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05030105CITY OF CUPERTINO.. �'. BUILDING DIVISION PERMITCONTRAC�'TOR;INFORMATION s$x�u�t,° BUILDING ADDRESS: ABC COOLING & HEATING PERMITNDO5030105 OWNER'S NAME: PERMn' ISSUE DATE KH SANITARY C TRC NOL NO. CHITECTIENGINEER: BUILDING PERMIT INFO IAR BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATIONJob Descri tlOn I hereby affirm that 1 am licensed under provisions or Chapter 9 (commencing Pb Section 7") ofDivision 3ofthe Busincssand Professions Codd,and my license is co1carc""d`�«'zag REPALCE FURNACE & ADD A/C & s Dam 11 DISCONNECT CIRCIUT FOR A/C ARC no I understand my plans shall nc used as public records Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Conower's License Law for the following mason. (Seeuun 7W 1.5. Business and Professions Code: Any city a, county which .,at. a permit to construct, a@L impmvc, demolish, or rope, any structure prior to in iasuancc, also ¢quire the applicant for such permit to file a signed summers Ft. Floor Area Valua"* this he is licensed pursuant to ft provisions of the Commuor's I-ecnse Law (Chapter 9 Sq. 475 (commencing with Section )cep) of Division J of the Business and Professions Code) or Nat he Is exempt th oafrom and the basis for the alleged emmpsion, Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mom than five hundred dollars ($500). 35608013.00 ❑ 1, As owner of the pmpcny, or my employee with wages as Nei, to comperset on. � Re uired,Ins Inspections 9 P will do the work. And the structure is not intended or offered for sale SAC'. 7()44. Business and Prefa cions Code: The Contractor's License Law does not appI Ito An owner of property who builds or improves hereon, and who docs such work hi If. tight his r i _.Required, - -IDU, own employee, provided Nat such improvements see not immndcd naeeted forsalC. ILhudldc nNeWilding aveseorden of Pmemis Bald within aneyw ofimpl-Fen builder will nave Ire burden or proving Inas he iia wt bund or impmusole.)'It❑ 1, as Owner of ane property am exclusively convening withE-nanAcool the project sec.1014. Business and Professions Code) The Contractors Li.,am law does not apply to an owner ofproperty who buildsorimproves thereon, antl. who convicts for such projects with aconaacsor(s) liecoaed pursuant ue the Convenor's License Law. ❑ 1 am exempt under Sec. . B h P C for this reason Owner Dam WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of este following declarations: 1 have and will maintain a Certificate of Cement to sclf-insum far Worker's Compcn- ,. titian. as provided for by Section 3700 of the Labor Code. far the performance of on, work fa, which Nis permit m issued. have and will maintain Worker's Compertssuon Insurance, as requited by Section Trp of the Labor Cede. for the pefo,mance of the work for which this permit is issued. My Worit a Com nsau m Insurance carrier and Policy number am: S �'^ fibre{ 15f-aJ9 C.mcr. • Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section new nos M eomplemd if the permit is for ort hundred dollars (5100) ' or sus.) I certify Nm in the performance of Inc work for which this permit is issucd, l shall not employ any parson in any manner sn a to become subject to the Workers' Compcnsaion Laws of California. Dam Applicant NOTICE TO APPLICANT: If, after making this Ccnificem of Exemption, you should become subject to the Worker's Compensation provisions of the labor Code, you must fuMwith comply with such pmvisious or this Permit hall Im deemed mvohcd. CONSTRUCTION LENDING AGENCY 1 Whilty Nat IMrt u agency for the performance of ! . Cv, the work for which Nis permit u issued (Scc. 7091, Civ. C.) which s e d (Sec. ' Lenderi Name lender's Address I ttgree Nn I have rod Iris application and sum mm Inc about information is 1 agree il comply with all coy and causes oNinanccs and sum laws relating to building Conswction, and hereby auNarim rtptesentairma of this city to enter upon the S above-meminncd properly for inspccuon purposes. above- (We) egrte to save. indemnify and kept Must the City of Cupenino against i IhIdilisia,judgments,costs and expenses which may in any way accrue against said City l� in c0"ucnc the grami ( APPLICA the D WILL MPLI^WITH ALL NON-POINT ^� ^�� Issued by: Date .j SOU j Re-roofs Type of Roof Signature of ApplicanUConvactor Dale HAZARDOUS MATERIALS DISCLOSURE Will One applicant or future building occupant team or handle hazardous material As dcfincd by she Cupenino Municipal Code. Chapter 9. 12. and due Health and Safety cwt, S❑mYoesn 2553207 All roofs shall be inspected prior to any roofing material being Installed. %' If a roof is installed without first obtaining an inspection, I agree to remove Will do, applicant or future Wilding Occupant use equipment or devices which mit miardnus air conmminaruu Jcyswd by dm Bay Arta Air Quality Management all new materials for inspection. ❑Yes No 1 have mad do,hmaNnus materials requirements under Chapter 695 of ftCalifnr ria HcaIO d Safety Code, sections 25N15, 25533 and 25534.1 understand that tftho building Jou not curt yhaveaten nL smy res nsiM1ititymroi l y do arupr, of the mgrbpmp len m pn wiaaaan- ncp,trtea,pOra,pp " Signature of Applicant Date 3 7/1I< All roof coverings to be Class "B" or better atone, err aamodved stent �., Community Development R 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 �UPEkTINO Building De artment 0 JOB ADDRESS: 02 s 1..HCP4.PERMIT # 05 a-3 o l es OWNER'S NAME: BUSINESS LICENSE # PHONE # �$d - 2 _p L/ GENERAL CONTRACTOR L' 4- FAX # I am not using any subcontractors: axe- c V (WS Signafure r Date Please check applicable subcontractors and complete the following information: 3144 s 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 3144 s Date r] SHIM - CITY Or CUPERTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM -S APN # -35 (- — O8- _ o 11-3 Date: Building Address: 22-105, 2-103 l �� Y nC��' BREMFURN Owner's Name: /� qr hone #:Z� ` � 1 p I Contractor: Ph ne: (2,6 C ( .� ttl-` SIO q 7/ — �l �/ License #: 3 L z 3 �3 Contact: Ph ne: Cupertino Business License #: A/C Units <= 10, 000 cfm MECHANICAL Building Permit Info: Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Bldg ❑ Elect Plumb Mech Job Description: a o._ — D K - - M 1A1 c 3 •,5 7 O -V - ,Vo ffnti A e Residential Commercial ❑ Mech Permit Issuance For Residential Installations: PPERMITFEE Attic ❑ Is'floor ❑ 2nd floor ❑ PLUMBING Adhere to min set back re uirementI, Bldg Permit Fees For Commercial Installations: BPLANCHK Replacement same weight ❑ Additional weight (structural calcs) ❑ BUILDING Structural Calculations required for new installation ❑ Business License New installation Planning Approval Required ❑ Cost of Project: Type of Construction: 6, q Z5" Occupancy group: Strapped ❑ On Platform ❑ , Bonded ElSq.Ft. Floor Area: New ❑ X Location Replacement Qty. if Aoolicahle Fee, M Fea Tlrcrrintinn Foo f:� I BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL 1 BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL 1 BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING l EPERMITFEE Elec Permit Issuance ELECTRICAL i MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License r BUILDING