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05120071 CITY OF CUPERTINO BUILDING DIVISION PERMIT GONTRACTO I1 �OATTC111) ' : BUILDING ADDRESS: A & H HEATING PERMITNo.05120071 20100 LAS ONDAS CT OWNER'S NAME: PERMITISSUEDATE TAKEMOTO KENNETH T AND JUD TH770 CHESTNUT ST 12/14/2005 ONE: SANITARY NO. CONTROL NO. (408) 279-0722 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 30o LICENSED CONTRACTOR'S DECLARATION 7obDcri VOA 4 Ga I hereby sfflrm Wet 1 am Iiaved under Provisions of Chirac,9(commencing p with Section 7000)of Division 3 of the Emblem and Profrasium Code.an l my liceaso is ate„ in mumceand-fr _La W R & R FURNACE - ASCM14D 0 VOLT CIRCUIT b Z_ Lietme Class Lk.{ O — Dam canlruwr As small use D public mcca I understand my plain shell he used u public records /e� �o Licensed Pmfcsimmal OWNER-BUILDER exempt r DECLARATION E A I bcrohy,(Sam that 1 1. exempt from We Csourtsn as License Law for The i p o which re moron.Permit t 71131.3,Business and w,de um Calc:Any clay or county which requires a eennt re cnmwd alum mprow,h remit t ri s pair d umctunt $9500 —�y pdormist issuance,also requires the applicant for each permitmfile tai{rod memtnt < Wet he is licensed Pursuant in the provision of the Contractors Lleense Law(Chapwr9 Sq.Ft. Floor Area ItTIVeNaluation $ (commencing with Section 7000)of Division 3 of the Business and Profession.Cadc)or Wan he is exempt therefrom and Me bub fa the alleged exemption,Any violetlen of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not orae than Ow hundred dollars(5300). T ccupancy Type ❑L u owner of Ne property,or my employees with wages as Weir sole compensation, will d.the..,it.and the structure is ran Intended os offered far W.(Sec.7044,Business and Profession,Coda The Communes License Law does not apply n an owner of Required Inspections propeny he builds orimproves thereon.andwho doessuchwort himself orthrough his own employees,provided Wel well improvement am notinetned coffered retail-If. however,the building or Improvement Is said within em year of complexion,the owner- builder will have the burden of proving that he did rot Wild ar Improve for purpose of ales). ❑1,u owner of the property,am exclusively contracting with licensed cam uwn in common the project(Sec.7044,Business and Professions Code)The Camomile,U. comes Lsw dose not apply 0.n owner of propsurt who builds or improaa thereon,and who conancu for such mallets with a eonuactor(O Ilcemed puasnt to the Connors License law. ❑Iamucmptunder Ste .Bk PCfmthismasson - Owner Data WORKERS COMPENSATION DECLARATION 1 herby e1Rnv under penally of perjury arc of the following doolaruto e 1 haw and will maintain a Certificate of Comte to selbinsum fa WarkeesCompen- L adon,as provided for by Section 3700 of the Tabor Cade.for We performance of the work for which this permit Is Issued. ❑1 have and will maintain Winker',Compensation Imursnce.u required by Student 3700 of Ne labor Code,fm rte performance of the wart for which this permit is Waned. My Worker's CampsmWon Insurance artier and Policy number are: Carder.'flLe 4AC I n.! S Policy No.:&fI g t B w CERTIFICATE OF EXEMPITON FROM WORKERS' COMPENSATION INSURANCE (Tbb section road not he completed if the permit is foanc hundred dollarm(SI00) or lest) I certify Wet in the performamc of the work far which this permit is lasmd,I shall not employ any person in any manner an as in become subject to the Workeri Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:if,after making this CeniOcaw of Exemption,you should become subject in the Worker',Compensation provisions of the Lobar Code,you muss _ vJ O foMwith comply with each provisions or this permit shall m domed revoked. „'Z,r oCONSTRUCTION LENDING AGENCY [—t l hereby arms that then is a construcdnn lending agency for the perfulmana of a the work for which this permit is Issued(Sec.3M.Civ,C.) QI ari Name - 7 Z Landees Addrtu U Q I coldly that I ban read this application sib sum that the thew informed.Is lL F corm 1 apo or comply with all city and county onimncm and see lave muting in Q U Wilding construction,and hereby authodes representatives of this city to area upon the Itl above-mentiamd property for impecmn puriroset y (We)agree 1.mw,indemnify ad keep harmleae the City of Copeman.against fA liabilities,judgments,coast and expenses which may In my wayaceru,agbw wild CRY V Z in amegance of the panting of this permit ^•t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date SOUCEREG�ULATIONS. Re-roofs Si{nuurt ofApplica tcommosor—Tem Due HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant acre or handle hasrdem material u Zacd by tin Cupertino Municipal Cede.Chapter 9.11,and rte Health and Safety mt.Sectionz353uan All roofs shall be inspected prior to any roofing material being installed. 7mqdm ❑Yes 9r. Will the applicant or future building occupant use equipment or device.which If a roof is installed without first obtaining an inspection,I agree to remove ithmannm all conuMmnu a dented by the Bay Area Air Quality Management all new materials for inspection. wic17 0Ycs t]J� I hwc mad dm hmsnnm mmdais mquimmcnu under Chapmr6.95.ftht Califor- HcalthhSafcayCode,Sccdan.25NU,73533ad33534.1undemad Wulfthc building s rool not how a nmthat it Is my mspomn ihllity redly the motmenl of the uhemon which bcmmpriorw' u cora eldnmmef0caromy, SignatureofApplicant Date �Z Owner at awhodmd agcm -0 All roof coverings to be Class "B"or better Dew aCll Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 SUPEkTIN.0 Building De artment JOB ADDRESS120 1BQ 'S PERMIT0S/ LOO--? S/ Lvo--? / OWNER'S NAME: PHONE # 2 GENERAL CONTRACTOR: FAX# 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 R Owner/Contractor Signature Date / C CITY OF CUPERTINO FURNACE/AC �PERTINO PERMIT APPLICATION FORM APN# Date: ` 369 3o o39 , a: Building Address: ao l oo 4As oq S CT, u; Owner's Name: Phone#:o�s.3 O$•a 9 K.�mo b r: Phone: License# C to F61 .G i. X79-o�aa. Contact: Phone: lbCupertino Business License#: 9LE A S �79�o7aa- .Building Pemut Info: Bldg. ❑ Elect Plumb ( Mech " ,Job Description: 7— Residential Residential ri Commercial ❑ For Re idential In6 ilations: r Attic M 1" floor 2nd floor❑ M d6aere to min set back requirement 2( tf r Commercial Installations: tural calcs) ❑ Replacement same weight E] Additional weight (struc Structural Calculations required for new ins' llation ❑ New installation Planning Approval Required Cost of Project Type of C�lruFtion: Occupancygroup: Strapped• On Platform Bonded Sq.Ft. Floor Area: New Location R lacement Qty. if Applicablq Fee ID Fee Description Fee Grou BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL . BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BI2EMA:IRHALI A1C 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 —T—umbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING