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05030259CITY OF CUPERTINO '�CONTRACTaRINFORMATION'.4 BUILDING DIVISION PERMIT Bu1LDINc noDRFss: 10222 NQR llQQ1.z2 SQ HUSSEY BROS INC PERMIT NO. 5030259 OWNER'S NAME: PERMIT ISSUE DATE ONE: SANITARY 0. OLNO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECN O O O O LICENSED CONTRACTOR'S DECLARATION Job Description o 1 hereby antro that 1 am le Ircenscd under provisions of Chapter 9 (commencing P with S«tion TBW)of Divlsion]of NC Busnusamm Icssions Cade.end mYlicenseu in full torte arta crt Licenxciaa -LV Lm.a REPLACE FURNAC$,&?ADD A/C Da¢ Contrxtor U ARCHITECTS DECLAR ION U V 1 unecraanJ my plans shell w trod as public mrorN Licensed Professional OWNER—BUILDER DECLARATION 1 hereby 1 frontthe Contractor's Liana Law for 'r s(Brn that mexempt ted following on. (Sae]RSC1. A Bnsinar and Code: Any city or moony reason. (Sudan improve, deriom which requires • permit ne nsuucl, altar improve, de or repair any awcwn, �\ Permit t poor b its issuance, also rrquima the applicant for such permit a file a signed natemenl pu Division of the Businesstar commepursuant lath) pro visions of ted Canuxar's Liansc Law(C Code) (commencingand Ca, n.rAny (cat xempth Sectionors, Sq. F[. Floor Area �/f, h - Val ua[lon �. r Nn th«e0om and r icd exemption. vi a he I, it the baso Ne allegedppinamto Any violation of u a . or Semon ]W l3 by sty, applicant fora permit subjects Ne applicanno a civil penalty of io 31.5 b it - 3 ]4 4Tjtj tg*er0 0 ✓ Occas ae T Occupancy Type P animate than Ras hundred dollen ($SW). ❑ Las owner of sir pmparty, «my wgu u compewness otinwnw orale (xk will Pr the work, and the awnum it n es Lnded or a w de s not a(Sec. ]011, wninw end Professions cede: The Conuersim License law does not apply lf rt owner of Required Inspections avv thereon, and who does such wart h r his property who wlidoor ed Own employees,provided t such impa ene offered sude. If. id withinYear fcorleeredrot owner - pr within one year or completion. pu owner - however. the building or ins of proving is dust Wilder will have th harem of proving rhos rte did n« wax or Improve for purynx or zg) o❑le.). I, as owner of property, exclusivelycontracting with licensed contractors, t��( arJn NC plaec, ($C. ]BC, BwnV and professions Code:) The eanlramb'a L - rf is cense Law does not apply in an owner of property who Wada or improves themen.and. who contracts f« such projects with a contracsor(,) licensed Formation to the Contractors ��O` License law. ❑ I am exempt under Sec. , B k P C for this mason QU Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under anally of perjury rue of the meowing declarations: I have and will maintain a Certificate of Consent to self -insure f«Worker's Compen- V u on. as provided for by Section S]W of the Iabor Code. r« ted pedomna«s of the rk for which this permit is issued. I have and will mainsin Wartrr'a Compensation Insurance, as rtyuired by Section Ic" W of the Laver Code. f« the pctformance of the work for which this permit is issued. y Workers Cn{"pensation Imuurarcce carrier and Polity umbo am: rtier.?f�a is;• 4rff ,a.• Polity CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu ae«mn need not memnid ed ifdo permit is for. hundmd dollars(SIM) or less.) I cenify that in use perforrnauc of the work for which this Permit's found. l shall net employ any person in my mentor sin u an become subject to dte Worker: Compensation laws or California. Data Applicmt NOTICE TO APPLICANT: Ir, after making Nu Certificate or Exemption, you should become subject to the Worker's Compensation provisions or Ne Labor Code, you in= forthwith comply with such provisions or this permit shall W deemed nwoked. CONSTRUCTION LENDING AGENCY 1 Wmby aRrm that Vert is a construction lending agency for ted performance or Ne work fur which Nu permit is issued (Sec. SWT, Co. C.) Lender's Name Lender: Addrtas I certify Nu I have read this application and stale Nat fee above information is Comm I agree to comply with all city and county ordinances and mute laws missing to Wilding construction. and hereby as«ire minescremn,t of this city to enter upon Ne above property, for inspection purports. (We) agree to eve, indemnify and keep harmless the City of Cupertino against jugmentioned may in eny way attroc against mid City inconsaxim eorthegrantandofpenuawhich or the granting of this Permit. APPLICANT PLIC NT AND WILL COMPLY WITH ALL NON -POINT Issued by: Dale SOURCE REGU OSTANDS -L�JAS Re - roofs Stgmnum of ApplranV murrcar tj Date HAZARDOUS MA ALS DISCLOSURE Type of Roof Will the, applicant or for= Wilding raupmi stem or handle hmardous material Mdefined by the Cupertino Municipal code. Chapter 9.11. and the Health and Safety code, Section 25532(a)? —1 Yes All roofs shall be inspected prior to any roofing material being installed. Will the apPlicent or fm a building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove g P g h harallous air contaminates as dented by Ng Bay Arca Air Quality Management imicR all new materials for inspection. ❑Yes__ I have read Ne hvaNtwsmaariau mxEumMc xunder Cbapwr6.95oftw Czlirm. 2 n A n -sea ldth Surety Code, Scetioae155B5,255I5 and 15551.1 undersand Nnifthe Wilding —0 docs not eurre pyvc a tenant Nat it u my napomi hility w many Nc axupmt or the J reyuirtmcnts ptl metprirraiaxan«rraccmifiatcaf7"-m�A J �Daate Signature of Applicant Date All roof coverings to be Class "B" or better Owner orauthorimAagent 4 CITY 0, �UPEI�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS:.LbZZ3 lvor-I h COV, $iRV4re - PERMIT #CEJ D 3 0 2_ '� OWNER'S NAME: n tr a PHONE # 9ve 2S -'i T7 GENERAL CONTRACTOR FAX # I am not using any subcontractors: $- - 29-0s Signature Date Please check applicable subcontractors and complete the followin¢ information: Owner/ Contractor S` iZp e '3-iL)-or Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Ca ' ets & Millwork Cement ' hing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood IY Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic T She etal (eet Rock tile Owner/ Contractor S` iZp e '3-iL)-or Date NORTHPOINT HOMEOWNERS ASSOCIATION PROPERTY MODIFICATION NOTICE Please indicate below which modification(s) are planned fof your property. Provide brochure(s), if possible, and copy of any proposal(s) including the contractor's license number. Any modification not expressly listed herein, or not conforming to the restrictions and requirements listed herein for that modification, will require an Architectural Review Application to be submitted to the Grounds and Architectural Committee and the Board of Directors for approval. MA Modification Restrictions and Reouirements Air-conditioning unit Unit will be designed for quiet residential use. Unit will be located within the enclosed yard of the property. There will be no parts of the unit visible to common areas. Installed by licensed contractor. Replacement window/ Must be same size aperture and location of existing sliding door window or sliding door. Any necessary touch-up painting is the responsibility of the homeowner. Installed by licensed contractor. Garage door Must be windowless and in conformity with general architectural style of the complex. Repainting to conform to exterior color scheme is responsibility of. the homeowner. Installed by licensed contractor. Satellite dish/receiver Specify type and size below and include sketch of intended location. Installation of dish in the least type: visible location to receive signal. Cables routed inside size: attic, crawlspace, or wall near the dish mounting to minimize visibility. Other guidelines may apply. Any damages caused to property as a result of modifications will be the homeowner's responsibility. All prohibitions, restrictions, conditions, and rights of the Association enumerated under Article V of the Amended and Restated Covenants, Conditions and Restrictions of the Northpoint Homeowners Association are applicable to modifications contained herein. City permits may be required. P/ease prior Homeowner Name(s):_ i Z�b C2I C/.-, M/f Property Address: 0OA.73 N027't/C6 JL S(S Phone: Y08 - ;1-5-7 - /7�S Date of Notification: „J — / /—c�S' Date of Completion: Homeowner has six months to complete the designated modifications and is responsible for notifying management upon project completion. --official Use OO Notification Received by: n./ Completion Verified & Approved FORM ADOPTED 9/10/1999 REMED 5/00 MAR 2 9 2005 r.r. ---------------- Date: Q 1 Date: CITY OF UPERTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM O , 3oZS� APN #Date: 316 w D Energy BUILDING Building Address: -0�.�--� No�(� Cove S�vgrt Relocation of Furnace Owner's Name: BREMACOVER Phone MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm Contractor:'`�� $ Phone4 F-7 —4360 t 1 BREMRECEPT License #: f'o%SAGS' Contact: I Phone:: Nix BSEISMICRE Cupertino Business License #: .Sttvc BSEISMICOM Seismic Commercial Building Permit Info: EPERMITFEE Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: Mech Permit Issuance MECHANICAL PPERMITFEE Residential- Commercial ❑ PLUMBING For Residential Installations: ❑ s` ❑ Bldg Permit Fees ttic 1 floor 2nd floor BPLANCHK dhere to min set back requirement ❑ BUILDING or Commercial Installations: Business License Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project Type of Construction: Occupancy group: DOD/ Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if Avvlicable Fee ID Fee Descrivtion Fee GrouD BENERGY Energy BUILDING BRENU URN 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 ,q///J'"(7 4,