05080123 CITY OF CUPERTINO ' *�
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING
ADDRESS: CONDITIONED AIR - PERMIT N005080123
9991 T.A MAE DR
OW NER'S NAME: PERMIT ISSUE DATE
TAMAR ERLICH 1701 LITTLE ORCHARD nR/1f; /2oo5
,NE: SANITARY NO. CONTROL N0.
(408) 291-2220
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uop LICENSED CONTRACTOR'S DECLARATION
w I hereby affirm that I am Licensed under previsions of Chapter 9(commencing Job Description
i�' with Section70YO)of Division 3 of the Business and Professions Code,and my license is
�„ infullfirma andeffef REPLACE FURNACE (@ ATTIC) ,
p tjZ Lianso Class Lic.N �'
$F p Dam Contractor f �A s�. A/C
ARCHITECTS DECLARATION
Sc m I undcra.ad my if...shall he ad u Public records
>yU
s10 Licensed Professional
!fOWNER-BUILDER DECLARATION
g<P I hereby affirm that 1 am exempt from the Cnnbanors License Law for the
00 following meson.(Section 703 1.5,Business and Professions Cade:Any city of county
<m which requires a permit in consumer,shed improve,demolish,or repair any structure
prior to its issuance,also mquircs the applicant for such permit to file a signed statement
r< that he is licensed pursuanuo the pmvisimss of the Commcmr's Licca law(Chapter 9 Sq.Ft. Floor Area Valuati%ff 675
it-a (commencing wi th Section 7")of Division 3 of the B usiocss and Professions Code)or
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section]031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than fin hundred dollars(S30B. 36910041 . 0 0
❑I.as owwa of the propetty;or my employee with vegeta their sole campcnsation,
will do Ne work and thesuectu a is not intended oroffered forsale(Sec.7044,Busine¢
and Professions cads:The Contractor's License taw does not apply to an owner of Required Inspections
Own enywho builds provided
Oat suthch improndwho does such work ed or offered
his
however,thees.Ping or i prvementproold cras within
not year of
for owner. O -�
however,the building or improvement is sold within one year of completion.the oversea v
builder will have the burden of proving that he did not Wild or improve for purpose of
1,construownerof the n
❑ property em exclusively contracting with licensed centncmrsm
ocom La the project(Sec 704,Business and Profusions bus Code:)The es Riacmr's nd j
c ss law docs not apply to an owner of property who builds or improve thereon,or's • fi
whocontractsfor¢u<M1 projects with a contractors)licensed pursuant m the Contractor's MG-
Owner
Licca Taw.
❑lam acmpo-ondcr Sec. .B&PCfw Nis reAmn _ ._. � � __- „_ _
Date___
WORKER'S COMPENSATION DECLARATION '
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Cenifcue of Consent In self-ins..for Warkera Compere
cation,as provided far by Section 37W of Ne labor Cade,fm the performance of the - -
work for which this permit is issued.
have and will maintain Worker's Compensation Inaum=as rnquimd by Section
7o0 of the labor Code.for the performance of the work for which this permit is issued.
My Workers Compensation Insurance ea ief.pd!Pol icy number are Q �
Carrier: �aC�1,Y�[�/i,ntl?I?I a�nS �olicy No.:
CERTV IFICATE DP EXiMPr10N FROM WORKERS'
COMPENSATION INSURANCE
moaresumnneed nalbecompkted ifthep man.isfaronehundreddollars($Ills)
or less.)
I camty that in the perGtrnance of the work for which this permit or issued.1 shall not
mPloyaaypesoninanyman rsnuo comesubjecuothe Worker'Compehsation
Lawsof Califor ' Dam
APPlicam ^
NOTICE TO AGP CANT:IL it,,making Nu wwom,am of Exemption,you ihmuld
become subject y the Woher'a Campeat is provisions of the reedLabor Code,. meq
.J',Z roMwith comply with such provisions or mise Permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
'f. .�. I hereby Orion Nat there is a construction lending agency for the performance of
the work for which Nis permit is issued(Sec.3097,Civ.C.)
GA Lendces Name
z Leadels Address
U C 1 certify that 1 have reed this application and gate Net the above mono ttan is
Ly H cmmet.I agree to comply with all city and county ominamcs and some laws relating to
�Ubuilding construction,and hereby authorim represvnatives of this city to enter upnn the
Lw •hove-mentioned property for inspection purposes.
(•” gy (We)agree to save,indemnify and keep harmless Ne City of Cuperlmo against
(n liabilities.judgments.count and expeas which may in any way acerae against cud City
U in consequence of the granting of this permit. - - ✓
^ APPLICANT UNDERSTANDS AND W L COMPLY WITH ALL NON-POINT Issued by: Date
SOU REGULATIONS.
lK '.
Signa o���v`con� //6 �p to Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future Wilding Occupant atom or handle h t udous material
as defined by the Cupertino Municipal Code.Chapter 9.13.and Ne Health and Safety
otic.seethe.25532(a)t All roofs shall be inspected prior to an roofing material bei.
❑Yea P P Y g g installed.
Will the applicant or rmure building Occupant use equipment,or device¢which -If a roof is installed without first obtaining an inspection,I agree to remove
it hawdous air contaminants as divined by the Bay Area Air Quality Management all new materials for inspection.
strict?
❑Yes O�tlp
1 have re W the hvaNnus mamrialsrtyuimmenu under ChaPmr 6.95 of the Califor-
nia Health&Safety Code.Secdoes 25505,35533 and 25534.1 uMd m..d Nat if the Wilding
does not surreally have a•nam,Nat it is my responsihilky m notify dirt Meupont ordim
m antwhich rums recto' noissumceofa CCmf1Cmof OcvupamY. Signature of Applicant Date
/6 o All roof coverings to be Class"B"or better
or authorized agent Da¢
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS: Cj Sp 14 PERMIT #
\c1c1ai Lz mzr Cir Cis �r mr� os f
OWNER'S NAME: IPHONE #
GENERAL CONTRACTOR: FAX # aci 1 - ,993(/
I am not using any subcontractoQ��! /16 ids
ignature Date
Please check applicable subcontractors and complete the following ' ormation:
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 Met
Painting/ Wallpap
Paving
Plastering
Plumbin
Roo
Se c Tank
eet Metal
Sheet Rock
Tile _
8-116 tO5
er/Contractor Signature Date
ran-
CITY OF CUPERTINO
`CI FURNACE/AC o S 6 �? 01 Zj
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
3 6q - I d - O`-t C)71 /6 /vS
Building Address:
1 La CD
Owner's Name: Phone#: CLOS)
SN 3 - �,q
Contractor: Phone: License#:
Condi{;onQcl Y�,r 195 L1(-1S16'�[ - C -90
Contact: Phone: Cupertino Business License #:
a X33�r
Building Permit Info:
Bldg ❑ Elect c9L Plumb ❑ Mech
Job Description:
Q r tC' \ c 1110
Residential Commercial ❑
For Residential Installations:
Attic als` floor E�-2"d floor❑
• Adhere to min set back re uiremei
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: Nvt� C, Occupancy group:
1
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Re lacement ,E3,
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Ener BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BRENL IRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
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 J O BUILDING
I -