The URL can be used to link to this page

05100022300 4zto nom_ ,—o r� JtLLL 'jO3 Spa 5$� EFC Q Z r ' CITY OF CUPERTINO� CONTRACTOR INFORMATION •. BUILDING DIVISION PERMIT Bm01LDlacnoDREss: ALTON AIR CONDITIONING! & MITNo.05100022 194RR PL OWNER'S NAME: PERMrr LSSUE DATE PEGGY NELSON 45300 INDUSTRIAL DR #4 10/05/2005 NE: SANITARY NO. CONTROL NO. (510)490-5655 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG EIPCr PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am licensed under provixior¢ of Chapter 9 (commencing p with Section 7")of Division 3 ofthe Business and Professions C .apdmy feet. is in mu mrQ am L_ tSoo REPLACE FURNACE, INSTALL u,anm loos Lk.a v=�/(dx Dale DOOIOcmf 220 ELECT. CIR. CHt1ECTS DEC O Of. mce I underaund my phos dull Ise used u public reco L. OCTt. Licensed Profesioull OWNER -BUILDER DECLARATION �oo� I hereby .(Aero that 1 uemps from dr': Crtions 0ra LKGIY Law for dX VZ`� o mama. (Suction icon LS, Business and iom Carr Any oily or county 1. whichre on, de which rtyuiru a permit m cnnswcL allot. impmvc, demolish. or repair any structure a A prior In its issuance. also requires she applicant for such Not to rile a signed smtemem Nat he is licensed purmanun Ne, provisions of the Commemr's Lune law (Chapter 9 Sq. Ft. Floor Area .�r;—t N.600 ua (commencing with Section 11108) of Division 3 of th, Business and Professions Code) in Nat he is attempt uterefrom and the basis for the alleged exemption. Any violation of Section 1031.5 by any applicant for a permit subjects the applicant to a civil penalty of five hundred dollars APN Number Occupancy Type p y yp not mora than (M). 31626079.00 01,u owner of the prop,ny. or my employees with wage a their ml, commutation, will do the work, and the suucture is not intended or Offered for sale (Sec. 1041, Business and Professions Coda: The Contractor's Liave law does not apply to an owom of Required Inspections property who Wilds moribund durcon, and who doessuchwerkhimaelforthmugh his Own employees, provided that such improvements an, notinm ilud or offered for We. If. however, the building or improvement is sold within one year of completion, the owner - builder will ban the burden Of pining that he did not Wild or improv, for purpose, Of We.). ❑ 1, as owner of the property, am exclusively contracting with licensed conlrmmn to construct the project (Sec. 1044. Business and Professions Cotler) The Conuactor's Li- cense Law docs not apply to an owner Of pmpwy who Wilds or improv damon, and . who contracts for such projects with a contracmraf licensed pursuant to the Contracar's Lice. law. ❑ I am exempt under Sec. B & P C for this moon eer Dale WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury One of the following dadaratimss: 1 ham and will maintain a Cenifncam ofCOesent m self -inure for Worker's Compen. on, as provided for by Section 37M of the labor Code, for the Performanw of the k for which this permit is issued. 10;'!�',iof 1 have and will maintain WOrk,ri GOmpenamon InsuMa, as rayulmd by Section the Lmor Code, for the performarue.fthe work for which this permit is issued. Worker's On ummo nsura.ca iu andPolity numbersme' �1 e Polity No.:�/6 RTIFICATE OF EXEMPr1ON FROM WORKERS' COMPENSATION INSURANCE (Mi.:anion need nut bec.mplined If [be permil is forene hundred unit= (SIM) or less.) 1 ccnifv that in Ne perfmmmen of Ne, work for which this Permit is issued. I dull in employ any person in my manner m as In become subjeel to the Workers'' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Cmutome of Exemption, you should become subject 10 the Workeri Compensation previsions of the Labor Code, you must foMwilh comply with such provisions or this permit shall W d,emctl revoked. CONSTRUCTION LENDING AGENCY I hereby .from that Nem is a eonmuninn lending agency I'nr the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name, Lender'. Address 1 artily that I have mad this application and sum that the salve information is . cortmL. I agree to comply with all city and county ordinances and sum laws rehdng to Wilding construction, and hereby authorize rcpresenativ Of this city w enter upon the a Wve-mcnuomd progeny for inspection purposes (We,) agree to ave, indemnify and LOOP humlcss 0. City of Cup,nin0 against expenses which may in any way accme against said City eunce inof incostaand Aconsequence Of Ne granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOUN Issued by: Date "V 4 Re -roofs J M Sign tar fApplicanuconuacmr Dam HAZARDOUS MATERIALS DISCLOSURE ER Type of Roof ill the applicant or future building occupi m store or handle hazardous material as defined by the Cupenino Municiul Code. Chapter 9.12, and the Health and Safely Section 255324P / 0y.QH Will the applicant or future building occupant use equipment Or devices which h it ezamnus air eonmminants ss dlim D l at ed by the Bay Area Air Quality Management El Yes 1 have mail the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth& Safety Code. ScWats 25505.25533 a W 1134.1 understand than if the Wilding does rut curoody ham a ¢pant Nat it is my romma ihdily to notify Ne occupant of the regyigemcros yhoiQµ5Lk.0Qtor to issuance Of a Certifies, of Oemomv.— All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: © E PL . PERMIT # C) - 2 2 - OWNER'S NAME: PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: O— Signature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical L o c�, 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 i Sul - CITY OF CUPEkTINO CITY OF CUPERTINO FURNACE /AC PERMIT APPLICATION FORM APN # 3 1 0 - a� -u�1q Date: Building Address: \Olq Owner's Nam N2 l Phone #: 1-4w - 2SS -� 100-j Contr License #: CS Contact: C`, �` -T Phone \� `t Appl' ontractc 0=\ A/C Unit > 10,000 cfm Building Permit Info: Bldg Plumb ech Job Descri tion: �Ct M \00 UM rY\Ac� �� 1)ara: ' s dentiaL• � p G =10, d3l,Cw(UObmmercial: Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: Valuation: CnCXq, Ga Type of Construction: Occupancy Group Qty. if Applicable Fee TD Roo no ..r:,. BREMFURN of Furnace " V.VU MECHANICAL BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <-- 10, 000 cfm MECHANICAL BREMMISC Misc Apparatus ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMrrFEE Plumbing Permit Issue PLUMBING BPERMFEE Bld Permit Fees BUILIDNG BPLANCHK Plan Check Fee BUILIDNG BUSLIC Business License BUILIDNG # 3( VIA Ste' 2?% 3`f