03110056 E�'ILDING
ITY OF CUPERTINO �»'`'-*-.-< "
BUILDING DIVISION PERMIT yCONTRA T0WINN), TION
ADDREss: GOSAL HEATING&AIR CONDITIO C5"003110056
'0071
OWNER'S NAME: 2679 CHERRY BLOSSOM WAY PERMIT ISSUE DATE
PRADEEP JIAN 11/12/2003
(ONE: (510) 441-2318 SANITARY NO, CONTROL NO,
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
loo LICENSED CONTRACTORS DECLARATION
L� 1 hereby afOrm that 1 am limpand anud motor
nder provisions or Chapter 9(commencing Job Description
with Section 7(MM)) Division 3 of NC Business and Professions Code,and my license is
< imm�mrmrmd e^e. O - FURNACE CHANGE OUT
j Z
Date Clan Lin.r
Date Contractor
ll H11 al DP.61y'c pamN
f a IY crstanJ my plans shall W used s tic records `
C.
G Licensed Professional
,5 OWNER-BUILDERexempbumDECLARATION
COO I hereby affirm on 1 am exempt from Ne Contractor's :Any c Law county the
COO following remora.Section ID3L&Business, uct, and improve,
demolish.
Code:Any city ar county
<m which requires a e.also w eoname,pWq Impma,demolish,nr ea sig any awment 1'l C,(]
that
wslts i[NaaeCaleUmq.him the ponvianno,orcant Me each Permit lUfln.Lae(Chapt statement
E IhmheislicenseJpursuonttothepmvisimm�fNeComruwriLicenulaw(Chaptm9 Sq.Ft. Floor Area Valuation
d Q (commencing with Section 7000)ofDivision 3of the Bminers and ProfessionsCode)ser 36929002 . 00
s that he is exempt therefrom and Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a penaluubjects The applicant to acivil penalty of ApN Number Occupancy
not come than five hundred dollen($500). P Y Type
0 1,as an,Of the property,or my employees with wages As Their sole compensation,
will do Ne work,and the sweurt is n.I intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's Liecam Law doe not apply To in owner of Required Inspections
property who builds or impwws thereon,and who doessuch work himselfor through his
own employees,provided That such improvements are not intended oroffercd for Asia.If.
however,Be building or improvement is sold within one year of completion,Ne owner
builder will have the burden of proving that he did not build or Improve for purpose of
.to l —_ T
❑1,as Owner of the propend,am exclusively convecting with licensed conmetors to �i`EI C XVr".D
coawa Ne pmject(Sec.7044.Business and Profession CodcU The Contractor's U.
cense law dors not apply to an owner of pmpeny who Wilds or improve Neuron,and, _•„_ .� L
who contracts for such projects with a contractor(s)licensed puruani to Ne Contractor's ;g�,1gV7
License Law.
❑I am exempt under Sec. ,B&P C for this mean
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affrtm under Penalty of perjury one of tis following declarations:
1 haw and will maintain a Certificate of Continuo selGimum for WorkersCompen-
amimr as provided for by Section 37W of the Labor Code,for The performance of The
work for which this permit is issued.
0 1 have and will maintain Workcri Compensation Insurance,As required by Section
3700 of the Labor Code,for he performance of the work for which this Permit is issued.
My Workers Compensationinsurancecarrier and Policy number art:
Cartier: .JN/a/!/ Polpy,No.: 2'
CERTIF�F EXEMI6'I1MFROM WO K RS'
` COMPENSATION INSURANCE
(Thu section need not he completed if tbe motor is for one hundreddollars($100)
or less)
1 Certify Net in Ne performance Of lW w it for which this permit is issued,I shall nut
crod.y soy .on m anymanner sn As In become subjcm m The WorkeK Comens
pation
Laws of C forJ$!ie.Date
Applicant R ES7¢ n, i
NOTICE TO APPLICANT:7f.after g-LiSnifaw of panorama,comma,you should
become subject to The Workers Compensation provisions of Ne Labour Code,you must
Q O forthwith Comply with such provision or this Permit W deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
I bemhy,affirm Nat Nero is a convection lending agency lot the performance of
the work for which Ibis permit is issued(See.3097,Civ.C.)
W�A Iander's Name
=z Lender's Adduss
I anify that I have rad Nis application and sate that the above information is
;-" COMM.I agree to comply with all city and county On inseces and sok Iawi Milling TU
C)tC^J building convection,and hereby authorim repreunutim of Nis city To enter upon Ne
show-prom Toned property for inspection purposes
fr G (We)agree to save,indemnify and keep harmless the City of Capetian against
it LO liabilities,judgments.costs and expenses which may in any way accmc against mid City I/(
U in consequence of Be granting of this perm it.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SgUIfiEREGULATiONS. 9 a
f.�it ,��( , l /2/dam Re-roofs
IS wrco ApplreanVCAsc or aceto /
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle haardous material
As defined by the Cupertino Municipal Code.Chapter 9.12,and The Health and Safety
ode.s�tYes 25532(a)? n All roofs shall be inspected prior to any roofing material being installed.
Will Nc applicant or future building Occupant esu equipment ordcvices which If a roof is installed without first obtaining an inspection,I agree to remove
ill horardous air contaminants As defined by the Bay Area Air Quality Managrmom , all new materials for inspection.
iavim?
OYes ApNo - -
I have mail the haaNrws materials requirements under Chapwr 6.95 offt Califon
nice Hcalth&Sa(ctyCoOk.Seeioa25505,25533 and 25534,1 understand Melrose,Wilding
dors not currently haw a tenant that it u my normal w nobly Ne occupant of Be
rc lawhichmust bemepoor it aananraCearlemiofOcapmy. Signature of Applicant Date
owns rase ha ,.Cd Daw All roof coverings to be Class"B" or better
CITY OF CUPERTINO , 5
0311
FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN # �j/ 0 o I--- Date: I///2,1a 3
Building Address: ,;2 ao 7l xC l Fl nA
�/
Owner's Name: ,� , /tn'�'' L4i�. Cpl T I� Phone #:
Contractor: '/L Phone: S7ty —t1 N `2.3j,? License #:
o � t/yA-�
Contact: L — _ _—Phone: �Q y N� Z31 Cupertino Business License #:
Building Permit Info:i' C � �4F eH�4 e G l
Bld ❑ Elect ❑ Plumb ❑ Mech ❑
Job Descri tion:
A0 c67 eH,,17L-4 Dom'
Residential Commerc'
For Residential In llations:
Attic ❑ 1" floor 5y 2"d floor❑
�. Adhere to min set back re uirement❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculatio equire 4or new installation ❑
New installation Wanning ApprQval Required ❑
Cost of Proje : /2.;-vio Occu c gro
Strapped On P orm ❑=TenstructBonded E2 Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
App e Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
13REMACOVER 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
BSEISMICOM Seismic Commercial BUILIDNG
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