03100156 CITY OF CUPER'I'INO ,
BUILDING DIVISION PERMIT iCONTRAC�TOR�INFORMATION s'*
BUILDING ADDRESS: A PERFECT CLIMATE PERMIT N003100156
OWNER'S NAME: 10570 S DEANZA BLVD PERMIT ISSUE DATE
SOMANI BASANT K AND PUSHPA 10/21/2003
NE' (408) 861-9545 SANITARY NO. CONTROL NO.
ARCHITEC IENGINCER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j00 LICENSED CONTRACTOR'S DECLARATION p IOb DaSCrI I10n
I hereby affirm that 1 am licensed took,previsions or Chapter 9(comen
mcing
with Section 7")of Division 3afthe Businessand Pefmanm Code.md my liken.is / r
?nn' imfall mreear`""it REPLACE FURNACE Q/
6 License Class Uc.«
F q Data Convector
ARCHITECTS DECLARATION J \
f i understand my plans shall be used an public records /
>yU O
T01 Licensed Professional \Vl
] ,g OWNER BUILDER DECLARATION
d i f I herebybeam .('firm Ilam 1 ore exempt from Nc Convenor's :License Law cu Ibe
5❑O which re fins a (Section t 703 o1.5,Business,aus, and Proldemoli Calc:Any city s roomy
$ which requires Issuance,permit re enoswn,alma improv,h permit t Fi repair any swment 14 0 0
-Ia thathe itsensedom requires theapplicantthrench e Contrctor'toFile aicense ned Law(Chapter
2�reto come licenudpunuool10 the 7")ofDiviomerrtheConwness ndPrulaw(Chopmr9 Sq. Ft. Floor Area Valuation
(commencing with Senion 70oo)of Division 3nf the Business and Profeuinm CsWe)or
`<$ That he ie exempt therefrom and Ne basis for the alleged exemption.Any violation of 3 6 6110 66 . 00
Section 7031.5 by any applicant for a penaluubjects the applicant to a civil penalty of APN Number Occupancy Type
not mart Nan fivo hundred dollars(SSfIOI.
K.m owner of the property,or my employees with wages u their sole cumpensnloa.
wi do Ne work.antl Ne swcmre is not intended or offered forsale(Sec.7044,Business
and Pefessions Code:The Contractor's Liceme law does not apply to an owner of Required Inspections
propany who builds or improves Nercon,and who deessuch work himself or through his
own employees,provided Nm such improvements arc not intended or offered for sale,if,
however,the building or Improvement ie mid within one year of completion,the owner.
builder will haw the burden of proving not he did not build of improve fur purpose of
rale.).
t co L a owner of ct Sec.7,am sachusivclyad contesting with licensed unimmutore to
contract the menet(gee.7044.Business and property
who Wilds
Code:)The Comfmmrs nd
come Law docs not apply je t,owner of proper(who builds of improvers thereon,and -
whoacu for such pmKcu with acantutor(s)licenutl pursuant to the Convectors
License
Law. -
❑I em exempt
�under
�Sam. ,B&P C for this recon
Owner 1, u
WSCOMPENSATIONDECLARA ON
1 hereby air:=under penally of perjury one of Ne following declarations:
73071,
ave and will pound.a CeniGene of Consent m self-insure for Worker'sCompen-
,m provided for by Section 3700 of on Lebo,Code,for Ne perfonnatce,of Ne
for which Of,permit is issued.
have and will maintain Worker's Compensation Insurance,u reyulmd by Section
f Ne labor Code,for the performance of de,work for which Nis permit is issued.
orkers Compensation Insurance carrier end Policy number are:
r. Polity Na.:
CERTIFICATE OF EKEM MON FROM WORKERS'
COMPENSATION INSURANCE
(Thu Auction need not W completed If the permit Is for one hundred dollars($I(10)
less)
1 cenify that in the performance of the work for which this permit is issued,1 shall not
employ any pecan in any manner an as to become subject to the Workers'Compcnsadon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,alter making this Cenirmau of Exemption,you should
become subject to Ne Worker's Compensation provisions of the ISMr Code,you must
z foMwi In comply with such provisions or His recruit helf be deemed revoked.
OCONSTRUCTION LENDING AGENCY
1 hereby AfErm Nal them its eomtmonito lending agency for the pe,reme .or
Y. �
be work for which this permit lsissukd(So..3097,Civ.C.)
Undoes Nano
2 z Lender's Address
Q 1 certify that 1 have read this application and sum that the above information is
y H coned.I agree to comply with all city and county entireness and sure laws relating to
�O building construction.and hereby authorim reprounmiws of this city to enter upon the
N G ah.vcmemioned property for inspection purposes.
(We)agree m save,indemnify and keep harmless the City of CuPcrlino against
-' N liabilities.judgmcou,costs and expenses which may in my way moose against said City
,z in comkgecum of the Stenting of this permit.
'-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S CGULATIONS.
— /a3 Re-roofs
gnnu of App canl/Contre rDue
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or ran.building occupant store or handle heotpWas metrial
A,defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
alk,skedear 2ssn2(a)?te All roofs shall be inspected prior to any roofing material being installed.
❑r
PWill the applicant of mart building occupant nso equipment or devices wblkA If a roof is installed without first obtaining an inspection,I agree to remove
it haiendous air committees As dI by the Bay Area Air Quality Management all new materials for inspection.
District?
C]Yes
I have read the hamdousmamdals requirements under Chap erb.95 of the Califor.
ria Health h Safety Code.Secdom25505,25533 and 25514.1 understand the if IM building
docs not currently ham a unmt,Not it is my reeponsihility to nndl'y the rccupmt of the
requirements which must W mel prior to issuance or a Cenlficaue of "ou"Y. Signature of Applicant Date
`o O�
owner atm .satin ant All roof coverings to be Class "B" or better -
_-� 0 / z
CITY OF CUPERTINO
FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN# Q ` Date: 1 Q
Building5 Address:
31D Oro (blas r
Owne 's Name: Pone
� 5'o�-n
Contractor: Phone: Lrcensi#:
PERrEcr Cl-I MA E
Contact: Phone: Cupertino Business License#:
I
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech
Job Description:
Residential Commercial ❑
For Re idential In ations:
Attic f 1St floor LJ 2"d floor❑
• Adhere to min setback re uirement❑
For Commercial Installations: /
Replacement same weight ❑ Additional weight (structuralEl calcs)
Structural Calculations required for new installation El
New installationflagning ApfflT9VO Required
Cost of Projec . le of nstruction. Occupancy group:
Strapped ❑ On Platform ❑ Bonded LJ Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. i
A li b \ 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 Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
• PPERMrrFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License —BUILDING