Loading...
04040050 CITY OF CUPERT[NO BUILDING DIVISION PERMIT CON7'Y2A.CTOYi� l�t�UtMATION .BUILDING ADDRESS: A & H HEATING PERMIT No.04040050 ' PERMIT ISSUE DATE OWNER'S NAME: PAT SANITARY OL NO. ONE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0,�g0� 0 0 .�o O LICENSED CONTRACTOR'S DECLARATION Job DescriFIN Ay�l�k LS 1 hereby affirm Ibut 1 am Im mead under provisions of Chapter 9(commencing rr--n e» with Section 70110)of Division 3 of the Business attd Pmfammor Cads,and my Iiccnse is I.fallCi an`effa ec C.»� ADD A/C APR ]3. 2004 qq? Lima An L'J ppGp Dem Cunueclor 9H ARCHITECTS DECLARAGO s I uMusund my plans Ntll be used as public mmrth BU'LE)ING 3 u In Licensed professional OWNER-BUILDER DECLARATION I 1 hereby affirm that I am exempt from the Contractors License Law for the eT_a O following mmon.(Section 71013,Business and Pmfcsaium Cade:Any city or county $ which retodrm a parmit m conswn,alar,intPmw,demolish,m""'any atmelure t• Priormiuissuancc.alwt�uiredmeAppliantto,suchPcrmivafle.ftnedsumment Sq.Ft.Floor Area Valuate gjQ thntha is licensed punuantto the pmvisiomofthe Contncmrs License Law(Chapmr9 gzC (commencing wire Sen1on7000)of Division 3 of the Busirtess and Professiam Cade)ar 3$ ren he is acmpt me¢!an sod the buts far the alleged momption.Any viola0oo or �., k, Section 7031.5 by any eppllunl for a Permit subjects the apPlicanl to a Civil penally of 3 AID7,5 Y NaikeT o o Occupancy Type not more man Bw hundred dollars(SSW). I,nawmsofthepropeny,mmyemploycawioma mmeusolecompenadon, will do the wart,and me structure Is notinended or offered fonaie(Sec.70th,Business Required Inspections and Pmfew ous Code:The Conuano's License Law docs not apply to an owner of propany who buil&as im sowaIherean,andwho damouch work himselfrethrough his Own employees.pmvided that such impmwm VA artmaimanded re offered for sale.If. howewA the building or improvement is cold within one year of completion,the Owner. Witter wIII hew me burden of proving mat he did not build or improve far Purpose of sale.). ❑1.as net of the progeny.am exclusively contracting with licensed contestants to construct the project(Sec.701.Business and Professions Cade)The Contractor's Li- cense Law dose not apply m an owner of pmpeny who buil&or impmw dsreon.and. who convects for such projects with a comraner(s)licensed pursuant to the GOnRaeto's License Law. Iatnmentptunder See ,BAPCforthisresson Owner Data WORKER'S COMPENSATION DECLARATION r� 1 hereby inn under penalty of Perjury arc of me fallowing dalendam: `/ I haw and will nuuminn CcNBcamof Cament to self-inaunforWorkersCompun- .1 n,As provided for by Section 3700 of the labor Cade.far de performance of the were for which this permit is issued. QThaw and will mainmin Want's Compensation Insurance,as required by Section 3700 of me labor Cade,for the performatee of de work fm which this Permit is issued. My Wencees Compensation brommuree artier and Polley num;r sec: 7—�7 Cartier. , Ll Policy No.:N Qf1ILf1 CERrIP1'CA OFEKEMPIION PROM WORKERS' COMPENSATION INSURANCE (This section need not Wcompleed If the Permit is forone hundred dollars($100) at leas) I cent(,met in the performance of the work far which this permit Is issued,I shall nut employ any person in any manncrso as In become subject to the Wofkori CompensatlOn Laws of California.Dam Applicant NOTICE TO APPLICANT.IL after making this Cenificam of Exemption,you should become subject in me Worker's Compensation Pmviuons of the Labor Code,you must Z forthwith comply with such Pravisimm or this Permit shall be deemed roosted. .Zi O CONSTRUCTION LENDING AGENCY F.. 1 hereby affirm mal mem is a comtroctinn lending agency far the Perform uce Of C the work for which this Permit Is issued(Sec.3077.Civ.C.) W A Lender's Nsme IL Lcndcr's Addmm V0 1 anify that I haw mad this application AM slate mat the abow ittom"A siun in uL4 f" correct,I agree to comply with all city and county a dinamm and sale laws rtmting in p V building construction,and.Inde aumand representatives a this OfCuPy to nmrupnnde W shove-mentioned property for inspection purposes (We)ju agree m ww,indemnify and hap harmless w City mCupenst Against req Ilabllidu,Judgments,coals and expenses which they in any way accrue against void City U inconsequence ofthegrantingafthispermia Date ^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. ^ � �✓(�I `�b� Re-roofs Signuu of ApplicmVCantraclor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will me applicant or future building occupant stare or handle haaardom mate&1 u defined by tis Cupertino Municipal Cade,Chapter 9.11,and the Health and Safety We,Section 35532(a)7 t3 All roofs shall be inspected prior to any roofing material being installed. Ya If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which mil hazardous air contaminants As dc0ncd by the Bey Arca An Quality Management all new materials for inspection. Diurict7 ❑Yes aM� 1 have me,me".Mom mm:rials on aimmem s under Chapter 6.95 of me Califn> Cita Hwim k Safety Cade,Sections 25505,25533 and 73534.1 undersu al that ifine building does Inst currently haw a meant mal II le my reaparric4ty m notify me occupant Of the requ' mcnmwhic r. I aanaafaccrermmofaaparmy. Signature of Applicant Date yz= s"m Ly—g All roof coverings to be Class"B"or better ruror e Owneauthord agent —� Dam Community Development a 10300 Torre Avenue � Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building Department JOB ADDREi:� © PERMIT # (�� FX{ OWNER'S N A_ L_ PHONE # GENERAL CONTRACTOR: FAX # Z 7 5 lew 7 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followinginformation: 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 1 jCon gnature Date CITY OF CUPERTINO FURNACE /AC is CUPEkl-INO PERMIT APPLICATION FORM ;VPN � _ 5_0 L( --� Building Address: Owner's Name: Phone #: PAIL , _ Sb+ - fvolo Contractor: 1" License #3o '71. Contact: (� _ 5 ,�R EF Phone #:.17f—o? � - �- Applicant/Contractor: al Building Pei nut Info: BId � � Plumb Job Description: 4j(j_ +015—�� ._ Residential: _ Commerciat: Sq.Ft. Floor Area: $/Sq.FL.: Architect Engineer: Vuluatiot Type of Constntctiun: Occupancy Cnp: _ — r�-— Qt f A t .. bic Fee 1D Fee Description Fee Grog BENERGY 11 14Y BUILIDNG BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfm MSCI IANICAI, _ BREMAIRFIAN A/C Units <= 10, 000 cin MECHANICAL BREMRECEPT Recptt, Switch & Outlets _ ELECTRICAL. _I BSEISMICRE Seismic Fee Res BUILIDNG LL /� EPERMmCFEE Elec Permit Issuance ELECTRICAL CD MPERMTFFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue _ PLUMBING BPERMFEE Bldg Permit Fees BULLID\G _ B—PLA NCHK Plan Check Fee BUILIDNG —BU SL[C Business License BUICI D\G j ��. 27