04070002 CITY OF CG
Bu1LDING Drv]SION PERMIT CONTRACTQI2INFORMATION„s:
BUILDING ADDRESS: PERMIT"04070002
040,70002
n142 Nr)RTwc-PP.CT go
OWNER'S NAME: PERMIT ISSUE DAM
LOUIS
lipONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
trap LICENSED CONTRACTOR'S DECLARATION -
I hereby affirm then(she licensed under previsions of Chapter 9(crown cncin, Job Description
im ith Sbcliouj7PW)of Division 3ofmc Business and f Mons Cade,and my licensors a
n< in full fes d offs 4 (�❑
i9Z DamnmClas Lim
imenar REPLACE FURNACE & ADD ASC
ARCHMMI'ECLA ON CONTRACTOR: HANK WOO JUL
I in dersund my plans shell be used a public Z 2004
3p Licensed ProTsional
OWNER-BUILDER DECLARATION � � ��OC
I 1 berehy affirm N4I I am exempt from the Contractors Licfinlo LeaM�f6i'tfie
0 O fallowing mann.(Section](81.5,Business and Prom u nal 05 :tArIY airy�pr ceumy
$ which rt9uiro•Pcmlitto cnnswct,eltec impmvn,demoBg{{hh allotny({wcwm
�y prior N its iauerec'.hu mquiro thcm;PI.m forsuchperm:It- Elc�iWOrA3WIc_ m
q that he is licensed pumuanuo the previslonsaf the Cmursdtors to-ctiseaM(Cheptcr9 1`Sq.Ft. Floor Area Valuaf ,ni 00
m
may $ (comencing with Section]0007 of Division 3 of the Business and Promotions Cook) r
at .rAA1` v
Nhe u exempt therefrom and the basis fur Ne alleged exemption.Any vielaliopf1 l.PoV
Section]031.5 by any applicantfw a permll subjects Ne applicator a civil pcnalt�ji ane Occu u
not mum Nan Bve hundred dollars(SSW). 11��0'mber ber p yType
❑1.as;owner of the property,or my employees with wags u their sole com0 „penm
will Pr lesion,ends:Them Mesoderm,is he's Lndcde Law ed dos Out e(S9C.WQ}{,�st a ���1L Required Inspections
and Professions Code:The Contractors LIttIIm Law does not apply-_cI'p lr�oYner -w.a(a ` q p
propertylowma,proerimprovesat hunpo.andwho thesauctradmuimxe or ll u t ,JM
41
awn emplMebuil building
orided prom ent is mmenuartne eartta{{Wqmfw�� "a
builder,illhaw the
rimproxement is al he
one year of firnriwtforN eof
builder will have the burden of proving Net he did not build or improv for purpose of
ale.).
❑1,u owner of the property,am exclusively contracting with licensed contractors to
coawcl the pmjee(Sec.7044,Business and Professions Code:)The Contractors U. .
cease Law does nut apply to an owner of property who Wilds or improves Nemon,and
who contracts for such projects with acommelor(s)licensed pursuant to IN Contractors
License Law.
I am exempt under Susm./.// B k PSC for
JNis�reason
Owner '�,i�li .g,. 99�Dam lye
WORKER'S OMPE O DECLARATION
I hereby afflmt under penalty of perjury ON of the following declarations:
1 have and will maintain aCordfems of Consent to sef-Insure for WerkersCompen-
aM.,u provided for by Section 3700 of the Labor Cade.for to pm ormaece of Ne
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as im vined by Section
37W of the Labor Codd,fol the performance of Ne work for which this permit is Issued.
My Workers Compensation Insurance carrier and Policy number am:
C Polity v
CERTIFlCATE OF IXEMPON MOM WORKERS'
COMPENSATION INSUNC
(Thlsacmion need not becompured irde,permit l root hundmddnllam(51007
or less.)
I ttnily NeI in Ne performance of IN ork for whmh this permit is issued.I Mal not
employ any person in yammer.agt Wm�l sybjttI to the Worlons'Compeaation
Lawsof Celifo
APPlicent
E TO APPLICAiffalt,a Ice making this Ccnificau of Exemption,you should
e subject to NC Worker's Cumpctuation previsions of IN Labor Come,you most
with comply with such provisions or this Permit Mall W deemed toted.
,zoO CONSTRUCTION LENDING AGENCY
work
which
MBthi Nat voted
innlcnding agencylarthc performance of
!Yi ► Ne work for which this permit Is issued(Sec.3097,Civ.C.)
�0 Landers
D Z Landers Addrem
U Q 1 certify that I have mad this application and slate that Me above information is
Ly f” correct.)agree to comply with all city and county ordinances and sum laws misting to
OV building construction.and hereby euthorim repramnutivm of this city to enter upon Me
aMve-mentioned property for inspection purposes.
F y (We)agree to save,indemnify and keep harmless the City of Cupertino against
cn Iiabilida.judgments,costs and expenses which may in any way accrue against mid City -
(, in consequence Orlin Stenting of this Permit,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 2�6& Date
SOURCE REGULATIONS.
dC Z,6 ", rmy Re-roofs
sig5oofd, iwnUCentnnor Dim —
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or fuum Wilding occupant atom rehandle hnanl mamrlal
m chfned by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
a,jMLCode,Section 25572(a)?
Yes All roofs shall be inspected prior to any roofing material being installed.
YJ�Ju
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil Iment.ua air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District? L
❑Yes l[]Nu
1 have mad the heardoa materials mquimmcnu under Chapter 6.95 of the Carter.
.is Health&Safety Cods,Sections 25505,25533 and 25534.1 understand that if Ne Wilding
mol eumcmly havea tenant,Nati u my mspatuibillly Its nndfy ow occupant of the
id, xwhichred,NmetPIn issuance old CortiRcate ell9trancy' Signature of Applicant Date
owner er set xe sen, , All roof coverings to be Class"B"or better
Community Development
9 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDR S: PE IT lb U b
b/ 1— h(o r,A-k\ ('reS'C 6&
OWNER'S N - La« S K;.w\. PHO s 2G
GENERAL CONTRACTOR: FAX
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork M ; T& r
Cement Finishing NX U
Electrical
Excavation ju . c i Cav
Fencing CITY 0I CUPE
Flooring: Carpeting BUlp_["KlC- DEPARTMENT
Linoleum/ Wood
Glass / Glazing
Heating a� `5 McG�taM-Ga
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
-- �
C /Contractor Signature Date
NORTHPOINT HOMEOWNERS ASSOCIATION
PROPERTY MODIFICATION NOTICE
Please indicate below which modification(s) are planned for 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.
Modification Restrictions and Reauirements
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
cdmmon areas. Installed by licensed contractor.
Replacement window/ Must be same siz '` �l�p y�
p pertu'3ie andllocat;q�ofiexisting
sliding door window or sliding a Any `Qgce'ssary tou f1!�]��j
painting is the responsibility oft�e I{otr��rner
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 I cati0 UU� v si in IAC les routed inside
size: attic, crawlspa �d�wa��l, nea tjte:di
to minimize vis�sii'''"111I11i C t er 5 1 8 ly.
Any damages caused to property as a result of mo i&f1i2 IQgJ will be the
homeowner's responsibility. All prohibitions, restrictions, con IttHYis, and rights
of the Association enumerated under Article V a o nerl stated
Covenants, Conditions and Restrictions of8 )it� owners
Association are applicable to modifications contained her'eii1: t may
be required.
Please print
Homeowner a
Name(s): ��� f/YJ
Property v 1� D C
Address: 001'4D
� t«�/ Phone: .
Date of Notification: �� 0 Date of Completion:_ 6ehl Lo 4 —
Homeowner has six months to complete the designated modifications and is responsible for notifying
management upon project completion.
—OMicial Use Only—
Notification Received by: Date:
Completion Verified &Approved by: Date:
FORM ADOPTED 8/10/1149 REVISED 5=
_�. CITY OF CUPERTINO o Z
FURNACE/AC
CM OF
PERMIT APPLICATION FORM
APN# 3 ) � _ 57 - O U 7 Date: }t„
Building Addres
)-014 )- yor cr A Q
Owner's Name: // Phone #:
K�vn
Contract Phone License#:
—Z3
Contact: Phen�' Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech
Job Description:p`
0
Residentia C mmercial ❑
For Residential Installations:
Attic ElI" floor 132nd floor El�•
dhere to min set back requirement Flor Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning A roval Required ❑
Cost t Type ofConstru& O
n ccupancy r�
Strap ed ❑ On Platform Bonded LJSq.Ft. Floor Area:
Ne Location ElReplacement ❑
Qt if
A li able Fee ID Fee Description Fee Group
BENERGY --Knergy BUILDING
LK BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfin MECHANICAL
BREMAIIZHAN 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