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04110006 CITY I BUILLD cDIVISIONNO PERMITCONTRACTORINFO RMATION _. BUILDING ADDRESS: PERMIT NO. ATLAS HEATING 04110006 AM PERMIT ISSUE DATE . NE: - '" SANITARY OL NO. ARCHITECTIENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a00 LICENSEDCOMAACTOR'SDECLARATION _ Job Description P I Mmby affirm that 1 am licensed under provisions of Chapter 9(commencing sew wiNSeclion700O)of Division3oflhe Baurc udR fauiom Code.andmyliceneis . ^ w in full force and affect. j�_ Lianse Clas L'e.X WALL HEATER REPLACEMENT ,;:Q Dam Contractor , ARCHI'IFCI•S DECLARATION ji z I unwwand my plain shall iw dud u public Iecnrda - - ''o G LiccnuJ Pmfcuionel v ` g OWNER-BUILDER DECLARATION <� 1 hereby.fain that 11. exempt from tete Comns Co e:Any C Law for the p o following uiresmason.Permit i )(131.5. t.altar, and are.dcdamp Calc:Any city m county / x .10 �+ which requirex a al m canstru0.plan improve,demolish, fi repair any umaure 'e y thatpoinOr its issuance.en dpons r mQo ersthe Rhm roviam applicant for such Contractor's is Lim m Law(Capt eel that he is license)pursuonlm the previsions of the Comncmri License law(Chepter9 Sq.Ft. Floor Area WWAS (commencing with Sation?")of Division 3 of lbs Business and Pmfessm.Code)or y _ that he is eumpt therefrom and Ila Eau for One alleged exemption.Any violation of Section 9031.5 by any Applicant for a permit subjects the applicrot to a civil penally of ,.ftffgbigkser --• Occupancy Type " not mon man fire hundred dollars($500). 3 7't Y17 UY1,7". 0 0 1,as owner of the property,or my employees with wages as their sole compensation, willda the work.and thesBucure is notintended oroffered forsade(Son.9614.Business ns Required Inspections and Professions Code:The Contrecmrs Li.Law d.rat apply a an owner of - q P pmpeny who builds ver improves thereon,end who docs such work himself ver through his own employccs,provided that such imPTOWWOu m not intended or offered for We.IL however.the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of .[a.). ❑1,as owner of the property,em exclusively contracting with licensed contracmrs an construct the project(Sec.90x4,Business and Professions Code:)The Canvacar's Li- aeae Law dans our apply in.n owdef of property who Ulllds or improve thereon.and - who contra¢for such pmjecls with a commctods)licensed pursuant o the Contractor's Licenu Law. 0am eaempw/n�Ief�SS��am. ,B&PCfor this reawn ow�!�,[�___,�i m D �;V66RIcc��((S IS thereby. irmundcrpcnaltyof,..S,.yoncafmc 11 1ngdMvatians: I Id.n and will maimuin a C.o fia.off of Cosa.m self-in um for WortdsCompcn- rauon,as provided far by Section 39W of me Labor Code,for the performance of the - work for wM1ieM1 this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section _ 3900 of the Labor Code,for the Performance of the weak for which this permit is issued. My Workers Compensation Insurance caries and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE f@u section reed not be completed ifthe Permit is foredo hundred dollars($100) Icss.) I cenify mat in the performance of the work for which this permit is issued,1 shell not employ any person in any manners to to tecome subject to f Workers Compounded Laws of California.Data Applicant NOTICE TO APPLICANT:Ir,arm,making this Ccnifcate of Exemption,you should - become subject to the Worker'&Compensation provisions of ft Labor Code,you must - .JO fuMwuheomplywith arch bovi,ions or this pc.transit be warned revoked. Z" CONSTRUCTION LENDING AGENCY Fa vN_. I hereby affirm that them is a construction lending agency for the performance of x Iltc work fur which this permit is issued(Sec.3097.Civ.C.) r[7 A Lender's Name U z tender's Address U O 1 cenify that I hast read this applicrron and sum that the above infolmauun is II. F-' correct.l agree to comply with all city and county ordinances and sum laws relating to 0U building continuation.and hereby authoda represemntiva of this city to enter upon the 41.1 alar&mentioned property for inspection purposes. (War agree to save,indemnify and keep hamllcu the City of Cupertino against _ F� Iiabilida,judgments.costs and .,.which may in any way accrue agernsl said City fll6;: U Z s pandrit. APPLICANTCof due lotamIng Of UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 1 SOU EREGULATIO - '/ / /IIiP/n �f 1f Re-roofs S nf��n�� V ver ./ HAZARDOUSMTERIALSDISCLOSURE Type of Roof Will the applicantauorfmurebuildinge,Chapter tsmrc or handle hazardous and az defined by dte Cupertino Municiryl Code.Chapmr 9.12.and dte Halm anti Safety Cade.SectiYoes L(Nun 25532(.)? All roofs shall be inspected prior to any roofing material being installed. Will the applicant or furaesu equipment building occupant eseqme uipnt ver devices which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. islrict? L�� QYa p. I have mad the haradiduSstha erial&requirements udJerchapter 6.95 of the Calimr niaNalth&Safety Code.Sections 25505,25533 and2553<.lunderrand lhatiftlte building data nml eurand have a mnan�Nat it is my mspearbility a nuuly Ute acupaml of thc require ts-whtchmost hemet poortoissnanceoraCanramofOceupaney. Signature of Applicant Date o aammiae `/� Dave All roof coverings to be Class "B"or better Community Development £ �'M 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �.UPEkTINO Building De artment JOB ADDRESS: PERMIT # � 4 l ifs G 6 O R'S NAME: NE # •- 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 O�Wr/Contractor Signature Date CITY OF CUPERTINO �- _ CITY OF PERMIT APPLICATION FORM CUPEkTINO APN# 3� 1 / v /-3 Date: / i:f-, 2!P- U Building Address: 2 1 e93 5- z- Mailing Address (if different from building address): Owner's Name: e#: i Contractor. / Licen Contac . hone: $b^ Cupertino Business License#: .,- Fax:' ? Building Permit Info: Bldg le ❑ Plumb ❑ Mech ❑ Job ascription: / Residential ❑ v CorpmerciaALeikoLot4�6 Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this bo 'f the pro' is a A 11k second-sto addition: Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group , BAPPLOTHER .Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING _ BCONSTAXR Constax-Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of CITY OF CUPERTINO CUPEYOF PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO CUP TOF Yo PERMIT APPLICATION FORM Quantity Fee ID Fee Descriptio'n Fee Group BREMSIGNAD Rmdl Signs Add Banch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Ternp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot _ ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL -_ MPERMFEE . Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE_ Plumbing Permit Issue _ PLUMBING ._- PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG _ Address Chane BUILDING 3 of 3