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03120032i CITY OF CUPERTINO 0t4tAS(t"r' ORM BUILDING DIVISION PERMIT BUILDING ADDRESS: ASTRO HEATING & AIR COND I M""03120032 OWNFWSNAME: PERMIT ISSUE DAM iftOL N SANITARY NO. A CHITECT(ENGINBER: S BUILDING PERMIT INFO DO ELECT PLUMB MECH LICENSED CONTRACTOWS DECLARATION Job Description I thereby affirm that I are licensed Under Provisions Of Chapter 9 (commencing inf REPLACE FURNACE Limaw BUILDING 5 following moon. SmOon 7031.5, Busumas and ProIcssions Code: Any city or county which .,.I. . Permit 1. central. ]Mr. improve, darawlialb. of no'n, any mmatme 7 prior to its issuance. aim requires; Me applicant rot Such Permit to rile a signed statement Common's License Law (Chapter 9 Sq. Ft. Floor Area G Valuat "Ion9 c that he I, licensed purnmal to the provisions of Me wommunneffig with Section 7") of Division 3 of Me Business and Professions Ced,) or that he is exempt therefrom and Me basis for Me adleged exemption. Any vialad on of 3 WN—Ifttero 0 Occuparbcy`I�pe Secdon 7031.5 by my, applicant for a Permit subjects Me applicant to a civil Penalty of not mom Man five hundred dollars (S500). Required Inspections and Pourcuumo Code: no Cmufamm's License Law does ran apply to an ..a, of ownernpl.yees, provided linamch improvements surs Out intended oraffered far.].. If, however. Me Wilding or Improvement is sold within one year okompoefimn, Me awne� bulder will have Me burden of proving tat he did net Wild or borrow for purpose of E] 1. a Owner of the property, am exclusively contracting with licansed contranewers, to construct Me pmjca (Sec. 7W, Business and Proosions CoMc) The Chairman's Lt. came, Law does not apply to an ovmer of property who Wilds or barrows thencon. and who contracts for such projects with a controuctorts) licensed pareasto to the Contracter's License La - 0 1 One exempt mder Sec. B & P C for this man -- Owner Data WORKER'S COMPENSTTION DECLARATION I hereby nnon under penalty of penjur, one of Me following deftatimue I have and will mountain a Candficate of Consent an scif-hossup far Worker's COmpc"- ,man, Ox pmvidcd far by Sudan 37M of the Labor Code. for Me performance of ft ware for which this permit is Issued. Fl I have and will maintain Workets Compensation Insureance, as featured by SmUnn 370D of the Labor Code. for Me performance of the Owns for which this permit Is issued. Policy bir,N C1 'i 4=Dcl (This random need not W completed If Me cook is for am hundred dolton; ($191) I camly that in Me performance of Un, work for which Ibis permit is Wood, I shelf not employ any parran in any manner an ar to become subject to the Worlmrs! Compransaflon Laws of California. Dam Applicant NOTICE TO APPLICANT. if. after ending this Certificate of Exemption. pu should become subject W the Worker's Compensation previsions of Me LaIWr Code, you mum forthwith comply with such previsions Of this Xnail. Stant tat deemed revoked. CONSTRUCTION LENDING ACIENCY I hereby affinat Me, Mom is a construction lending agency for the pcolonames or Me work for which this worn Is issued (Sm. 3097. Cv. C.) Leaders Name 1 cardly that I box rom his application and new that the above information I, correct. I alince, to comply with all city and county ordimences and state laws retailing in building construction, and hereby offione, mpeormunive; of this city to color upon Me above-mentioned property for Inspection poormses. 17 (We) agree to am, indemnify and keep harmicas the Cit If of Cupertino against 'EA2 r, lialdhics,judgments,costs and expenses which may in my way morm against mid City I n co nsequence ordw a( Ild it. gronfiag APP STANDS A WILL COMPLY WITH ALL NON -POINT AP Issuedby:9 Date , , U Embuild Will t1w.ppil""'m or I; occupant now or handle hatcondous material as earned by Ic Capartim, Municipal Code, Chapter 9.12. and the Health and Safety of Codc. Section 25532(a)l All roofs shall be inspected prior to any roofing material being installed. Oyu Z, abuilding If a roof is installed without first obtaining an inspection, I agree to remove Will Me applicant or Occupant use equipment or devicts, which ran haardour air contaminants a defined by Me Bay Area Air Quality Managcmen, all new materials for inspection. District? t 0 Yes n w'wft.UE�� Signature of Applicant Date j "13 All roof coverings to be Class or better Do CITY OF CUPERTINO FURNACE/AC O PERMIT APPLICATION FORM 3/2-0022- APN # 3�� 3yaz Date: 3 Building Address: BREMFURN a0W11far v.� x MECHANICAL Owner's Name: -} Su�r� anAo'do`. Phone #: -+U3- T4�I - o Contra tor: Phone: a 4-1-2-W3 License #: 5228 Co tact: Phone: Cupertino Business License #: byCk17n -2 (D4'5 Building PtTtnit Info: BSEISMICRE Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: -Fwrl�csL Seismic Commercial ve EPERMITFEE Residential Commercial ❑ ELECTRICAL For Residential I t ations: ❑ ❑ Mech Permit Issuance Attic 15` floor2nd floor PPERMITFEE Adhere to min set back requirement ❑ PLUMBING or Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Bldg Permit Fees Structural Calculations required for new installation ❑ BPLANCHK New installation Planning Approval Required BUILDING Cost of Project: I q,()C53 Type of Const ion: _ Occu r Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: ❑ /6 New Location Replacement Qty. if A --l:! W - T: v. TTl Fer T1Psrrintinn Fee Groun BENERGY Energy BUILDING BREMFURN Relocation of 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 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 BUSLIC Business License BUILDING � 12 ,�/