03050149 CITY OF CUPERTINO x' �+new2w?. fi"» +»^' " "
BUILDING DIVISION PERNIIT CULT 4U6.T, 00NF.W MAT10N
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BUILDING ADO0.FS5: ATLAS HEATING PERMITNo03050149
AnAM TNT
OWNER'S NAME: 155 SAN LAZARO AVE PERMIT L`BH&DAfI6,9/2003
OMAS T FUJINA VD/ `
NE' (4 0 8) 73 9-0 516 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BO EO PLO O
Som LICENSED CONTRACTOR'S DECLARATION Job Descrl tion
i�FCs I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing p
`G with Section 70M)of Division 3 of the Business and Prefculum Code,and my license is
hmn rL=UAps1m ED
Iota and effect, NEW A/C UNIT IIS
z Dude Clue Combacwr
p ARCHITECTS DECLARATION JUN 1 7 2003
understoodtt33,7ii I undernd my Piens shell he used As public records
Is Licensed Professional
50 OWNER-BUILDER DECLARATION BUILDING
1 hereby of on that I am exempt from the Conoanor's License law for the
O D following ration.(Section 70313,Business and Profnuinns Code:Any city ar county
S$ which rectums a Permit to construct alter.Wpmw,demolish,or repair any structure
_Z on Pdar m its issuance.also requires tic applicil foramen Permit to Ne a signed mamment
p < NethcislicensedpurmantroNeprovisionsofNeCanlractorlLIttnselaw(CNpmr9 Sq. Ft. Floor Area $2N4¢I®tion
y 9 (commencing with Section 7DOEm'Division3ofthe Busummand ProfessionsCade)or
9 that he is exampt therefrom and Uro buss far the alleged exemption.My violadan of
Section 71031.5 by any applicant for a pesmlt subjects the applicant an a civil penalty of a16erO O Occupancy Type
out mom Nan five hundred dollars(SSW).
❑I,At owner ofthe property,or my employees with wages As their sole compensation,
will do thewatlt and theewmum]seat intended oronemd fm sale(Sec,7Df4,Business 301 —
And Pmfesslom Code:The Committee's Liaise Law does oat apply toan owner of 303 - ROUGH 11005
propertywhu buildsorimpraws theran,andwho doessah work himself orthrough his
own employeeprovided that each improvemmu are not Intended or offered forsam.E• 304 — ROUGH ELECTRICAL
however,Ne building or improvement is sold within ons Ste of ampledon.the owner.
bonderwins have ten o
he burdf Proving gore Ile not Wild um d improve far purpose of 501 - FINAL ELECTRICAL ENERGY
sale')' 502 - FINAL PLUMBING ENERGY
I.as cotter of the Property.am exclusively unmeaning with Hamad contraction be
o sates the project(Sec.70ea.Business and Professions Cade:)The Currencies'Li. 503 — FINAL MECHANICAL ENERGY .
anm Lew doss nut apply In an owner of property who builds or improves thereon.ad, 505 — FINAL ELECTRICAL
whocontR6Yfor such projects with a canm6ter(s)licensed punuamt m the Contractors 507 — FINAL PLUMBING
License Law.
I.eemptu Scc. � B&PCf thin reams 508 - FINAL MECHANICAL
Owners /� A Y.a' \ Date �; 0
� X—WORK CWPEN TION D TION
I hereby air=under pmedly of perjury,arc of the following decluatiou;
1 have am will maintain e CeNOamof Consent to ansf-u um for WorkeesCompen-
motion,As provided for by Section 3700 of the Labor Code,for the performice,of the
work for which Nis permit Is issued,
❑1 ban id will maintain Workers Compensation Insurace,an required by Section c
37W of the Labor Code,for Ne performance of the work for which this permit Is leaned.
My Workers Compensation Issuance carrier and Polity number arc:
Cortico Policy No.:
CERTIFICATE OF MFMP00N FROM WORKERS'
COMPENSATION INSURANCE
mut section sed not be completed if the permit is for one hundred dollars(SIM)
or leu.)
1 cenify that in to performance of the work for which this Permit is issued,I shall not
employ any person in my miner an As in become subject to the Worlans Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this CeeiOam of Exemption,you should
become abject to Ne Worker's Compensation provisions of the Labor Code,you mum
,J O forthwith comply with such previsions or Nu Permit shall he decmed annulus.Z " CONSTRUCTION LENDING AGENCY
[••i .�., , Ihereby&Man that themisaconstmction lending agency for thereafncomccof
Nc work for which this permit Is issued(Sec.3097.Civ.C.)
Q Lender's Name
U 0 z Lenders&&mei
I cenify that 1 ban mad Nis application and sum Nat the man information is '
0 F cnrrtck I agree te amply with all city id Coity ntdiniaund sum hos r upang te
�U buildingconstruction.ion,ad hereby euNon p rents.representatives,or this city be enter upon Nc
LLj abovcmcntiorted property for Inspection Puryatev BJ`\//
Q. (Wc)agree to an,indemnify and keep harmless the City of Cupertino gains)
rr V1 liabilides,judgments,costs and expenses which may in my way tame against said City
In consequence of the granting of this permit. 1 9
/Z--7
APPLICANT UNDERSTANDS MD WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU CE RE TIONS. `— L7/03
Re-roofs
.44nmuafAWicmaACormmmjf U Dam
HAZARDOUSMATERIAISDISCLOSUR Type of Roof
Will the applicant or future Wilding acupsnt Ann m hand a ha'zImmul material
as,defined by she Cupeeing\Municipal Code.Chapter 9.13,and the Health id Safety
Cade.See •XNo All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It heal..air ciuminenu As defined by Ne Bay Ama Air Quality Managcmem all new materials for inspection.
DisuictT ,.
❑Yes ` 14. +
1 ban mad the huadtmtmateriah mquimmenu under Chapter6.95 of the Califor.
nix HcalNB Safety Crede,S.-b.25505,25533 uW 25531.1unMrsmnd good Wilding
d not curmntlY hen a moil gore it h my responsibilitymtify the it of
m i cn ' hmuatbc erpri'cInissuance ofICcdOcaeof ¢panty -Signature of Applicant Date
S
/�
\ Owneraulhorinda t Dom All roof coverings to be Class "B" or better
Thomas Fujinaga
Tony@propertyproltd.com [property@best.com]
' Friday, April 11, 2003 10:09 AM
To: Thomas Fujinaga
Subject: RE: HOA approval for air conditioning installation
Tom,
Approved! D fns a
Tony lJ
MA 2
-----Original Message-----
From: Thomas Fujinaga [mailto:tomfuj@attbi.com] By
Sent: Wednesday, April 09, 2003 9:33 AM
To: property@best.com
Subject: HOA approval for air conditioning installation
Tony,
As we discussed over the phone, I would like to get HOA authorization to install an air conditioning unit in my backyard. I
believe the unit is the same make & model as the one installed at my next door neighbor. There is some urgency to this
request as I will need the HOA approval to get a City permit for the installation.
.Thanks in advance and please get this done as soon as possible.
• Best regards,
Thomas Fujinaga
10174 Macadam Lane.
05/29/2003
CITY OF CUPERTINO o��
FURNACE/AC v 3
CUPERTINO PERMIT APPLICATION FORM
APN# ' 6Date:
Building Address:
IJ/7°I Mgcadao, 1,n G e.-t,,= C/4
Owner's Name: T Phone#:
7HoynaS /, Fv.nu a HoS-873_�76y
Contractor: Phone: License#:
/+-Hos Paa-f,',
Contact: , Phone: Cupertino Business License#:
Building Perrin Info:
BI Elec Plumb Mecl/-'
Job escription:
Residential Commercial ❑ �1
For Residential InL lations:
Attic ❑ 151 floor 2nd floor❑
• Adhere to min set back requirement❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required
Cost of Project: 62o Type of Construction: f Occupancy gr p:
Strapped ❑ I On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location Replacement ❑
Qty. if
A lic Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
EPERMTTFEE Elec Permit Issuance ELECTRICAL
PERM FEE Mech Permit Issuance MECHANICAL
. PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
3 c'