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05110071
wJ� z. G W U i U4. E<E 0 C UU G � CITY OF CUPERTINO MkCOi'TRA�'QIt INFURMATIp., BUILDING DIVISION PERMIT , re rq J{xA ,c w� dsiga,r dr!�,�ue��irxlg ^r n Y BUILDING ADDRESS: GOSAL HEATING&AIR CONDITI NTTIUp°'05110071 10900 NORTHSKY S OWNER'S NAME: PERMIT ISSUE DATE GREG KRODEL 2679 CHERRY BLOSSOM NE: SANITARY NO. CONTROL NO. (510)441-2318 ARCHItEC (ENGINEER:BUILDING PERMIT INFO -BLDG ELECT PLUMB MECH j LICp lob DCsC17 (Ion am thatEDCONnRd underBDECems or CON 1 Mreby shim Wl l 3 ftheud under provisimts of Chapter 9 (commencing is with S,dun ndgcel. on 3ofWBusiness and Profrsdaro CAN,Andmylicensem nrmiforeeand arcea r� �l-,��`� / REPLACE FURNACE (�] p(Y/1(fr ,{/� f(g Lic9. Clue Dtto Contractor +Q DECLAR , �/�/ i undervand my plans shill �S An pubilc E ren �Y o1 /rte 1005 Licenced Professumal S OWNER -BUILDER DECLARATION /II4YJ)dr ,,},yyyj �irLs, 1 hereby .tiler that 1 A.1. exempt from the res mamars e: My taw for W > ng mama, lebdm 7ommu Budnbs and Professions Calc: My city Of munre #1 #^ whubt m uinmacL apes. men. en which roquirb a sir say structureeat, Y $1700 permit ntprow, h permit e At ,l ceased e. er c a mquirn@eimmonl forsuch t LBbmI.A.(Chapter9 Sq. Ft. Floor Area 'ion be 1,prior put WofDisiamofWConuueKamiProelakeCode)w (commolkeroW Scedon7 3 (commemint's'Ith Serino 7000), Division7ofW ButmeuW Prafessiau Caic)or Wt ha is exanpr therefrom and the bald for the alleged nemPLIM MY violation of r Occupancy Type Sad, 7031.5 by AM Applicants for • permit subjecta W Applicant to n dvil Penslly of Ads mart thin R. hundred dollars (SM ' ❑ L u swim of W property, ormy emplayeb with warn a bemseemmpewdon, Required Inspections p wiemthework,mdlhes ismtimmndedwanemdfarulc(SM.7044,Busircu and Ptaresslons Cale:: Mw Contractors Liam, Law (10411 ret apply 0 m owner of q _ property who bupdsorimprowa lhaco,md wbodouaahwurk Mmadfor Waugh her owaemplay on. provided that each Improwroentt ate not Intendnd aoffered renal, If. howaw x, the building or Impmwmmt is sold withinaac Year of aompkdan. W awner- boildes will now W b rden of proving that he did ret bdto or Improw for purpose of ale.)• (J I, As cams of the property. stn esd"Wly contracting with Band mavaMrs to construct W project (Sec. 7044. Business and Professions Cade:) The Cac MOusel Li- cense Law does not Appy to an owner of propenyv1s, Indian w impmwn thman. and. who contraca for such projects with a contracuu(A licensed personal to the OnWAC ars Lk: num Law. [Il nm amp, order See. ,B d PC for this moon Owner Due WORKERS COMPENSATION DECLARATION I bereby Affirm under penalty of Perjury sae of the fallowing declaadats: I ham and will memah, aeeronato or ewsem An self-bsum for Workers Compen- aaWn, u provided for by Satan 3700 of the Labor Cad, fee the perfamuum of the work for which Nis permit is issued. ❑ 1 haw and will mdoxam Workers Compensation Innis ana, As required by Section 3700 of the labor Cale, for Ne performance of the work for which thin permit is leaned. . My Workers CompensationvnIInssurm^m wartier and Policy numb, w� Z Cartier. 3///'rG !IM -'K Policy No.: CERTIFICATEOFEXEMPItONFROM WO ERS' COMPENSATION INSURANCE (7htssoctiar need Out hecompteted Ifft permit Isfmonc hundred donan ($100) or leu) I aAry that in W pufammee of W work for which this permit is imbed, l shall nm employ any person in any mamerso as to become subject to the WorkmA Compensadan Laws of Califami, Data Applicant NOTICE TO APPLICANT: IL emr making this Certificate of Exemption, you should became subject b the Workmen Compensation provisions of W Labor Code, you mut raMwith.amply with such provisions or this permit shill bo domed nrvoked. J CONSI'RUCr10N LENDING AGENCY I hereby Arm that them Is a construction lending agency for W Performance of the work for which this permit is issued (Sec. 3097, Or. C.) Lenders Name Lenders Address 1 cenKy that I Mw read Wer application and sum the W show infomudun is comet. I apo to comply with all city sod county ordinsneer and sue lawn realiog In building construction, and hereby authority rep omonudws of this city to entorupon W fen inspection U sbow-mendamd property purport, (Wo) Agra to saw, indemnify ad keep hamlets W City of Cupertino aPinst liabilities. judgments, core and expenses which may in my way amue qmM aid City it in consequence of the gandng of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT //J�/�_O Issued by: Date // Jr" SOURCE REGULATIONS. �. ...... �,/( //�/12ti Re -roofs 1* of Roof Signature of Applianu Camaxor Date HAZARDOUS MATERIALS DISCLOSURE Will W Appllant of future banding occupant nom or handle hazardous mamrW As defined by W Cupertino Municipal Cada. Chapter 9.12. and W Health and SectY otic, So=on sss7x(a)?t +.All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove WIII W Applicanfuturt building Occupier men, equlpmml or devim Mich m emir ho Mous air camuninanu u eicReed by W Bay Area Nr Quality Mmagcmcat all new materials for inspection. Disuin? Cl Yes Qi10 I haw d W mahandless maerials rtqulrenents under Chapter 6.95 often CAlifor- nia Health ! SectyCad, Sadw 255W.73577 And 25574. l uMmund low if W building dab ret currently haw a genus Chad It is my nespomlMlhy b notify W occupant of W nai ma which mem be mat pd�°�mwme ora cadnam afaapancy. Signature of Applicant Date � ///ADam All roof coverings to be Class "B" or better Owner or mthodred agent ' CITY 0, �UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: 16 lyO PE O�//DO OWNER'S NAME: PHONE # ,�-1G — V/ GENERAL CONTRACTOR: FAX # As I am not using any subcontractors: Signature Date Plaaca rhPrk annlirable subcnntractnrs and complete the followine information: Owner/ Contractor Signature SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing j Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature 17 SCITY OF CUPERTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM APN # 3%1 yo 0-9' y Date: /1/15— Building Address: 16 BREMFURN Owner's Name: Phone #: %39 30S % BREMACOVER A/C Unit > 10,000 cfm Contractor: �~4 4%/L. �� _ License #: ,,e L100cJ1 Contact: o S�1 L Cupertino Business License #: BREMRECEPT S—u z z Building Permit Info: BSEISMICRE Bldg ❑. Elect © Plumb ❑ Mech E7 Job Description: Elec Permit Issuance oeA114&F .4� 4E noT 16,oaadff7zv, e C^ --a Residential ® Commercial ❑ Mech Permit Issuance For Residential Inst Ilations: /� ❑ & El 6L % PPERMITFEE Attic ls` floor 2nd floor L7 i4,, q PLUMBING Adhere to min set back requirement ❑ Bldg Permit Fees For Commercial Installations: BPLANCHK Replacement same weight ❑ Additional weight (structural calcs) ❑ BUILDING Structural Calculations required for new installation ❑ BUSLIC New installation Planning Approval Required ❑ BUILDING Cost of Project: Type of Construction: Occupancy group: 51117'e Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement 14 Qty. if Applicable Fee ID Fee Description Fee Grouo 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 License BUILDING