06020166 C ITY OF CUPERTINO .........
BUILDING DIVISION PERMIT 4CON "C'-TIORI 10 6AMWON.1'.
LDING ADDRESS: CONDITIONED AIR PERMITNO-0 6020166
0203 MINER PL
NER'S NAME: PERMIT ISSUE DATE
SAUL GOLAN 1701 LITTLE ORCHARD ST 02/28/2006
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0 OWNER S NA B
W NE:SA L C SANITARY NO. CONTROL NO.
(408) 291-2220
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ARCHITECT/EhOTMER: BUILDING PERMIT INFO
BLDG MECH
0 LICENSED CONTRACTUR'S DECLARATION
1 hereby M.do.,I am limined under powisions of Chapter 9 worsommin, Job Description
huh same.7Mk)).fDivI9.a 3.f the flushrosit it Proftismars Command my If..I,
in oil to.ar,off
REPLACE FURNACE A/C, ADD A/C
jm� Lima Lic
Contractor TJ C%
ARCHMECTSDECLAIR Im
I understand my piano"I W=it a public mcards MAUD
Licensed Professional
I hereby tirtions OWN'R,'U'LDE'DECLARATION
that I am exempt from the Contronclor's License,Law for ine MAR
cO following ressam.(Section 703 1.5,Business and Profesm.Coca:My city or=my
which".I..permit to,construct,alm,imprictm,demolish.ar repair any shructure r,-N n st w $10000
prior ui its issuance.also requires the applicant for such Permit to rile a signed statement
that ho is licensed pummant In the provisions of we Contractor',Ummon,Law(Charter 9 Sq.Ft.Flofo&'W Valuation
(commencing with ScWon 7")of Division 3 of tho Business and Proulbraines,Code)or
chat he is mmpL dismisses and the basis far the alleged exemption.Any violad an of
Section 7031.5 by any applicant for a pormitsubjects due applicant w.civil ponallytir MiRFar u u Occupancy Type
not mom dim live hundred dollars(M).
0 1,asityamerafthe prapertycarry,conploynne,with wagesas theirsole compientardim.
will do am work.And themouctme Is not intemmit co,ifficon!forside(Sm.70",Business
and Professions Code;The Contracku's Licemoss LAw imes not apply W an owner of Required Inspections
Property wine bull&or imporroo,theramm,mil who dootmichavorichanselforthrenigh his
.employees.promad most such improvements am not fivended ortiffened Imitate.It.
however,the building or improvement Is sold within raw your o(completion.the evown-
builder will no"the burden of proving chat M did net build or improve for purpose of
.1.1.
C3 L as masser of ft property,am catcluesively contracting with formed contromon,0
construct dia prt(Sec.7W,Business and Prolamines Coale)The Coneracuses U.
mass Law does act apply to an owner of properywino budids or improvics dienaw,and,
who marmot for sucla projects with a connowums)licensed pursuant W due Corturommus
License Law.
0 larricanspimumes". -.B&Pcr.mi...
Owmer Dow
WORKERS COMPENSWnON DECLARATION
I hereby&Mm mother penalty of perjury am ofma following daclarmhouse
I have and will madmain Condflow.rommot to wit-losure InsWorlecet,Compen.
I
zuou�
action,wo providsm for,by Sections,3700 of the Labor Code.far we pouldrommes,of me
walk Am which this permit is warned.
w
I h,
I haw and will maintain Wofte,Compensation Insurance,a required by Sixtion
37 ofilre LAWrCocw.for the perfarrotioccofthowark lonwhich misrommitis formed.
My We
My Warkwe.Compensation Insurance carrier and Policy a
Carrier
Carrier. Policy No.;_11T
ITION FROM WORKERS'
COMPENSATION INSURANCE
(nds worse need act baccirepicted Ifths,permit is foram hundred dollim,(SIM)
[as&)
I ceralty that.in the performance of the work for which this permit is issued,I"I nan
amplay my remain in my numocrim as in beccome subject in ft Wormso'Compiessumn
Lt.,of California.Dam
Applicant
NOTICE TO APPLICANr.If.after making this Cieftifieste of Flemplimir.you should
became subject in the Wmkces Compensation provisions of me Litior Codc.you most
3z forthwith coreply with such normoismant or this Permit she]M decormil nevaked.
z CONSTRUCTION LENDING AGENCY
4 1 lummytifthrin ft.ft.I,a menconvown leading agency for the,perfamosomm-I
> the work for which this Permit is hichand(Sec.3M.Civ.C.)
Undoes Name
Lodan'sAddruni
U I cerilly chat I ban read this application stood most that dim above finforromma Is
L1,P contact.I agree W comply with all city ad county ordinances and slow lam missing W
OU building construction,and tamby Authorize representatives or this City W enter upon the
Above-mentioned property far inspection purposses.
(We)agree in sove.indammilly and lxcp harmless,the City of CupcdiOO Aglindi
V] Ilabiliticsjwignicams,com,and expocauten,which may I.my way.. joint sold City
U In consequence of the Spromfing of this permit.
APPLICANT UNDERSTANDS AND i�*COMPLY WITH ALL NON-POINT Issued by: Date 2___z crtc/."
SOURCE REGULATIONS
X, -roofs
— Re
Sigamit"17A,licalu/01mirmad Dow
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ft applican,a,future Wilding raccuraint am.handle humardam,notterial
as defined by ft Cupertino Municipal Code,Chapter 9.12.and CIA Health and Safety
ode,Section 25532(3)1. All roofs shall be inspected prior to any roofing material being installed.
[3ye. Rk. If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future Wilding occupant ow equipment or dcvi=which
it havAndaus air contaminants as deflned by ft Bay Area Air Quality Management all new materials for inspection.
lDistnct?
i
oyce;
I ham mad the humordmis materials requirements under Chapter 6.95 of ft Califor.
nia Hot"Sa[cyCm1c.Sections,25505,25533 and 25534.1 wimmuend load If ft Wilding
does not currently law a wram.that It 6 my responsibility so notify ft occurpant of the
'"Nizne
is Which in=W met Prior to i#mcc of a Cerfiflaw of Occupancy. Signature of Applicant Date
J114, All roof coverings to be Class"B"or better
0,
O*er pKauth.rimd allbou Dow
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
aClOF Fax(408)777-3333
�UPEI�TINO
Building De aAment
JOB ADDRESS: PERMIT#
10@03 Mmar \ G O Zo /
OWNER'S NAME: % PHONE # 265 • 4 `,-
GENERAL CONTRACTOR FAX #
I am not using any subcontr s: 198"/06
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
Vo 6
er/Contracto ignature Date
CITY OF CUPERTINO
FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
�G - d 66 - a7-o
Building Address:
lod43 1M1 yn P1gCC:
Owner's Name: Phone#:
1, GSI SIM o8-2&T-- qB q Z
Contractor: License#:
�mvrv" Am ASS o G lA'I'r--f S Z
Contact: Cupertino Business License#:
Building Permit Info:
Bldg i J Elect 5D Plumb ❑ Mech
4b Description: r
Residential [ Commercial ❑
For Residential Ins allations:
Attic ❑ 151 floor 2nd floor❑
Ab Adhere to min set back requirement a
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required
Cost of prgject: Type of Construction: Occupancy group:
,� 0 W 3
Strapped ❑ On Platform . 4 Bonded El 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 cfm MECHANICAL .
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
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
BUSLIC Business Licens BUILDING