05090153 CITY OF CUPERTINO £ r ` f_._, 11 ' ?i
BUILDING DIVISION PERMIT kCONTRACTOR INEORMATION�q
BOLDING ADDRESS: VALLEY HEATING & COOLING PERMIT No 05090153
a2638 OAKCRES
W NER'S NAME: PERMIT ISSUE DATE
MERVIN KATO 1171 N 4 TH ST 09/22/2005
ONE: SANITARY NO. CONTROL NO.
(408) 294-6290
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
°00 LICENSED CONTRACTOR'S DECLARATION O O O O
I U b C affirm N
I hemby at I am licensed under provisions or Chapter 9(commencing Job Description )
iq? with Sccuon lIXlU)of Division Sof NC BusilmArand 0vic,aMmylic is (y s
in full fade and cfre f REPLACE FURANCE/WATER HEATIER i rs Ik1�W
a«Case Cl 7—ZO -�_ of—
��o Dau r Contmcmr ADD A/C rT
sy
ARCHITECTS W use OECLA nON O{.rIC
rc [understand my platy shall W used as public records I 2005
JyU
g�tl Licensed Professional
5 OWNER-BUILDER DECLARATION [[[jjj (7 tf a II W
.�0 0 1 Wrcby.(Sure Nati 1. exempt from IW C Professions
:Any c Law for the \ y
p D following moon.(Suction TW L5,Business and Rofcssions Code:Any oily or county
i m which requires a permit to construct,slue improv,demolish.Car repair any nrucmm Imo✓ [J
LZi prior to its issuance.also mquims the applicant for such pertniuo file a signed su¢ment 1
< thatbe pure
carol licensed puranto ft provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valu ibA44
%1- (commencing with section 7000)of Division 3 of ted Businrss and Profusions Code)or
It
$ that he is exempt therefrom and the buss for tie alleged exemption.Any violation of
Section 7031.5 by say applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom thin fiinhundmadollars(5500). 34248004 . 00 p y YP
❑1,as Owner of the property.Or my employees with wages as their sole compenution,
will do the.,it.and the swctum is not 5ntended or offered(.,.cele(sec.?061,Business
and Professions Code:The Conuxcm's License law docs not apply on an owner or Required Inspections
property who builds or improves Ncman,and who docs such work himself or thmugh his
own employees,provided thauuch improwmenu arc not intended oroffemd for was.If.
however.the building or improvement is sold within We year of cempleuon,Ne.,-
builder will love the burden of proving that w did not build or improve for purpose of
sale.).
❑1,as owner of Ne property,am exclusively contracting with licensed contraction to
contrast the project(Sec.704a,Business and Professions Code:)The Contractors Li'
cense law dors not apply on an owner of property who Wilds or improves thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
O l am exempt under Sec ,B&P C for this mason
weer Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury,am of de following declarations:
1 haw and will maintain a CertlfnCam ofConxnt an xIf-insum fetWorkefsCompcn-
Union,as provided for by section 3700 of the labor Code,for the performance of the
wort for which this permit is issued.
❑1 have and will maintain Waiter's Compensation Insurance,as required by Scction
371W of the Labor Codc,for Ne performance of the wort for which this permit is issued. '
My Wollme pemauon Inv a Cartier and Policy
Cartier. Policy No.:L
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not becompleud if rte permit is furore hundred dollars($IW)
or less.)
1 cenifv that in the performance of the wort for which this permit is issued.L shall not
employ any person in any mamurw u m become wbjwt to ted Wurkars'Compensation
laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making Nis Certificate of asempdon,you should
become subject to the Workers Compenxuon provisions of the labor Code,you must
.J z forthwith comply with inch provisions Or this permit shall W deemed rewkcd.
z O CONSTRUCTION LENDING AGENCY
[-+ 1herebyaf naOut thereatt,mawmjor.emingagmuyfor thepeffurme.cor
lli du woh fm which this permit u issued(Sec.3097,Civ,C.)
CUndies Name
z Lenders Address
U Q I certify Nat I have read this application and suss that the shove information is
ii.,F correct-I ague to comply with all city and county ordinances and alae laws misting to
OU Wilding construction,and hereby wNorim repreaematives of this city to enter upon ma
above-mentioned property(an iexpe expenses
portents.
H a (We)agree to ow,indemnify and keep harmless the City of Cupertino against
.-s h Iiacmacquetec of the
ex ponsas which may in any way accrue against said City
fJz Aconsequence Of Nr granting Or this perm it.
r SOURCANT RSTANOS AN ILL COMPLY WITH ALL NON-POINT Issued by: Dater—"Z�--rte F.
Re-roofs J�
Sig ore can ontractor Oat L
AZARDOUS MATERIALS DISCLOSURE' Type Of ROOF
til the pliant mfmure Wilding oceupantsmmmlundk hvardous material
as do red by Ne Cupertino Municipal Code,Chapter 9.13,and be Health and Safely
ode.section 25533(x)?
❑Yes All roofs shall be inspected prior to any roofing material being installed.
Will thea hcmt or mt9m Wi If a roof is installed without first obtaining an inspection,I agree to remove
pp g occupant tax equipment or devices which g P
Di it Ire ardrus air conmminanu u der nn by tW Bay Area Air Quality Management all new materials for inspection.
E)Yes
I have mad the harasdrmsmaterialsrequirements under Chapter6.95 of the Cabror-
niaHealth&SamlyCede,Sccuons MY)5,35533 and 35534.1 understand that iflW Wilding
does.not currently have a-Urn.that it u my responsibility m nuul'y thm e uc<upaof Nc
uyucrecnts wit awe on cen;fie,ueraapamy. Signature of Applicant Date
.sorer utheR dagent Dam All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
F/ Cupertino CA 95014
Telephone(408)777-3228
CITY 0,� Fax(408)777-3333 UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
OWNER'S NAME: a IPHONE #
GENERAL CONTRACTOR I FAX #
I am not using any subcontractors: ..2,2 OS-
ignature Date
Please check applicable subcontract sd com Tete the following information:
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
Tile
2Z
Mer/Contractor Signature Date
CITY OF CUPERTINO Sz /J -3
FURNACE/AC
olvol
CUPERTINO PERMIT APPLICATION FORM
APN# G/) Dat
Building Address: OC
��-f�s Lx1JtC
Owner's Name: 5(�
Contractor: �\ License #:
\\ o_&_K<DL V
-TQontact: Cupertino Business License #: Iz�
�S�1 R&Q_ t YZ
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech
Job D scription:
11Ct rYv -1k-Lan�incrc. t �a
Residential Comfuercial ❑
For Residential Installations:
Attic ❑ Is` floor ❑ 2"d floor ❑
Adhere to min set back requirement❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required
Cost of project: Type of Construction: Occupancy group:
44 �
C
Strapped On Platform Bonded Sq.Ft. Floor Area:
New Location ❑ Replacement El
Qty. if
Applicable Fee ID Fee Description Fee Group
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
EPERMITFEE Flee 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
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