05120070 CITY OF CUPERTINO - +s "� = •
BUILDING DIVISION PERMIT ,CONTRACTQRINFORMATION:.
BUILDING ADDRESS: AAA FURNACE & AIR CONDITI R€TIR1O05120070
921 LIBERTY CT
OWNER'S NAME: PERMIT ISSUE DATE
WANG PETER 1712 STONE AVE 12/14/2005
E; SANITARY NO. CONTROL NO.
(408) 293-4717
ARCHT1ECUTINGINEER: BUILDING PERMIT INFO
BLDG ELF.C7 PLUMB MECH
0 0 0
o O LICENSED CONTRACTOR'S DECLARATION
I hereby arirm Nn 1 am licensed under provisions of Chapter 9(mmmcncing Job Description
with Section 70l of Division 3 of the Bustnessand Profession Code.and my license is
n� mfullfoceend Het' FURNACE REPLACEMENT, AND DUCT REPAIR
Ls, LkenA.Clw / Lk.N
4e 2i�
Dam CamDECL /
A C ship
be used
DECL3 G
I understand my Plains shall W used u public rtcnma
s
ted Licensed Professional
OW NSR-BUILDER DECLARATION
.� 1 hereby affirm that I am e&cmpt rmm the Convenor's License Law for the
_
O o following mason.(Section 7031.5,Business and Rofeuluu Cade:My city m county
$ which Acquires•permit m....4 alter.Inom
ah,clownish,nr ir any moctum Q 5
S^
prior An its issuance.also requires the appliant forsuch permit to file&signed ammment
p < Nm he is licensed pursuant toNcprevision ofNCConvactentLicense Law(Chapter 9 Sq.Ft.Floor Area Vaasa
Y $ (commencing with Section 7000)of Division 3 of the Business and Profcuions Code)or C
3 Nat he is"Amid showroom and Ne basis fir,No alleged eumptlon.Any violadon of JM
Section 7031.5 by arty applicant for.permit subjects the applicant to a civil penalty of rOceupan pe
Act Were Nan fin humred doll..($500). pp
❑1,u mw of the pmpeM,m my employee withsings u deo role cempenudon, ORO 00!ta
will do'site work and Ne spuemrt ts cot Imm�ded.offered fm ask(Sm.70a,B Wi p7
Bud Poefa.dnm Cede:The Convacmrs Lkense Law don cot apply m an owner or Required Inspect3 s ll
property who builds m improv thereon,and who does such wank himself or tluough his
own employee.provided Nat such IMPAMAM IS are notimmmded aro@red for ale.If,
howew,the building or improvement is mid within one you orcomple0on.Ne owner-
bu0der .wru have the burden of proving N.he did rot Wild or Improve for purpose of
ole
.
)
co 1.As Owner p of the property.,Business nand conuteting with limned cenvacess m
cents La Ne es not pply 701x,anonofand Professions Cache)The Couu&cmra Ll-
and
whoLaw dons not ah r e an owner of propeny.who sed p or improv Comon,and
who nonvmts fm such aojects with a contractor(s)licensed pursuant m the Centnctor's
LkLaw.
I am
❑ em exempt under SAO. ,Bk PCfor this moon
krDam
WORKERS COMPENSATION DECLARATION
1 hereby of irm under penalty of perjury o^e of the following declarWons:
an And will maintain s CnlOesm of Content m self-insure fm WmkersCompen-
,u provided for by Section 3700 of de Inbar Code.for Na performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,m required by Schon
3700 of the labor Cade.for the performance of the work for which Nu permit is coved.
My Workers Comleumon N nce carrier and Policy number am:
Carrier. Polity No.. o
CE I•CA •OFEKEMPTION FRO /OR ERS '
COMPENSATION INSURANCE
crnbaction tem nmbe completed IDIe permit ts free=hundred dollars(g10(1)
or lea.)
1 amply that In the performance of the work for which Ni.permit is Wood.l"I net
employ anypermn in any manner m As Be become subject to the Workors'Compensation
Laws of California,Dam
Applicant
NOTICE TO APPLICANT:If,after making this CeAffete of Eumindon,you should
become subject to tle Worker's Compensation provision.of the labor Code,you roue
.,O
55 forthwith comply with such provisions or NU Permit shall be resound reveked.
z., CONSTRUCTION LENDING AGENCY
N.
[r syn Ihereby affirmNem is a con.troedon lending agency for the performance of
ai Ne work for which Als permit A; 097
Issued(Sec.3 ,Civ.C.)
A Lender's Name
7 z Lender's Addwam
U 1 coal than I have red this application am wan Nat the&hove inform&tim h
U.F crosrx' I agme m empty with all city and county ordinances and some IBM milting m
O construction,Wilding consction,and hereby authrepresentatives moonrise representatiof Nm is city ensu upon Na
W above-mentioned pmpeny for inspection purposes.
(We)agree to save,indemnify ad keep harmlea the City of Calandra against
r to IlabiliBe.judgmenu,costs and expenses which may In my way acme against said Coy
(�7 in comINIMACe of the granOng of thi.permit ,p
Fl APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU EREGULATIONS.
((//.. -�'�--.� f'� Re-roofs -�
Sjnuure of ntiecmr am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fuvme building Occupant stow or handle Munitions martial
As deffmcd by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
We,Semon 25532(e)? All roofs shall be inspected nor to an roofing material beim installed.
❑Yes ON. P P Y B g
will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
J tit heramnm air cone ninanm a defined by the Bay Am,Air Quality Management all new materials for inspection.
I.VICI?
❑Ye. ON.
I ban mad dee hoamous materWs m uimnuMm under Chapter 6.95Aides Califor-
AMRuth d:SafnyCode,Scmimo25505,25533 and 25534.1 understood ft die,Wilding
Jan not currently have a WMAL that It 4 my responsibility to Acuity the occupant of Ne
requiremema,hichmue W me 'arminuanceoface ficamof Occupancy. Signature of Applicant 'Date
° mer or authorized agent te All roof coverings to be Class"B"or better
r Community Development
., 10300 Torre Avenue
:fCupertino CA 95014
Telephone(408)777-3228
4170F Fax(408)777-3333
#I Building
Buildin De artment
JOB ADDRESS: PERMIT #
L14e,, I (felveC oS 2oo? O
OWNER'S NAME: —E �j v r�G. PHONE # ,44-d J 3- 912 7/
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors: 41 Z
Signatur Date
Please check applicable subcontractors and complete the following ' ormation:
63 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating a
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
i
Owner/Contractor Signature Date
1 'v
iQ CITY OF CUPERTINO
dS20 �-7
FURNACE/AC
co
UPEkTINO PERMIT APPLICATION FORM
APN# 3 S,1 / / ` 0 r, Date:
Building Address:
Owner's Name: Phone #:
fit D •dJ - 7/
Contractor• License
Contact: Cupertino Business License #:
�u,2E,f
Building Permit Info:
Bldg ❑ Elect Pte- Plumb fl— Mech
Job Description:
Jc
Residential Commercial ❑
For Residential Ins allations:
Attic ❑ l" floor � 2"d floor❑
Adhere to min set back requirement❑
or Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Plannin A royal Re uired ❑
Cost of Pro'ect: Type of Construction: Occupancy group:
jxaa, QP
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement Er-
Qty. if
Applicable Fee ID Fee Description Fee Group
11 BENERGY Energy BUILDING
11 BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 clip 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
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
411- -78