04110160 'CITY OF CUPERTWO - - ""}�"�Tyy WA.{'�
BUILDING DIV PERMIT S,Vivl• 2CFlQA IN"F3TtM;<1.1IgN K ,
¢., .2.a:. F m.�+„r •'-,a. .4 ,;lh: tau __
BBUILDING ADDRESS: WEIGEL MECHANICAL & REFRIG PERMIT N004110160
10713 LARRY kiV
OWNER'S NAME: -
PERMIT'ISSUE DATE ..
NATHALIS 'BENETTI 823 SAN ALE
ONE: SANITARY NO. _- - CONTROL NO.
.
(408) 252-2338
ARCHITECffENGINEER: ' BUILDING PERMIT INFO
BLDOO ELECT O PLUMB MECH
D O
+�oo LICENSEDCONTRACIORS DECLARATION Job Description
- - .• - - - --
1 Wmby affirm Nal 1 am Received under provisions Of Chapter 9(commencing” -
withSec��onoy'-�)nfDivwon3of theH sirrcis aM Profeuium Codc.entl myliccnsesa
in rml by2c�ypJ(��d�A/ e REPLACE_ FURNACE
..Z Z„ Licenu Glkss yLic:x --
Dale 'Con mr -
? ARCHITELTSD public
ATION
I u red my plana shall he used u M'e meoMs
v I OWNER-BUILDER DECLARATION, /
>iso f Licensed Pmfesaionel
I Lhercby.affient Section 1 1. exempt from the Contractors Co License Law for the 7 .. ..
-p O following umns a Section 7(131 r Business and bereave,
de Professions Cade:Any city of county
$� which reyulrcs a pemnit m construct,eller.impmw,demolish,m repair any awetum . . ,.. _. � � " " O — -
F fyn prior to its issuance,else equines the applicant forsuch permit to rile a signed statement
Sq.Ft.Floor Area
-�< that W is licensed p...am to the provision,of the Cmureme,Limon law(Chapter9 Valuation-
s $ (commencing with Section 70100)of Division 3 of the Buiinese and Professions COde)ur'
3.. that hes exempt Natefmm and the basis for On alleged exemption.Any Vulade of
SeNon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 WVKHRRarOOccupancy Type
not mon than five hundred dollars($5007.
❑3,m owner of the pmpeny,or my employee with wagm ss their sole compensation, '
will do the work,and thestructue is out intended or offered for..le(Six.70th,Business Required Inspections -
`. and Professions Cade:The Contractors Liam Law does not apply'lo an owner of '• ,1T1 q p - -
property who builds ar i m proves thenen,and w bo does such work himself or through his
ev n employees.provided tWtsuch improvements am not intended aroeend for sale.If,
however.Ne building orimpeovement is soldwiflim Oneyeaofampldon,Ne owner.,
builder will have the burden of proving that he did not build or improve for purpose of
sale.),
❑I.as Owner of the property,are exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Cade:)The Crummunr's Li
tine Law dean not apply to an owner of property who Wilds or improves thereon,and
who contracts for such projects with a conhaatar(s)licensed pursuant a the Comeactoh
Limn.Law.
❑I nm exempt under Sec. .B&P C for this mason
- Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby aftrn under penalty of perjury one of Ne following decimations:
I hawmd will maintain a Ceniflate of Consent to ml6lmum for Worker's Compere -
anion.ss provided for by Scetiore 37011 of the TOW,Code,for On perfermame of the
work for which this permit is issued.
_.. _
❑1 haw and will maintain Worker's Compensation Insunnm,u requited by Section -
3900.fthe labor Cod,for one performance of the work forwhich this pcmtit is issued. -
MyWmkcr's mretention Insurance career and Polic number am:
mlcm-w-n-00
CERTIFlCATE OF E%EMP170 SI OMWORKERS' -
COMPENSATIOtfINSURANCE
phis action neetl not hccompletctl i7iAe permit isforanc hundnddollan(SI00)
or Mss) ,
1 certify that in the performance of the work for which this permit u issued.I shall not -
employ any Nixon in my manner m as in become subject to the Workers Compensation
Laws of California.Dam
Applicant _-
NOTICE TO APPLICANT.IL after making this Certificate of Exemption,you should
became subject to the Workers Compensation provisions of the Labor Crea,you must
.J O forthwith comply wife each provisions or this permit shall W deemed revoked.
Z CONSTRUCTION LENDING AGENCY
E1 hereby affirm that then is.commactinn lending agency for the performance of
> the work for which this permit is issued(Sec.3(197,Civ.C.) '
Q Lender's Nam.
z Lender's Address
U C I certify Oil 1 haw mad this application and state Nat the aWw information is
If.F cornet I agree m comply with all city and county ordinances and state laws relining m
0 U building construction,and hereby autharire mpnaemaliws of this city in enter open Ne
above-memioned property for inspection purposes. /
NW (We)agree to raw,indemnify and keep harmless the City of Cupertino against l
liabilities,judgments.casts and expenses which may in my way acerae against mid City
U 7 in consequence of the granting of this permit.
P APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Da e
SOURCE REGULATIONS. -
2 Re-roofs
Si a of Applicant/ retractor Doc
1 HAZARDOUS MATERIALS DISCLOqURZY Type of Roof
Will the applicant or future building occupentamre or haannle Wartime;material
m defined by the Cupertino Municipal Code,Chapter 9.12.'snd the Health and Safety
code,Section25532(a)? — — -'All roofs shall be inspected prior to any roofing material being installed.
❑yes �iau -
Will the applicant or future building Occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit Waardnus air contam], ta as it it it by Ne Bay Ama Air Quality Management all new materials for inspection. -
Diavict7
❑Yes o
lhummelmehana ousmamrialsmquinmcnmunder Chapmr6.95o(the Cali(oo
not Health&Safety Cad,Section 25505,25533 and 25534.1 understood that if the Wilding
dail.aft curently have a nO mt.Won is my mspomihility b mildly the acupnnt Of Ne
mqui mints wh' atbenetpriar to immune.of a Cemfcate of Occupancy. Signature Of Applicant Date
All roof coverings to be Class"B" or better.,. '-
Owner or authorized agent Data '
Community Development
f, 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADT S: . / PERMIT#
0 V
OWNER'S N P # ps'
GENERALCONTRACTOR: #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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 Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contrac - ' ature -- �� Date
CITY OF CUPERTINO
�?- FURNACE/AC
UPEkTINO PERMIT APPLICATION FORM
APN# D 2 Date: 02l
3�6 7
Building Address:
dIf2 ��
Owner's Name: Phone #:
V � e e e W 253-7Sv
Contractor: Phone: License#:
D .ZS2 -2
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb Mech El
Job Description: _
Residential Commercial ❑ /
For Residential I allations:
Attic ❑ l'` floor d floor❑
dhere to min set back requirement❑
or Commercial Installations:
eplacement same weight ❑ Additional weight(structural calcs) ❑
Structural.Calculations required for new installation
New installation Plannin �Ap val Required ❑
st of Project: /_.- Type of Consttuch j Occupancy r
a ed ---Oii Platform ❑ Bonded ❑ Sq.Ft. Floor a:
New Location ❑ Re lace ent
Qty. i
A 1' ab `� Fee ID Fee Description Fee Group
BENERGY Ener BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL
BREMAIRHAN 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 BUILDING