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04010051r CI'CY OFCUPER'CINO ,� l BUILDING DIVISION PERMIT CONT; AC' ' " ISi�L{,�yyI,,,,,,,N�FQRMATION dtlfj°6''2C t:�T`.iM.hm� o- BUILDING ADDRESS: ,OW 0269 PALQ ITTRTA.- RD PERMIT NO. 04010051 NER'S NAME: PERMIT ISSUE DATE ONE: SANITARY O. CONTROL NO. ARCHITECnENGINCF.R: BUILDING PERMIT INFO BLDG ELECT' PLUMB MF.CH (� 0 LICENSED CONTRACTOR'S DECLARATION lhereby mal.mlicensed under Chapter 9(commencing Job Descri tion oulProvnsnr wish Sectionmole)ect."' on]of the Businear and Profnssiuv Code, err mylicenm is 0).r P1NALED L1 enloce�nderreci. Lic.« REPLACE HEATING UNIT Date Contractor ARCHITECTS DECLARATION - FEB 1 0 2004 I uodcrawnd my pluns.h.11 he used as public reenNs BUILDING Licensed Professional OWNER-BUILDER DECLARATION I hereby Orion that 1 am exempt from the Contractors License law for the following reason. (Section 7051.5, Buincu and Professions Code: Any city or county which rcquiru a permit to construct, alter, improve, demolish, or repair any structure prior in its issuance. also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions (If the COnlmcmrsLicense Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division ] of the Business and Professions Coda) or that he is exempt therefrom and the basis for me alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects Our applicant o a civil penalty of 3 O Occupancy Type not mom than five hundred delta. (M). _WbiV"�,YerO ❑ I, as Owner of for property, or my employees with wages IS their sole compensation, will do the work, and the swaure is not intended or offered for sale (Sec. 7044, Business Required Inspections and Professions Code: The Contractors License Law dors not apply or an Owner of proTerty who builds or improves thercon,and who doessuch work himself or through his own employees, provided that such improvements are not intended oro0ered forule. IL however, lie building or improvement is sold within one year of completion. the owner, builder will have the burden of proving that be did not build or Improve for puryose of sale.). ❑ 1, as Owner of the progeny, am exclusively contracting with licensed Lonexclan to construct the pmject (Sec. 7044. Business and Professions Code) The Contracmes Li cave law does not apply to an Owner of property who builds or improves themon, and, who contracts for such projects with a contnctor(s) licensed pursuant m the Contractor's License Law. ❑ l am Mpsofstuoier\Sec. B & P C rnr this'AIDJUtreason ER'S COMPENSATIO RATION-N., 1 hereby affum under penalty of perjury ane of the following dalantions: 1 haw and will maintain a Certificate of Consent la selr.ivum for Workers Conpen- mdon, as provided for by Section 7700 of the Lattice Code. far the pedmmanes of dw work for which this permit is issued. ❑ 1 baste and will maintain Worker's Compensation Insurance, ex required by Section 3700 of the labor Code, for fie performance of me work for which this remit is issued. ' My Workers Compensation Insurance artier and Policy number art: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' . . . COMPENSATION INSURANCE (Thu section recd nm he completed if the Permit is format hundred dollara (SI00) an.) I certify mat in the performance of the work for which this permit is issued. 1 shall nm _ employ any person in any manner sat as to become subject to the Worken' Compensation Laws of California, Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you ahold become subject to the Worker's Compensation provisions of the Li M r Crede, you must - forthwith comply with Such provisions Or this Permit Shall be reamed revoked. CONSTRUCTION LENDING AGENCY I heathy of Irm that there its conswctinn lending agency for IM Performance or the work for which this permit is isswd (Sec. ](1 Civ. C.) Lenders Name Lenders Add. I «dify mal I have read Nis appliati ra and Mute that the above information is concct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives or this city to enter upon the above mentioned property for ina,clian pumoma (We) agree to save, indemnify and keep hamdess me City of Cupertino against judgments, costs and expenses which may in my way license against mid City in consequence of me $rooting of this Permit. (33liabilities, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Datil SO R TONS. Re-roofs it m ignature e picanuUmaractor Dem HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant Or future building Occupant store or hadlc harombus material . as defined by the Cupertino Municipal Code, Chapter 9.12, end Lha Health end Safety cock. saNan:ss]z(a)7 ❑Y All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant fware building Occupant use equipment ordevices whim I havardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. iIon ❑Yes No I have read the hmmdoM .=He]. mquimmcnts under Chapter 6.95 of me Calife, Six Health A, Safety Code, Seedons 25X15,23555 and 25534. I tr dersad that loch Wilding ' docs rot currently hart a tevnt. thin it u my responsibility m rodfy the occupant of the require cmustbe, melPlan ortuiasa of aCcmOcateorOnPrIyy..rJ Signature of Applicant -Date I All roof coverings to be Class "B" or better owne r amhoriaod og<m Date L,% f— CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM C) 0 6-�--/ APN #`� Date: / 5 BREMFURN Building Address: MECHANICAL lOZ- �,q r'Rl cO vks-[A V2� CA 9Som A/C Unit > 10,000 cfm Owner's Name: Phone #: --tow3TF, + CMo MEi LkE.N Lk3o yyko.5Lz3 Phone: Contractor: Phone: License #: we -,-k r,a MSE. 1"j\f� Og 2-07-- ke q `S BSEISMICRE ,Contact: Phone Cupertino Business License #: SA`t (taS Ai16 Seismic Commercial Building Permit Info: EPERMITFEE Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: Mech Permit Issuance _ ti,.ALE CFC il�+G- V N1i 0. TIL mr•c. Nlf-w Mo 4-C EFF1c IcAT UN1 Residential §0 Commercial ❑ Plumbing Permit Issue For Residential I st llations: BPERMFEE Attic ❑ 1" floor 2"d floor ❑ BUILDING Adhere to min set back requirement ❑ Plan Check Fee or Commercial Installations: BUS IC Replacement same weight ❑ Additional weight (structuralEl calcs) BUILDING Structural Calculations required for new installation El New installatio Planning Approval Required ❑ Cost of Proj , Type o o t i Occupancy grou r Strapped ❑ On Platform ❑ Tide Sq.Ft. Floor Area: ❑ New Location Replace Tit Qty. if Applica4le) 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 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 BUS IC Business License BUILDING