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04080215CITY OF CUPERTINO�--�^� Ci1NTRACTOR iNFOIR,, A 101 !"' BUILDING DIVISION PERMIT es. BUILDING ADDRESS: PERMIT N0. 04080215 OWNER'S NAME: PERMITISSUEDATS ONE: SANITARY OLNO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O LICENSED CONTRACTOR'S DECLARATION Job Descriptio 1 hereby affirm Ihm I am licensed n provisions of C 9 (commencing P INA ED with Sermon )Orel) ofOiviaion 3 of the BusincuenQ�rpfcuium Code,end my Ikcnu is i ss mdo.i in full a and effect. ✓— u.e Class <_¢.> - Llm# /S/S4f REPLACE FURNACE & ADD A/C CONTRACTOR: SUNSET HEATING CO SEP /6 2004 Dam Contractor ARCHITECTS DECk]i I N 1 t m Iona shell bc�Bedu Pu lic f — LiccnuI Professional OWNER-BUILDER DECLARATION BUILDING offal the, 1 Lew for I hereby .(Orin from the Ccommum'f"imm,Co my I.S.eBumpt li Code: Any city o e: Any c counr following massa. (Section 7co LrBusiness and Pr which mquims a permit re carves, aline improv, . dem ore sig any structure h KnolLsh, a em tatemet for suchpctors Rewe Law (Chapter poohtoslissuance. also reuant quires the Ire previsions ContracBusinessLittreLaw(Codc)or h) Sq. Ft. Floor Area Valuat (cothamencigwitpuation7 of Division (commencing with Suction 71100) of Division 3 of the Business and Professions Cud.) of 900 that he is uempl them(rom and 0th bole for the alleged eampdon. Any violation Of Section 7031.5 by any applicant fora permit subjects Ne applicant to s civil penalty of APN Number Occupancy Tr nut mart Nan Eve hundred dollen ($500). - P y `J Pe ❑1, as Owner of the property, ormy employees with wages u thersole compensation, 35704028.00 will do Newark end theanuctum ismotin¢nded oroffcmd forsale (Sec. 7044, Business and Pmfessiom Code: The CmmNcmra License law does not apply to an owner of Required Inspections property w ho builds or im proves thereon, and who dues such work him self or through his Own employees, provided thatsuch improvements am not intended arolremd (orale. IL however, the building Or improvement is sold within one year of completion. the owner. builder will haw the burden of proving that he did not build or improve for purpose of ale.). ❑ 1, as Owner of the property. am uclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li. cense law does not apply an an Owner of property who buil" or improves themon. and, who contracts for such projects with acontromoKU licensed personal to the Conmunes's Lacena Law. ❑ I on exempt under Sec. ,B&PC for this aeon Owner Da¢ WORKER'S COMPENSATION DECLARATION I hereby eRrm under penally of perjury one of the following declarations: ❑ I haw and will maintain a CeruftakOf Comicat toself-insum for Workers Comp.n. ration, as provided for by Section 37M of she labor COtle, fur the performance of the work for which this permit is issued. ❑ I have and will maimein Workers Compensation Insurance, as muddied by Section 37M of the labor Code, for the p.rformance of the work for which this Permit is issued. My mka,a Compensation firearm. artier and Policy number am: CO"'..�' C'n.e.o P. ,ewNo�t�%^��_ CERTIFICATEOFEXEMPrIONOFlIBMW RKERS' COMPENSATION INSURANCE (fhnscetion need not he comPlcmJ Blue permit Is future hundred dollars (SIM) or luso) 1 certify that in Ne performance of the work for which this Permit is issued, I Nall nut employ any person in ay maneru as in become subject to the Workeri Compensation Laws of California. Data Applicant NOTICE TO APPLICANT. IL aBcr making this C.difmate of Eacrapion, you should become subject to me Worker's Compensation provisions of she Labor CrMe, you must forthwith comply with such provisions or this permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that mem is a coasuuctim landing agency for me pofmmanac of the work for which this permit is issued (Sec. 3097, Civ. C.) Undoes Name Lender's Add. 1 certify that 1 have mad this application and sum that the &how infmmstion is toren. I agree to comply wish all city and county ordinances and some laws relating to building convection, and hereby aumorim minnem atiws of this city to order upon the medgirth property for inspection whicPYes. (We) agree IO saw, indemnify and keep harmless Bin City of Cupertino against liabilities. costs and expenses which they in any way accrue egelnnseid City incoitiuu consequence Of tu, inconsequence of the grating Of this permit APPL DERS777777ppppppNDS AND WILL COMPLY WITH AII,µ{{fffNON-POINT SOU RgG ATS Issued by: Date Re-roofs /\ 4 Signature of Applians/Commetor Dote HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.13. and the Health and Safety od., Section 25532(a)7 - Yea m Na All roofs shall be inspected prior to any roofing material being installed. A If a roof is installed without first obtainingan inspection, I agree to Will the applicant or future building Occupant use equipment at devices which P g remove emu hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Diiviel7 Dyes Nu 1 have mast the lire dausmamrims requirements unJer Chopmrs.95 of the Celifoe .is Health & SaWyCOde, Sectmos255115,25533 and 25534,1 undenmnd that !(am building does not cu w a moat, that it k my msponibility m easily the taxation of the mquimm.n a c a incl printm issuance Ora Ccnifia Of Oce ey. Signature of Applicant Date All roof coverings to be Class "B" or better rizeaag.nt aCO UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: U PERMIT # O�o8o21� ' OWNER'S NAME: Robsv--l- PHONE a ' GENERAL CONTRACTOR: FAX # I am not using any subcontractors: _ _ _ ,l W2-r/oy Signature Date Please check applicable subcontractors and complete the fnllnwino infnrmaHn„- J `' Ov r ontractor Signature Y / Date 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 J `' Ov r ontractor Signature Y / Date CITY OF CUPERTINO 6 2 S� FURNACE/AC 04 8 PERMIT APPLICATION FORM AP -N # 3,/-7 p Date: BUILDING BREMFURN Building Address: MECHANICAL Q /YJ /i -A i S �c�i A/C Unit > 10,000 cfrn erName: Own's Phone #: 0S6:,e- ert.rr97--S�G�6 Contractor: Phone: License #: Svc W e -o_ BSEISMICRE Contact: Phone: Cupertino Business License #: hE�T 715,61i Gro-zz2-OV? z Seismic Commercial Building Permit Info: EPERMTTFEE Bldg ❑ Elect Plumb ❑ Mech L� Job Description: Mech Permit Issuance MECHANICAL PPERMITFEE Residential T Commercial ❑ PLUMBING For Residential Installations: Bldg Permit Fees Attic ❑ I't floor ❑ 2"a floor ❑ BPLANCHK dhere to min set back requirement ❑ BUILDING or Commercial Installations: Business Licens eplacement same weight ❑ Additional weight (structural talcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Constructio / Occup cy gro S cam — ,ZIVA6 Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: ElReplacement N, New Location z....Y.-,.RI. RPP M Fee Deanrintinn Fee Groun BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL ( BREMAIRHAN A/C Units <=10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMTTFEE 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 L r b , ") 1