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CITY OF CUPERTINO''."a"iv�x'M
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' BUILDING DIVISION ' ' PERMIT
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BUILDING ADDRESS:
A & H HEATING
PEaMITNo04110158 -
11256 PALOS VERD C
OWNER'S NAME:
PERMIT ISSUE DATE
RICHARD CASLER
770 CHESTNUT ST
11/24/2004
ONE: _
SANITARY NO. ..-;CONTROL NO.. ..,_
(408)279-0722
ARCHITEC (ENGINEER:BUILDING
PERMIT INFO -
BLDGELECT PLUM MECH
O O
LICENSED CONTRACTOR'S DECLARATION
Job Descrl tion -- - - - '-
P
1 con Hommed der provision of Chapter 9 (commm ening
I hereby affirms than en
with Section 7000) of Division 3 of Ne Bum. and Prefessiuu Code. and my license is
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InrAlroreeendeff _ - :
REPLACE FURNACE
License C e Lm: $ $9
Dau Canvunor -
ARCHT Ee DECV� ATIO r
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Min
1 undersand my plan shall ha used u public rtcoNm
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Licensed Professional
OWNER-BUILDER DECLARATION
r's License w for the
I by Air.. Nal i am ca mpt form the Convenor's La
here
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following reason. (Section 703 1.5, Business and Porfeesiuu Conk: Any city or county
which requires a Permit to construct, alar, hnprow, demolish, or repair any seucture
- - - S-3000----- - -
prior uits iunnce, alw requires the applicant forsuch permit to rite a signed statement
Nu he is licensed pursuant to the provisions of the Conmcmrm Umnse law(Chepmr9
Sq. Ft. Floor Area _
_ _ Valuation''
(commencing with Section 7000) of Division 3 ofthe Businumand Pmfessiou Codoor
--------__ ._�_
that In is esempl Ilraefmm and the basis for the eluted co mptiwl. Any violation of
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Occupancy Type -'
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than ave hundred dollars ($500)•
❑ I. As owner ofthe property. or my employees with wages u their "to compensation.
Inspections
Required Ins -
q P '•. , L•' : -•
will do the work. and Ne mom Isnot intended 0. offered I.Aide (Sac. 7001. Budren
and Professio. coda: The Committees License Law does not appy m an owner of
propeny wha builds or i mpmws Nermn, and who doesduh work himself or awugh him
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own employces, provided l uaueh improvemenuam nminunded ora0ertd fusels. If.
however. the Wiliingar imprevcnamissold within oneyearofcompleMm. Neowier-
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builder will haw Be burden of proving that he did not build or Improve for purpose of
esu").
❑ 1. ea owner of the property, am eacluiwlY convening wife licensed contractors to
-
cantmet the pmjen (Sec 70th• Business and Profesdon Cade:) The CoMrsom's U.
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come Law does not apply in an owner of property who builds Or improves Merton. and,
who contracts for such projecm with a conuano*) licensed pursuant in the Convacar'm-
License Lew"
0 1 am aaempt under Sec. . B At P C for this moon
Owner Dae
WORKER'S COMPENSATION DECLARATION
1 hereby aTme under penalty of perjury can of the following doemallons:.
I have end wfl msinuin a CW Tram of Consent to self -inure for Worker's Co ni en.
section, u provided for by Section 37M of the Labor Code. Our the performance of the
work for which this permit is issued.
ave and will malnuin Worker's Campenetion Insurance, as required by Scetian
3700 of Ne labor Code" for Ne performance of the work for which this permit is luurA
--
MyWorker'sCompensationInuranceaarms, and Policy number ice:
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Cartier" L Policy No.: % t _27 " a
CER FICATEOFEXEMPI70NFROMWORKERS'
COMPENSATION INSURANCE
f 7h u femur reed nal be completed If the Permit it; frrone h undmA dol W a ($101))
or Lias.)
1 certify that In the performance of the work for which this permit B immune. I shall nut
employ any person in any manner m as in become abject to tie Workers• Compemtian
Lowe of Califomin. Data
-- -
Applin.
NOTICE TO APPLICANT: If, after making this Ccnificate of Eaemption, you should
become subject in the Workers Compensation provision of ice tabor Code. you must
fma.ith comply with such provision or Nis permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby Armin Nn More Is a commcun lending agency for dw performanm of
Oe work fur which this Permit Is issued (Sec. 3097. Civ. C.)
(sac Namc
Landers Address
I certify feel I haw read this and firm then show information u
ammo. I agree m comply with all city and coumy ^Niven and sou laws relating to
city and county end
e
Wilding enmsuuclineras hereby COMM PArtpresenutiwt of this ciyatour upon ere
above"mentioned for emnify an
in amiorly
keep ha
_ (We) agrees, taw, indemnity and keep harmless the City Of Cupertino gainer
-
expcn= which may in any coyaccrue spite aid City
incliabomsecrumc ofth
T of the RSTAN of Nis permit.
APPLICANT UNDERSTAND ND WILL COMPLY WITH ALL NON -POINT
APPLICANT
Issued by; Date .
SOU3QE REGULATIONS.
Re -roofs
gnatyDaf' p icon or em
AISCLOSURS,
NA7ARDZARD OUS MATEIUAF
Type of Roof
WIII fee a or forum building Went more u handle mueriA
AmHeardow
defined by the CupeNno Municipal Code. Chapter 9.13. and de HCAN and Sassy
Cupertinoe.
Code. S etian 25532(a)7 -
All roofs shall be inspected prior to any roofing material being installed.
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If a roof is installed without first obtaining an inspection, I agree to remove
Will Ne applicant or future Wilding Occupant use equipment or devices which
emit hsarEmu air co mminanu as de0ned by the BAY Ara Air Quality Management
all new materials for inspection.
District? �/
❑Yu ❑Nu
them cowl Ne huaremnmaurielsregvimmenu under Chapur6.95 of the Califor.
niaHealth B SafelyCode. Scc6mo25505.25533 aa2.553a, I unlmasol Nuiffec building
does mol Currently have a tenanl, that it u my responsibility in roury the nccupanl of Ne
myummhichmuubumelpn Leses aeaflCervnes
en wof aaptmY,
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or aulharisd agent Data
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information
Date
Owner/Contractor Si
finature
l"-2Date
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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
Owner/Contractor Si
finature
l"-2Date
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CITY OF
UPEkTINO
CITY OF CUPERTINO
FURNACE /AC
PERMIT APPLICATION FORM
APN 1 � C � � I D3 I
Date:
Building Address:
-
Owner's Name: .�� \�
Phone #:
Conu:tctor:, , _ _E�
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License #
Conner:
Phone #:
Applicant/Contractor.j.
Building Permit Info:
Bldg Elect I'lumb
Job Description: r -
Residential: Z ��� YuC_ Commercial:
Sq.Ft. Floor Area:
$/ScI.Ft.:
ArchitecG'Engineer:
Valuation: 7,),g��
Type of Construction:
Occupancy Group: -�
Qty t
Ann fickle/ Fee ID
Fee Description
Fee Group
BENLRGY
Energy
BUILIDNG
BREMFURN
Relocation of Furnace
MECHANICAL
BREMACOVER
A/C Unit > 10,000 cfm
MECHANICA1
BREMAIRHAN
_
A/C Units <= 10, 000 cfm
MECHANICAL
BREMRECEPT
Reeptl, Switch & Outlets
ELECTRICAL,
BSEISMIC'RE
Seismic Fee Res
BU1Lml\G
EPERMt'fFEE
Elec Pcrmit Issuance
ELECTRICAL
_
Lu/NIPERMII'FEE
Mech Permit Issuance
MECHANICAL_
PPERMITF'1-,E
Plumbing Permit Issue
PLUMBING
BPEk:V]FEE
Bldg Permit Fees
BUILIDNG
BPLANCHK
--�_ —
Plan Check Fee
BUILIDNG
-
BUSL.IC
Business License
BUILIDNG
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