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03070006 g CITY OR CUPGR'fINOe4z '•i•. +•c _ `�"=a BUILDING DIVISION PERMIT 6CONTRAGrORaINFO.RMATION / FM4t�•�,x Ia`:snn'a3. �t>„ �$s:%�C9�+,; BUILDING ADDRESS: CHARVEZ CONSTRUCTION PERMIT N003070006 OWNER'S NAME: 360 W 8TH ST PERMIT ISSUE DATE ONE' (408) 893-7693 SANITARY NO. CONTROL NO. ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ±00 LICENSED CONTRon&,SDECLARATION Fp 1 hereby affirm Nat 1 am licensedd under provisions of Chapmr 9(commencing Job Description with Section 70g))nfDiv'irn Softhc Busi rind Procession,Code,and my license is Ll iN fall Tome @ot. FURNACE REPLACEMENT 1�'�rAn /A pm lG'Plt Lieen¢CI C r Date Corer O CHITECTS DE RATION p undcnland my plam.h.11 to d public record. JUL 1 O 2003 >yU 5pG Licensed Professional 3 OWNER-BUILDER DECLARATION <X I hereby affirm that I am exempt from the Contractors License Law for the BUILDING following reason.(section 7131.5.Business and Professions Cale:Any city or county $ which requires a permit w cnmlrun,aloe improve,demolish,or repair any.ructure -xi poor o its issuance.also roquims the applicant(orsuch permit to ties xipnednalemenl s that he is licensed pursuant to the provisionts of the Conumboora License Law(Chapter 9 Sq.Ft. Floor Area Valuation IN$ (commencing with Section 7")of Division 3 of the Business and Professions Code)or e ro3 that he is exempt therefrom and the basal for the alleged exemption.Any violation of 35715013 . 00 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 00th Number Occupancy T not more NanBvehundreddelta.(gane SCID. P Y YPe 1,as owner of the pmpeny,or my employees with wages as their sole compensation, will do the work,and the stsuclum is not Intended or offered for sale(Sec.7044,Business - - and Pmression.Code:The Contractors License law doe.not apply to an owner of 3 0 3 — ROUGH 4005 PORI who builds or improves Ihereon.and whodoessuch work himself or through his u own employees,provided that uch improsmenu are not n landed orortered formic,If., 304 — ROUGH ELECTRICAL however,the building or improvement is sold within one year o(completion,the owner. builder will haw the burden of proving that he did not Wild or improve for purpose or 505 - FINAL ELECTRICAL "th')' 507 - FINAL PLUMBING I,a.owner of the property,.Business exclusively contesting with licensed eonumlo.i. close a the es jet pply o an wneofand Profession.Cede:) prows then tort Li. 508 — FINAL MECHANICAL canoe Law does not je ts owner of property who bullas or improves themnat and whocontractsLacu for such projccu with a conuaclor(s)licensed pursuant loth Comnaoh License Law. ❑taro exempt under See. ,B&PC for this rtsson ' Owner Dau WORKER'S COMPENSATION DECLARATION I hereby aM.under POOR,of perjury ore of the(allowing declaratirm: I haw and will maintain a Certificate of Consent m self-maure for Worker's Compere sation,as provided for by Section 3701 of the Labor Cale,for the performance of the work for which this permit is issued. ❑1 haw and will maintain Workers Compensation Insurance,is requited by Section 3701 of Inc labor Code,for be,performance of t e work for which this permit is issued. CY WfrkeY�mpenn rJn grr'POI Cand Policy number are:Z2 � 0, CERTIFICATE—OF L•%EMPTION OM WORKERS' COMPENSATION INSURANCE (Thal scalar need mol be completed find permit is for..M1undreddollan(SIM) micas.) I cenify Nat in the perfroth.h a of the work for which this.it..issued.I shall not employ any penin in any manner an as to become subject to the Workers'Compensation Laws of California.Date Applicom NOTICE TO APPLICANT:If,after making his Certificate of Exemption,you should become subject to the Workers Compensation previsions or the LaWr Code.you most O forthwith comply with such provision.or his permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that Nem is a Construction lending agency for the Performance of W' M the work for which this permit is issued(Sec.3097,Civ.C.) LQ Q Under's Name = z Under,Address U Q 1 cenify that I have read this application and sou that the above information is fA P correct.1 agree to comply with all city and county ordinances and state laws releling to DU building convection,and hereby mthmire mPoesCoWbol of this city reenter upon the 0. ahovc(We). .property for inpeai an mcpha. (We)egme to save,indemnify mtl kith harmless the City accrue Cupcnst against o-1".Z incormes.Judgmenhecostsn expcauwhich may in any way eceroe against said City fJz in conseyuencc of the gamin his permit.PLICA UNDERST DS ND WILL COMPLY WITH ALL NON-P INT Issued by: DaaeZ��> .. 5 RC GULATIO /� g i i / °] Signaturcof Applic�antlCo for o—� Re-roofs HAZARDOUS MATERI S DISCLOSURE Type of Roof Will the applicant or future building Occupant.mre or handle hamodsous material az defined by the Cuonmen Municipal Code.Chapter 9.12,and the Health and Safety cWe.Saodrn 25532(,)7 All roofs shall be inspected prior to any roofing material being installed. T-1 Yes Will the applicml or future building accupaml use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove it horsraa7 nus air conuminanu u cfned by the Bay Area Air Quality Management all new materials for inspection. it ❑Yes ;;No 1 how mad the Wmrdousmaterials requirements under Chapter 6.95 of the Califer, nix Hotel,&Safety Code,Secdon25505,25533 and 25534.1 understand lhm if Um Wilding dors nof currently haw a that it is my responsibility In nodfy be ac pant of the to1. Ims ehmcst to @ormissuanceoLacerdfie focc.pm Signature of Applicant Date owner or armnrived sent Dau All roof coverings to be Class"B"or better CITY OF CUPERTINO J �„ FURNACE/AC 03 07 CUPERTINO PERMIT APPLICATION FORM APN# 2� J� r 6/}� Date Building Address: / /� ( / 1e) 2--Z--1- ©/TA nr G F AU A—r , Owner's Name: E7?f} Phone#: � �7vu,� �ry 9�' (M / i Contractor:sseP Phone: rLicense#: G ityt✓ �'� `yt &93-766 3 D (�o4 Contact: Phone: Cupertino Business License#: �!-f a-(1swt-�- 8!3-7&f 3 2- 361 ' Building Permit Info: ld Elect Plumb ❑ ech escription: Residential Er Commercial ❑ For ResidentialVack tions: Attic Ells` flo d floor❑ • Adhere to min serequirement❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation PlanningA roval Required Cost of P &--.% Type of Construction: Occupancy gro Strapped On Platfo Bonded 11 Sq.Ft. Floor Area: New Location ElRe lacemet Qty. if A li Fee ID Fee Description Fe Grou 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 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 CT 4 lam: