04070014 CITY OF CUPERTINO
I BUILDING DIVISION
PERMIT CONTRACTOR INFU1tMATION�
BUILDING ADDRESS: SAN JOSE AIR CONDITIONING PERMIT ND04070014
10631 MER OWNER'S NAME: PERMITIfSUEDATE
PATICK MONTIJO 880 N. 8TH ST. nVo2 /2nn4
ONE: SANITARY NO. CONTROL NO.
(408) 286-2047
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
0 0 0 0
fop LICENSED CONTRACTOR'S DECLARATION
m hereby affirm that I em lianacd under provisions of Chapter 9(commencing Job Description
with! UV fDivislon 3ofthc Business and Pr of Sion Code,andmylimmic e, l�
ray i^fallexim 1ta^4e =ea REPLACE FURNACE & ADD A/C, ELECT. • CY/ALe
j License la ".Cut,
ic,p
n'p Dem C.utrmtar JUL
?pW ARCHITECTS DEC 114th 26' 2004
'y�Sy++77 I and and my plans shall ho used as public RmAds
;Q� Licensed Pmfamimcd ®CC ( a
I
OWNER-BUILDER DECLARATION SUILDin
1 hereby.frim that I am exempt from the Contractors License Law for the
�OOO following moon.(Section 7101.5,Business and Professions Code:Any city Or county
_'
12V which requires a Permit to construct,.term improve,demolish,or rtpull any elamure -
Zto prior to its issueneo,also requires the applicant forsuch Permit o file.signed.onement
that he is licensed reorient to the previsum of the Comractoes License Law(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section 7")of Division 3 of the Business and Professions Code)or
Nat be u exempt therefrom and the basis for Ne alleged exemption.Any vtoladon of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 48,TRqq9WG_r0 0 Occupancy Type
not mom Nen five hundred dollars($500).
❑I,a owner ofthe property,or my employees with wages as their mid compensation.
will do the work and the m setare Is notfmmmded medicated formle(Sec.7044,Business
and Professions Cods:The Conouctors License Law dors nut apply to an owner of Required Inspections
property who build,or ire pmm feemon,and who does such work himself or hhaeugh his
own employees,provided that such improvements are of inherited or offered for mid.If,
however,fee building or improvement is mid within one year of completion,the owncr-
buiider will heves the burden of proving that he did not build or Improve for purpose of
sale.).
❑1.as Owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Profeasioa Code:)The Contractor's Li.
come Law does not apply to an ownm of property who Wilds or improves thereon,and.
who contracts for such projects wife a eontrector(Q licensed pursuant to the contractors
License Law.
I ma exempt under Sec. ,B&PC for this moon
Owns, Date
_ WORKER'S COMPENSATION DECLARATION
1 hereby e0irm under penalty of perjury one of the,following declarations:
I have and will maintain a Certificate of Consent msel4ioure for Worker's Compos-
seeks,m provided for by Section 3700 of Ne labor Code,for fee performance of the
work for which This Permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the tabor Coale,for the perfmmance of the work for which this permit is toned.
My War 's Comperuauon Iaum cc cc and Policy number me:
mer. Policy No.;
CERTI^ICA - EXEMPTION FROM WORKERS"
COMPENSATION INSURANCE
(This section need not becomplemd if the permit is fmonehundred dollars(glmB
mss.)
1 cenify that in the Performance Of the work for which this Permit Is issued,l shall not
employ any potion in any manner so as to become subject to the Warkmr Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Cenifiam of Exemption,you should
become subject to the Worker's Compeaetion previsions of fee Ichor Code.you must
.JZ forthwith comply with such provisions or Nis permilabell W deemed revoked.
z O CONSTRUCTION LENDING AGENCY
'r (hereby affirm that there is a construction lending agency for the performance of
a the work for which this permit is ioued(Sec.3097,Cih,Cd
W Q Lender's Name
Lender's Address -
V Q I certify Nat 1 have mod this application and meta that the above information is
F' corten.Iagree ctcomply with all city riz county ordinances and sea lewd relatingto
e
Q O above-gconswetiro end hereby authorize repmsenulives of this city mentor upon the
r� abovc(Woioncd gree to ensfinemnify an keeps
(Wc)agreemcove,indemnityand hich WOrless in any
the City
roagainstagainst
UH liabilities,encs ontecostsang expenses which mayinanyway ucmc against said City
V z A APPLICANT
NDERSntlog Of this Permit.
APPLICANT nNDER$ DS AN WILL COMPLY WITH ALL NON-P INT Issued by: D o
JDisuictl
CE REGUL N . mv "
I.
Re-roofs
urt of ApplicmUConhroror Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Bac applicant or run=building Occupant store or handle hmaAous material
ned by the Cupertino Municipal Craft,Chapter 9.12.and the HcaIN and Safety
Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑kes "u
Will the applicant or f Nre Wilding occupam use equipment or dcvims which If a roof is installed without first obtaining an inspection,I agree to remove
azardous air contaminants a defined by No Bay Area Air Quality Management all new materials for inspection.
❑Yes on
I have mail the haardousmaterials requirements under Chepmr 6.95 of fee Califor-
lth&SafayCmc,Sectiore25505,25533 and25534.1 undcmend Nat if the building
Jaea not curcndy a errant.Na lis my msponsihility to notify IW occupant of Nc
m4eiremcne t ren pd iamence ofd Carole. Occgpancy
Signature of Applicant Date
Y r
Ow, manth ecda D„= All roof coverings to be Class"B”or better
Community Development
10300 Torre Avenue
aCITYF'
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
UPERTINO
Building Department
JOBA R S PERMPT #
o
OWNER'S N ` O P O
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: +
ignature 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
� Contractor.Signature Date
,FROM :Mary Kurti$ FAX NO. :415 276 2304 Jul. OB 2003 03:21PM Pi
CITY OF CUPERTINO 6 lE b 7 s a
FURNACEIAC
UPEItIN
CO PERMIT APPLICATION FORM
Date:
`l nn n�1' p�
Building Addresa: i O 3 �fJt A 'A F�U
Phone#: q� �C� b�„
Owner's Name: "I
A "1 Phwta f f License#:god- -73
Contractor:s Cl Jo Kog 9-1.6 '
`I
Phone: C'11winn Business License#:
Contact:
AaAA
Building Permit Info:
Bl ❑
Blest ❑ Plumb ❑ Mech ❑
Job Description: wc�' t; `G /1D 3 TU Ac'--
Residential
Commercial ❑ 230 Q 'v Loo 'W's Z
For ReaWentlnl Ilatioast
Attic. ❑ 1°floor
Adhete to mins roquiremnto
' For Co ial InstMI109";
Replace ent same weight ❑ Additional we (a�taral sales)
Struct Cnlouletiom required for new 111"Ad"
New i stallatiOn Plant A Mal uirea n
4caup�Y SMuP:
Costo Project: /2 Q I 0 Typo of Co on:
Strapped On Pllatforml ❑ ondad ❑ Sq.Ft.Floor Area:
❑
New Location Ra latxntuut
Qt .IfPee m pee Description Fee Grou
A .1 . h1a 13MDING
BENERGY rtcL6Y._ M&CHANICAL
HRfiMPURN Relocation of Furnace ML�Ck1AN1C
BREMACOVER AIC Unit Y 10,000 cfm
B MA =HAN AIC Unita to 10 000 cfm MECHANICAL
RRRMRF.t^RT'f tl Svyitcb&Outicts $BCfRICAL
9cistoic Tec Rcs BUILDING
B8t:ISMICRB plg;Permit Tssuance BLBL'CRICAL
EPERMTI FElr Meeh Permit TssuaMUB MEUT MAATICAL. .
MPEi2MITAEE Plumbi Permit Issue PLMBING
PPERMTfEfifi HU1LDllV0
tipTItMFETs Hid Permit Neal BU H DING
BPLANCHK Plan Check Fee HTIB.DWG
BUSLIC Business Lica