05080206 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORyINFORMATIQN �"
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BUILDING ADDRESS: A PERFECT CLIMATE PERMIT N005080206
7539 LOCKFORD CT
OWNER'S NAME: PERMIT LSUE DATE
ROBERT PADILLA 10570 S DEANZA BLVD 08/23/2005
NF.: SANITARY NO, CONTROL NO.
(408) 861-9545
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o0c LICENSED CONTRACTOR'S DECLARATIONfc'
WU I homb !firm thn 1 am licensed under s of Cho ler 9 mmentuncin IOb DCScr1 tion
C y a pmvisipn p g - 4, p,
tut with section 70007 of Division Sof NCBusine sand Professions Code.andmylicenseis (' Y�i
^3y L or ass
REPLACE FURNACE t p
5 uA z Licensee us Lie.0 e'�J-qV /1
F p Da¢ U TS DEC
ARCHITECTS W use DECLARATION V~�1 S al`7 /f��
¢� 1 untlersuW my plans shall W used as public rtmrds 1— C Z
31 U
3 u� Licensed Pmfcssional o0
�p3 OWNER-BUILDER DECLARATION S
to
1 hemby aRrn Nal I oro exempt from the Conuaeor's License law for the k 1,
p0 following mason.(Section 7031.5,Business and Professions Code:Any city nr county
K m E which rtquima a permit to construct,alter.improve.demolish,m repair any structure tj yp'�{ O $1927
FZeprior In its issuance,also inquires the applicant for such permit to file a signed statement
that he is licensed pursuant o she provisions of she Contractor's License Law(Chapter 9 Sq.FL Floor Area �� ILtdj. 'Q Valuation
niFp (commencing with Section 7M)of Division 3 of the Business and Professions Code)or Nk�
i $ Nat W u exempt therefrom and IW thou for the aBegrA exemption.Any violation of
Section 7031.5 by any applicant fora permit subjects be applicant to a civil penalty of
hat mem Iran five hundred dollars(5500). er Occupancy Type
0 1,as owner of be property,or my employees with wages as Then sole compensation,
will do be work,and be structure is not intended or offered forsafe(Sec.7044,Business
and Professions Code:The Conuumes License Law does nos apply to an owner of Required Inspections
property who builds or improves thereon,and whodoea such work himself orthmugh his
own employees,provided bar such improvements are not intended oroRered forsake.It.
however,be building or improvement is sold within one year of compledon,be owner.
builder will have the burden of proving Nat he did not Wild or improve for purpose of
sale.).
❑h as owner of Oe property,am exclusively contracting with licensed cuntncmrs to
comtmet On project(sec.7044.Business and Prefosal Code:)The Contncmrh Li.
cense taw does not apply Ve an owner or property who Wilds or impmses demon,and
who commets for such projects wit a contractor(s)licensed pursuant to the Comuacmfs
License Law.
❑l am exempt under Sec. ,B&PC for this recon
caner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of IW following declarations:
1 him and will maintain aCcnifirau of Consent to self-insum ror Worimes Compere
cation,as provided for by Section 3700 of be labor Cade,for Ne performance of the
work for which this permit is issued.
Ahave and will maintain Worker's Compensation Insurance,u required by Section
of be Labor Code,for beperformanee ofree work for which this permit is issued.
My Wp.a�e!r's��Cyoym/p,e�nysation Insurance carrier and Policy number am: QQ
Comet-41y � 7.Y9Y Policy Na.: el JAZ
CERTIFICA OEC FEXEMMON FROM WORKERS'
COMPENSATION INSURANCE
(Thu metim need mot W Completed ifft Isnot,is rorone hundred dollars(SIM)
or It..)
1 c=niry Nm in she performance of Ne work for which this Permit is issued.I shall not
employ any person in any manner an as In Wcomc subject to the Workers Compenuvoit
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become suhjcet to be Worker's Compensation previsions of she tabor Codc,you must
.,O forthwith comply with such provisions or this permit shall W deemed revoked.
z' " CONSTRUCTION LENDING AGENCY
�.. Ihereb affirm that there is a construction lending ac for
F Y 6 .)fey performance of
Ix ? Ne work for which Ourpermit is issued(Sa.3097,Civ.C.)
Cr landcls Name
Z Under's Address
U 0 1 certify that 1 have mad this application and sure Nat be above information is
F COMM.1 agree In comply with all city and county ordinances and slam laws mlating to
0U building eonsuetion.and hereby authorise npmscmmives of Nis city to enter upon be
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupcnino against
faq Tiabilisies.ludgmenu.costs and experucs which may in any way accrue against said City
U Z in consequence of Ne granting of this permit.
APPLICANT UNDERSTANDS AND WIIL COMPLY WITH ALL NON-POINT Issued by: Date
5 CEREGULATIONS,
Re-roofs
signuure or ApplicanUComracmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicem ser Twort building oecupanumre or handle harardous moonset .
as defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
C, urn.25532(a)+ /'yLNo All roofs shall be inspected prior to any roofing material being installed.
Will Ne apphcaru d furor=building aeeupant use equipment or duces which -If a roof is installed without first obtaining an inspection,I agree to remove
mit h t sol.or air contaminants u dc0ncd by Ne Bay Area Air Quality Management all new materials for inspection.
District] Vu
❑Yes It
Ih&Saet N=Waaednons 25%5.25533
5 ialsrtquinme5534.1rChapudthat ifbe Califon- r f- _ v /rn r� -s.� -0S
nice no, &Safety Gpe. orlans 255!15. try
255]4.l understand that ie.' Willing /�lll/�tYA,rl //`/.r [JY �(
does nos curtently have a tenant,that it is my resp 'hility m notify the oecupant nI J¢ �r
o'mmenkawhi=hrutin W�netprian irsg ar camr=ala Xrry;x Signature of Applicant Date
If Ile owner ter amthpriaca.g=rat(~
Date
All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Buildin De artment
JOB ADDRESS: PERMIT #
5 (!0,- ftl n_f'-0,f 0� o
OWNER'S NAME: ( PHONE #rjcE)Wf-qQS
GENERAL CONTRACTOR:' c FAX #
I am not using any subcontractors:.P,0aA/ie z •4 w e
Signature I 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/Contractor Signature Date
CITY OF CUPERTINO
w FURNACE/AC
�UPEI�TINO PERMIT APPLICATION FORM
APN # Date:
2 oo
JBuilding Address:
S 1
erIs N Phone #:
tractor: Phone: license #:
-7 3 S
ontact: Phone: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech
Job Description:
vna
Residentialo Commercial ❑
For Residential Installations:
Attic ❑ 1" flooX 2"d floor❑
Adhere to min set back re uirement❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Plannina Aooroval Re uired ❑
Cost of Project: Type of Construction: Occupancy group:
1 ` 2
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ElReplacement
Qty. if
Applicable Fee ID Fee Description Fee Group
/ BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAHULkN 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 v UILDING
BUSLIC Business License BUILDING