04120007 CITY OF CUPERTINO p s�mf� p�a,�♦ ft' �a`" _
BUILDING DIVISION PERMIT iCO��'i`g XC.TQ14�aIt1.L'O,R�iYlATIO 5
B IDINGADDRESs: ABC COOLING & HEATING PERMIT"D04120007
7564 ORANGE BLOSSOM DE
OWNER'S NAME: PERMIT ISSUE DATE
VIRGNIA BIGGS 31845 HAYMAN ST. 12 /ni /2no4
ONE: SANITARY NO. CONTROL N0.
(510) 471-8181
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+0, LICENSED CONTRACTOR'S DECLARATION
u 1 hereby af0rm Nal 1 em licensed under provisions Of ChapLcr 9(commencing Job Description
wish Section 7)[Kh of that 3 of IM Business and Professions Credo.and my license is
o. in fullfomeamMefaa Z FURNACE REPLACEMENT .
S ? License C ss Lic.N
n� Dau Contractor
ARCHITECTDECLADON
RATf N
undersand my plans shall M used as public
6
G Licensed Professional
affix
3 OWNER-BUILDER DECLARATION
0 Z T greeny affirm that 11. exempt Imre the Contractor's t:Any c Law for the Q
O O following neon..(Suction]coon. Bvaine,, and Ro,d.. I Code:Any city or county
100
$ whim¢.quires•pmmit rte cmtsuuet, plic impmw,h pormil t fi repair any nmmum
I-¢a priormiuissuaap pursuant
require thprovisions of she for suchpmmiuo Eleaei Law
04io thmn.co rig inauruanuM).( 3ofIm minsurslittnritant (Charon Sq.F[. F1oorArea Valuation
m s-$ (commencing wiLoSuvan,MdtheDasis.3.mNeeged eempton.A.innsC Of
r3_ Nn he u exempt therefrom,and the naso far b alleged armada..Any violation of
Section 7D3LB by airy red d.lb for a permit ubjeeu the applicant to•civil penalty of Occupancy Type
not more Warr Rm harrama rolls.($som. � er0 0 P Y YP
01,mownerofthepmpeny,mmyemployeewishwageufte wiecompmdon,
will do Locwons Code:
she Coeunotinvadedecawro rose
nota(Sec.]Oan,mrar of
Md Pmfwsibra Code:The Convector's Lin"•Law aces not apply lf an owner is Required Inspections
propcnywhob,provided ftteshtruprendwho decacnimwork himselfolWr ugh his
ownem.WeWiprovidedtharwmimprowmwitartnot arof cmlefiod for soler,
builder We Wilding eimprommennissoldedidnoneyd ofimrowfrNeowner-
buildcr will nave the Horden of pressing Nvl he did gar build or impraw for purpose of
Q I.as Owner of the propcny,am exclusively contracting with licensed convectors to
consmxt the pmject(Sec.]Oda,Business and Professions Cotler)The Contractors U_-
cense Law dans not apply m an owms of pmpeny who builds or improms themon,and '
who contracts for such projects with a contractor(s)licensed pursuant to the Convector's
License law.
Q 1 am exempt under Sec. B&P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pcalry of perjury,ane of the following declarations:
Q t Mm and will meinuin a Cenificaa of CorssenuO ulGinsum for Wartrr'sCompen-
sarion,as provided for by Section 3700 of the Labor Coal,for We performance of the
w h for which this permit is issued. -
a mond will maintain Wortr/s Compensation Insurance,as required by Section
3 W of she Labor Code,for the performance of the work for which this permit is issued.
My Worker',Comppeennsation Insu ace carrier and Policy number am:
Carrier. 'S r N(Awr.pL� Policy No.: 4 L 1415 1014
'
' R IFlCATE OF EXEMPTION FltOM WORKERS'
COMPENSATION INSURANCE
or less.)(This section need not be completed if the permit is for one hundred duties(Slip)
1 cenify that in Loc performance of the work for which this pmmit is issued,l shall not -
employ any person in any manwr u a In become subject In the Workers'Compensation
Laws of California.Data
Applicant
NOME TO APPLICANT:If,after making this Cenificate of Exemption,you should
become subject In due Worker's Compensation pmvisions of she Labor CMc,you muse
.J z foMwlth comply with such provisims w Nie permit shall he dccmcd mwkcd.
rz O CONSTRUCTION LENDING AGENCY
�--� Thereby afirm Nat there is a mnsvucrio.4ndinga1cay for the perfur .of
Ca the work for which this permit is issued(See.3097,Civ.C.)
QLender's Name
w1- z0. LowlerS Add.
V C) 1 certify that 1 ham mad this application and sura that the,hove infmmniun is
ga,t" COMM I agree to comply with all city and county ordinances and sum laws relating in
0 U .sending construction.and hereby authodmmpmsenatims of this city in enter upon Ru
CT7� ahow-mentioned pmprny for inspection purposes'gy (WC)egmt,to san,indemnify and keep harmless the City of Cupertino against
h Ilabiliti judgmen0.mmu,and aNnaaa which may in any way Mr W,against said City
t.3 z in cOdsopM ce of Lou granting of this fermi.
r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH AVL) -POINT Issued by: D-
ate
! g�° Re-roofs
Signature of Appinc. 'Ono.' Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will IM Mplicam or fulum building decupanrsms or handle hvudom mouniei -
u tlefood by du Cupertino Municipal Code.Chapter 9.12,and the Braids and Safety
ade.sectiet 2255324)?E2 Yes
194_ All roofs shall be inspected prior to any roofing material being installed.
Will she applicant or future building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
code
haardnos air contaminants as dcfncd by the Bay Area Air Quality Management all new materials for inspection.
District?
Q Yes
1 have read the hmardous materials requimmcnu under Chapter 6.95 of the Cutter-
niaHealth&SafctyCatic,Saud.s2M5.25533and253d.IuMcnstvWlhatifdr Wilding
dw nor curtcntly haw a anen4 Nal it u my meponsihility m notily the atop of the
mgaimm chmusl upriorwissu cofaCcmficauafGr4u a Signa[ureofApplican[ Date
l i°
Owner or aushamed aFcnt Data All roof coverings to be Class"B"or better
Ilea 01 04 10: SBa RBC COOLING & HEATING 5104718368 P. 1
11/3@/2004 22:57 5205383282 LEGALITIES 1W PAGE 01
Commuairy D"elopmem
Cj/a—)S3V-3 7-S 2 10300 Tone AV=,
Cupertino CA 95014
TelepLooc(408)7773228
FAX(408)777-3333
CUPEkTINO
BuilEn& Department
JOB ADDRESS: PERMIT N o q / Z o O�
75-44 it w..
Y OWNER'S NAME: .4/t PHONE f1 5 3 —/9-3
x GENERAL CONTRFAX N
A i am not using any subcontractors: y—
Si Date
Piease check a iicalile subcontractors and com to the followin information:
SLBCON`FRACTOR BUSIN SS NAME BUSINESS LICENSE #
Cabinets,&2�IIAwork j
Cement Finishing
Electrical
Excavation '
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/Glazing
. Heating .
Insulation
Landscaping
— Latllirtg
Masonry
Ornamental'Sheet Metal
Painting/ Wallpaper
Paving _
Plastering
Plumbing .
Roofing --
Septic Tank
Sheet Metal:
Sheet Rock .
v
Gwaei</Con rlSignature Date
i
I
CITY OF CUPERTINO
J FURNACE/AC
= CUPEkTINO PERMIT APPLICATION FORM
APN 13 g // Q /� Date: Z21 /
Building Address: (� � '/
?S 6ef 0" eL.,
Owner'sName: Phone#:
DLS3 - / 93
Contracto j: Phone: License#:
Contact: Phone: J C Cupertino Business License#:
a�rw��
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech
Job Description:
Residential Commercial ❑
For Residential Installations:
• Attic ❑ 1s` floor ❑ 2nd floor❑
Adhere to min set back requirement[-]
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural-Calculations required for new installation ❑
Newinstallation PlanningApproval Required ❑
/Cost of Project: Type of Construction: Occupan group:
�2QGt� • �" -,
Strapped ❑ On Platform ❑ �q( Bonded- Sq.Ft. loor q_
New Location ❑ Replacement Y"
Qty. if
A licable Fee ID Fee Descri tion Fee Group
1 BENERGY Energy BUILDING
1 BREMFURN Relocation of Furnace MECHANICAL
BREMACOVERA/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
EPERMITF'EE Elec Permit Issuance ELECTRICAL
MPERMI TEE Mech Permit Issuance MECHANICAL
/ PPERMITFEE Plumbing Permit Issue PLUMBING
-BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING