd if tk permit is for ane hundred dollars($UAF nr Icss/ 1 certify Cat in the perfomunce of the work for which this permit is issued,1 shall not employ any person in any mantmr so as to become subject to the Workers Compensation Laws of Califomia.Data Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should Wcome subject to the Worker's Compensation previsions of the Labor Code,you must �z forthwith comply with such provisions orthis Permit shall hedeemed revoked. Z O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency Rh the performance or D: Cc work for which this permit is issued(Sce.3007,Civ.C.) Q Lend.ea Name Z Lender's Address ;J C) I certify Cat 1 have read this application and state mat the above inforenatiun is y F cancer 1 agree to comply with all city and county ordinances and state laws relating to V building construction.and hereby autharim mpr[senmtivea of this city to cmer upon me W abovc-mcntioned property for inspection purposes. y (We)agree to save,inde nify and keep harmless h City of Cupertino against res liabilities,judgments.coatse expenses which may in any wey accrue agmpio..ol City / z in conuqucncc of mo gr sof this permit. '-' APPLICANT UN NDS A C PLY WITH ALL N POINT Issued by: Date SOURCER ATI Signaurc of ApgM�anVCunlracmr Dam Re-roofs / HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Cc applicant or fmu (ding occupant store or hanJlc hnrardous mamdel as defined by the Cupenino c al Code,Chapter 9.10 and the Health and Safety curie,seabas 25532(a)7 f All roofs shall be inspected prior to any roofing material being installed. ❑Y NO Will the applicant or Tom building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove fit hazardous airconmminaneaz cfi Jhy thC'Bay Area Air Quality Management all new materials for inspection. so"`7 []Yea N I have mad the WvaN� rialsm uiremamaim ser Chapmr 6.95oftha Califor nia Harlm&SxfetyCodc, ons 355(15,3 and15534.lundcrsmndthmifthc building docs not currently have ant.that it' sp arsibility m until,the.c.'s t of ma tequircmcntswhich et prior ofACcnlfinmofat. y Signature of Applicant Date oth ice' aE t ate All roof coverings to be Class "B" or better CITY OF CUPERTINO 3 '� l c PERMIT APPLICATION FORM APN # e. _()13 Date: Building Address: Owner's N• : o y- S � ,n„ „Y�ys n 0 Phone�� Contractor _ � /'' v;l�l License Contact: �T [ Cupertino Business License #: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech Job Description: ftu P4Gl Residential kP9 Commercial ❑ For Residential Installations: Attic ❑ 1" floor ❑ 2"d floor ❑ Adhere to min set back requirement❑ . For Commercial Installations: Replacement same weight ❑ Additional weight (structural talcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required Cost of Proje/c1: 0�' Type n struction: Occu a�F group: 31 f( fr Strapped LJ On Platform LJ Bonded El Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMF'URN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfin MECHANICAL BREMRECEPT Reept], Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee 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 BUILDING -� aa7 � 1