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04030038CITY OF CUPERTINO BUILDING DIVISION PERT /� �„ry.� ,ry,�.,,}ny1,�� VOL\SLf1lL1G'";�1.1�11�1.C�aII,M'1 ButLOwc ADDU 1 AAA FURNACE & AIR CONDITIO YMN004030038 ER'S NAME: PERMIT ISSUE DATE COPELAND CHRIS N[ SANITARY NO. CONTROL NO. 408 293-4717 ARCHITECT/ENGINEER: BUILDING PERMIT INFO O LICENSED CONTRACTOR'S DECLARATION BLDG ELECT PLUMB MECH � 0 F 1 hereby affirm that 1 am licensed under previsions of Chapter 9 (commencing Job Description with Section 7QMp of Division 3 of the H.M. ala Professions Code. and my license is n mfullfomean0 Z Lmen,a"a Lm.• REPLACE FURNACE PINALED Dale Iu C HlE�S �u re i I understand my plans shall be used as public ¢coma MAR 2 5 2004 3 Loan... P 4asamnal OWNER -BUILDER DECLARATION 21 Mmhy acern, in the[ 18ciempl from the Contractor's Licari Law da,” fallowing muun. (Section 70313, Doi. BUILDING and Pro@ss urn Cade: My city at County which on, a pm ou Io cnnnmc4 Chea imphave, demolish, our a pair any snclum c" o pd.,d...5a011Ce, 813U rtga m311M appllfanl far aaeh pCr1111Lb111Ca31g11ed s18m111Cn1 IMI he 4 licensed pumuammNep ism" of the Contractor's Umme law(Chaplm 9 (commencing with Section 7( 1 of Divisiu on 3 of the Busina°nd Profession, Code) or met W is Sq. Ft. Floor AreaValuation ' . exempt therefrom and the WO fm the alleged acception. Any violation of Section 7031.5 by airy applicant fm a permit subjects the applianno a civil penalty of not mom than fin hundred dolt. ($500). - 3WNTilff ier00 Occupanc 'T'ppe. Cl I, u owner of Ne pmpeny, m my employes with wegu u L eiranla m.penudon, will do the work and the aroclum ts not intended aro@thou forule (Sec. 7044, Business and Pmfichiana Cade: The Canuamm s License Law does not apply an an Owner of Required Inspections property who bui lds or improves thereon, and who does such work u msel f or drought his own employes, provided that such imprewmenls art not intended orortmed mesaIc if, howevea the building ar improvement is sold within olte year of completion, the owner builds will have the human of proving that M did not build m improve for purpose of um.). ❑ 1, as owner of the properly, am exclusively contracting wish licensed mountains in commons the project (Sec. 7064, Business and Professions Cade:) The Canuacmis U. came Law does not apply to in owner of property who builds or orphans thereon, and who contracts for Such projects with B conRacla1(6) licensed pursuant in the Con rmloes License Law. 1 am accept under See . B h P C for this moon rDate WORKER5 COMPENSATION OECLARATION 1 hereby affiren under penalty of perjury am of the following dclaaliom: 1 hiss and will maintain aCeNfieste of Come¢ a self -imam for Worker's Camper cation, as provided for by Section 3700 of the Isom Code, for the performance of sho work for which this permit is issued f1 have and will maintain Worker's Compensation Insurance, as mquired by Section W of ft Libor Code, for 0e performance of the work for which this permit is issued. y, Workers ompaludi-p I sunnxmrrimandl'.1kynumberam: Carrier. J s, f�- Yv� Policy No.: i :�a •a� CERTINLAMUPECEMPnONFRO WORKERS' COMPENSATION INSURANCE actims, reed not be completed if We permit 13 for one hundred dollars IS Q7) our cess.)(TO,f L certify that in the performance of the work for which this permil Is issued, I shall not employ any person in any mumrse as in become wbjecl to the Walk., Compensation Laws of California. Date APPlieant NOTICE TO APPLICANT: if. after making this Cedfimte of Eammthan. you should become subject m Ne Workeb Compensation provisions of she labor Crum, you must forthwith comply with such proviso— m this Permit shall be dimmed rooked. CONSTRUCTION LENDING AGENCY I Wraby afrfm that Nam its conslraCtinn lending agency fur the perrmmanm °r the wok for which 444 permit 4 Wood IS=. 3(X97, Civ, C.) Lender's Name Underi Actions 1 rcnify that L ban hand this application and sum the, On shove information is cored I Agree to comply with all city and county on intimas and sate laws resting to Wilding comuuction, and hereby aulhodu repmmaddins of this cily m enar open the .Wn-menOmad properly lm inspection purposes, (We) Agree to ave, indemnify and trcp harmleu the City o! Cupenmo again, Ilabilit a,judgmena, Cogs and espemes which may In any way accrue agailnl said City in consequence of the Bouncing of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT so REGULATIONS. REGULATIONS. Issued by: Date �5 '9 Re -roofs SignameofA"ocan✓Conuac r am HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII the applicam or factum buildin6 aecupmlatorc m handle hersmaus material creed by Ne Cupertino Municipal Coda, Chapter 9.12, and the Health and Safety . Said. 25532(4)? Oyu . Na All roofs shall be inspected prior to any roofing material being installed. If Will the applicant or (uwre building=upon, Ise equipment or dmvices which a roof is installed without first obtaining an inspection, I agree to remove emit haurdous air contaminants u defined by the Bay Area Air Quality Menagemcnl District? all new materials for inspection. Dy. I have read the lwrardu macrolsaquiremen4under Chapter 6.95aflhc Califor. ns, Health&SafclyC°d°, 505.255330nd255M.IundmswulN ifshe Wilding does ICI nrently haw a tenana met it i3 my reaponalhility in notify the mc.P.L of the mq mens which muss M mel prior¢ issuance ofs Comrcae of Occupancy. A4.--f, Signature Of Applicant l�l.- Ob "D1� Date All roof Cnverin ac anti tiP (`I waw or aumonmd agcm ..__ — -1 Ve13e1 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT # �z ` v 05l03do3C' OWNER'S NAME: ZPHONE #' GENERAL CONTRACTOR: a"&t FAX # 51f 7-iiarz I am not using any subcontractors: !tJ tiA At, i 3 'UG -O}, Signature Date Please check applicable subcontractors and complete the following information: - 6✓^ ��M ' V 7 D3 -OG SOwner/Cdrt Tactor Signature Date 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 - 6✓^ ��M ' V 7 D3 -OG SOwner/Cdrt Tactor Signature Date a r. OP- CITY OF CUPERTINO CITY OF CUPERTINO o J&. FURNACE/AC PERMIT APPLICATION FORM APN #l � S � - 06- z - Date: Building Address: BREMFURN Relocation of Furnace MECHANICAL Owrler'.s Name: n LY Phone #: MECHANICAL Contractor: I_ Phone: tMi2a License #: ,--Ai-.X93- Rec tl, Switch & Outlets Contact:Phone: Cupertino Business License #: ,l0 61 BUILDING Building Permit Info: Seismic Commercial B ❑ Elect ❑ �\ Plumb ❑ Mech Elec Permit Issuance ELECTRICAL robDescription: C Mech Permit Issuance Residential Co ercial ❑ PPERMITFEE For Resl a ations: PLUMBING Attic ❑ I" floor ❑ 2"d floor ❑ Blda Permit Fees Adhere to-1J1t;ekhackrequirement ❑ BPLANCHK For Commercial Installations: BUILDING Replacement same weight ❑ Additional weight (structural calcs) ❑ Business License Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Const n. Occup cy group:/ �p Strapped ❑ On Platform ❑ Bon Sq.Ft. Floor Area: New Location ❑ Replacement tf .Ao "ble) FPB m BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAHMAN 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 Blda Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING