06020149 CITY OF CUPERTINO .a�ta. 2P+'s1�- ^ "n �" "�3
BUILDING DIVISION PERMIT R: TORTNYRQAMATIOl ;E;
BUILDING ADDRESS: ALLIED AIRE SERVICE INC IFRMITNo'06020149
22438 MC _Q"LLAN RD
OWNER'S NAME: PERMIT ISSUE DATE
DICK STARK 661 SINCLAIR FRONTAGE RD 02/24/2006
NE: SANITARY NO. CONTROL NO.
(406) 934-8844
ARCHPIECTSNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONDIACf00.'S DECLARATION
1 hereby affirm that l are Handed under provisions of Chapter 9(Commencing Job Description
with Section 7010)ofOivision 3 of the Business and profession Coda,and my Because is
mmRmroeande L 6 3 — REPLACE FURANCE
Z_ License Clads Lk.g l�j ��ryg
Dam Canuacur � "p'
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ARCHITECTS DECLARATION FIS AL
I understand my plans Nall he used upublic CLARATION 111IIIJJJJJJ till
Licensed Protesters]5 tt g,!!aJ 10176U
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OWNER-BUILDER DECLARATION '` I� LE I hereby affirm that I am exempt from the Control License Law for the
02 folhiwing Mason.(Section 7001.5.Boainess and Professions Cade:Any city or County ,xzAi
9 which requires a permit to construct,alter.Improve,demolish,or repair any stroctum n THE wN t{'�.s p'ia, v'.` b $1500
Z(y^ prior to its iumnn,also requires tMapplicant forsuch permit to file asigned stammem
thou be is licensed ursanttow viaianofMeContrsemrsLamoe6w(Chapter9 S Ft.Floor Area Valuation
�th (commencing withSection7010) f^Division 3 of the Business and Profession Coe)or q• U ..t��
$ Net be is exempt therefrom and the basis(ser the alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit sel the applicant m a civil pculty of Occupancy Type
Out more than Rae hundred dollars($30(y).
wil❑I.0 Me nu of Ne property,,is maltreated withwagesu Neersole w44.Bud n.
and dathewers Code:and The ComumorsLicese awdateffeard rotapsly an an,Bwecas Required Inspections
proand Rtywho Wilds Cade:The Conhectorl who Lew don not apply lf an owner is 9 P
own cro wo s,prmimprowathercon,antlwodues3,hom ffered hrough his
own employees,provided that seem empro old wee m not awarded earofm,oRemd for Owner.
however,Me Wilding,improvement's attwithinone year o(compkdon,Neowner-
builder will have am When of proving out be did not Wild or improve for purpose of
nkJ.
0 1,as owner of the property am exclusively contracting with licensed material m
conwet the Iml(Sec.70x.Business and Profession Cade:)The Cornwell U.
neve law docs not apply to an owner of property.wo build,or improv thereon.Cod,
who..reread fm such pmjcm with•centrutor(q thenowd pursuant to the control
License Law.
❑I em exempt under Sea ,Bd P C for this Mason
Owner Dau
WORKERS COMPENSTnON DECLARATION
I hereby affirm under penalty of perjury MM of the following deelalatlen:
1 Nveand will mainain•Cenifiesua(Conentmself-InuM for WMdrels Compere
noon.as provlded f,by Secdan 3701 a(the tabu Code,far the part..,m of the
wart for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,u required by Sel
3700af the lab,Code,for the performance often work for which mu permit is'clued.
My Worker's CC9rur cation Insurance esmmr and Policy/nu.m.brt:
.er a
cum'. fad policy No:a^-'�P�t's'=
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need nut W Completed Ifthe parell Is Pascal huadmddollara($101)
or ksc)
I con'fy amt In the perfc^ma,e of the work fer which this Permit is leaned.I shell not
employ any person in any manner so us to became subject to the WMrwri Compem adon
Laws of California.Dna
Applicant
NOTICE TO APPLICANT:If,anor making this Certificate of Exemption,you should
become subject to the Workar'e CamPenssaon pMvisian of an LJher Col you mut
.,O forthwith comply with such provisions or this permit Nell be deemed revoked. -
rCONSTRUCTION LENDING AGENCY
'r rN. Thereby aM.Nat them is construction lending agency for the performance of
a the work for which two Permit is Issued(Sec.3097.Civ.C.)
6iQ Leal Name ,
=z Lender's Add.,
V Q I certify that I haw Mad this application and Cote that the above information u
{g.F coma I ague to comply with all city end county ordinances nd slow laws Mal m
0 V Wilding construction,and hereby aortal representatives of thiaeity to enter open the
W Move-mentioned property for Iupenion purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino again) 16
C,) Ilabiliaes.judgmenu,costs and expenses which may in any way accrual against aid City
U in covegnne of the granting of this Permit.
APPLICANT UNDER BT 5 AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
sou R ,_- a Re-roofs
noun of AppllcanuConwcmr 700 � Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will W applicant or f fluse building occupant porn orbandlc hmndous mamriai
u deftel by the Cupertino Municipal Code,Chapmr 9.13,was the Health and Safety
ode.Seeana 25s33(s)7
❑YexNo 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 hanrdnus it contaminants at defined by%e Bey Ana Air Quality Management all new materials for inspection.
D13m1e17
Oyu 16NU '
I have mW the hourardonmaterW,requirememi underCNptl of do Collins.
six Hal"SafctyCol Sectiorw25505,25533 ml i understand buifdn building
don Out currently have a nn thu II u my maponlblliry en .Of,tin occupant of the
m u n ch s me art etcc afa Ci caw Occas
�Z pe alas Signature of Applicant Date
01 net ar authorized agent ^� Dom All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
✓' Cupertino CA 95014
Telephone(408)777-3228
CI OF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT#
�C'LeZ15k� A0 O G l4 r
OWNER'S NAME: PHONE # lela8 9; BB
GENERAL CONTRACTOR mice FAX # 08 g c o
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
v" Heating �ies� .�' iu J�' 0
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owne /Ooi t ctor Signature Date
1
CITY OF CUPERTINO
®` FURNACE/AC p
CUPEI�TINO PERMIT APPLICATION FORM
APN # 3 Date:
B,% IPs.
Owner's Name,
rBe#:S� 9/30
Con ctor: Phone: License #:
/eo�i.PeSecvi� �L a3 1000 aS—
Co t� L/
: 8 Ph et�j:, / Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect.49— Plumb lg—� Mech C'1"
Job Description: ;Ft�2
Residential- Commercial ❑
For Residential Installations:
Attic F 1g`floor ❑ 2nd floor❑
Adhere to min set back requirement❑
It For Commercial Installations:
Replacement same weight ❑ Additional weight (structuralEl calcs)
Structural Calculations required for new installation
New installation Planning Approval Required
Cost of Project: Type of Construction: Occupancy group:
/�DD� 'R-3
Strapped El On Platform 0 Bonded 0 Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 efm MECHANICAL
BREMRECEPT Recptl, 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 BUILDING
BPGAS Gas Piping System Fe PLUMBING
BUSLIC Business License V BUILDING
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