03090089CITY OF CUI'ER'1'INO
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BUILDING DIVISION PERMIT
r CO NTRACTQR_ NFORMATION x,
OUI LDING ADDRESS:
ATLAS HEATING
PERMIT NO 03090089
OWNER'S NAME:
155 .SAN LAZARO AVE
FERMrr LSSUEDATE
NE:
(408)739-0516
SANITARY .
N0CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ON
LICENSED CONTRACTOR dunderSDEsims0f tuP
1 hereby af0rm that I am limnxd under p 'ons of Cbapmr 9 (commencing
1/'_.�uiuu
Job Description
p
Co ,an icense is
with Scnion ]q%1)af Division Sof NC Busin�cn� an/dp��
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infullf"Als, cff 2q Lk.
Licenu Class
ACE C�O-80000 BTU raiINeL�°°g.®
Da¢ Cunva r
Ro
ARCH1 iCTS DECLARATION a4
A
I understand my plans abut be used As publicrecords
SEP 2.:IS03
Licensed Professiunal
OWNER BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
mason. (Section 7031.5, Business and Proficamou Code: Any city or county
BUILDING
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior us its issuance, also requires the applicant for such permit m Ole a signed ftawmenl
that he is licensed pursuant to the provisions of the Cmmmoura License Law (Chapter 9
Sq. Ft, Floor Area Valuation
(commencing wi lh Section 7uno) of Division 3 of the 0asiM.. and Psufouinu Calc) or
that he is exempt therefrom and the buts for the alleged exemption. Any violation of
35607046.00
Section 7031.5 by any applicant far a permitsubjecO the applicant to a civil penalty of
— —
--- ppN Number
Occupancy Type-
not mart than five hundred dollan(5500).
.. _ _ -
P y ----—
C3 1, ss no, of the property, or my employees with wages As their sole compeuatlon,
will do the work, and Ne structure is not intended or offered for sale (Sec. ]044, Business
and Prolamines Code: The Contractor's License Law does not apply to an owner of
ns
property who builds or improves thereon, and who does such work himself or through his
,
3 03 - ROUGH M CHANI AL
awn employees, provided that such improvements are not intended or offered for axle. It.
304 — ROUGH ELECTRICAL
e building or improvement Is sold within one yeof completion, the owr-
however, thas m
builder. will have the burden of proving that he did not Wild or improve for purpose of
505 - FINAL ELECTRICAL
507 - FINAL PLUMBING
El 1, as owner of Ne property. am exclusively contracting with licensed contractors to
-
conswcl the project (Sec, 7044, Business and Profusion Code:) The Contractors u-
508 — FINAL MECHANICAL
cense Law does not apply to an owner of property who Ni Ids or improves themun, and
who contracts for such projects with a can Vaelor(a) licensed pursuant to the Contractors
License law.
❑ I am exempt under Sec. B k PC for this reason
.
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby airmm under penally of perjury one of the following declarations:
I have and will maintain a Cenidcam of Consent to seff-ma a for Workers Compcn.
Soffer, u provided for by Section 37M of the labor Code, for the performance of the
_ ,
A, k for which Nis Permit is issued.
have and will maintain Worker's Compensation Insurance, As required by Section
I of the Labor Code, for the performance of the work for which this permit is issued.
YWnrkcc,''a Compengalion In/a�of m e nicr and Policy number am:
G
Cartier: / I+i,A.t�{� f.V Wssti. Policy No.: 3 -1 ?O 7Z'S
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not becomplcwd Rise Permit is for one hundred dollars n](A)
,it less)
1 certify Out in the performance of to work for which thia Permit is issued, l shall not
employ any person in any manner an As bs become subject o the Worscri Compensation
Laws of Calif onia. Dow
1
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code. you must
.
forthwith comply with such provisions or this Permit shall M deemed rcvokcd.
CONSfRUCnON LENDING AGENCY
1 hereby affirm Nat there is construction lending agency lot the performance of
the .,k far which this Permit is issued (Sec, 3W7, Civ. C.)
Lender's Name
_
Lender's Add..
1 cenify that 1 ban read this application and sum IMI the above information is
correct. I agree to comply with all city and county Ordinemts and suw laws elating to
building construction, and hereby authorize r11a11Ma of dila Llly to enter VPnn the
above- fioned propertyfor an purposus.
(We) agree to saw, indemnify and kith harmless the City of Cupertino against
abilitics,judgmcnu, costs And expenses which may In any way accRIroc against said City
oncoueyucnce of tha r ling of this reit
APPLICANT UND ANpS COMPL ITH ALL NON-POINT
Issued by: Date
SOE RE
URC
Re-roofs
,/
/J7 ��
Wgnalum of ApplicanUComraclor Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will live applicant or future Wilding occupant note or handle havallou material
as deOned by the Cupenino Municipal, Code, Chapter 9.11, and the Health and Safety
Code, Section 35531(¢)? ]Yu ,._,nV!
p
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 or future building occupant use equipment or devices which
it harardnus air contaminants u�hy the Bay Arca Air Quality Management
all new materials for inspection.
avict7
❑ yes
In— -W thehaaN�usmareriab reyuiremenu under Chapmr1i.95 of the Califnr
-
nlsHulthASafclyCu,Sccuuu155n5,35533wd2534.1undcreundthwifdtc Wilding
dnu not currently haw a tenant Nat it is my rt pout din to nnufy the occupant cf tM
M--
mynirementawhichm re. Ao iia ¢maraca aao
/le /��
Signature ofApplicant Date
All roof coverings to be Class "B" or better
g
Owner oraotoo recd ager,
oto
' cCCa, J
CITY Of
CUPEkTINO
41
CITY OF CUPERTINO
FURNACE/AC
PERMIT APPLICATION FORM
D3U`o'0/
APN #
K7
Ener
BUILDING
g O
Building Address: nn
l06
MECHANICAL
Owner's Name: , /v
Phone #:
P�
BREMAIRHAN
Con tr or: Phone:
�✓� r -):3 -0,5
License #:
"76s z G 6
Contact:/? Phone
Cupertino $usess License #:
Building Permit Info:
BSEISMICRE
Bldg ❑ Elect ❑ Plumb ❑
Mech
Job Description:
�/a - 8�a, O 0 61-bi .
Elec Permit Issuance
Residential Commercial ❑
% MPERMITFEE
For Residential In illations:
Attic ❑ 1" floorA 2"d floor ❑
MECHANICAL
Adhere to min set back re uirement❑
Plumbing Permit Issue
For Commercial Installatjons:
BPERMFEE
Replacement same weight. LJ Additional weight (structural calcs) ❑
BUILDING
,
Structural Calculations required for new installation
Plan Check Fee
New installation Planning Approval Required ❑
BUSLIC
Cost of Project: Type of Construction:
� /00 - n
Occupancy group:
Strapped ❑ On Platform Bonded ❑
Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Fee. m
Fee rlecrrintinn
BENERGY
Ener
BUILDING
BREMFURN
Relocation of Furnace
MECHANICAL
BREMACOVER
A/C 'Unit,000 cfm
MECHANICAL
BREMAIRHAN
A/C Units <= 10, 000 cfm
MECHANICAL
BREMRECEPT
Rec tl, Switch & Outlets
ELECTRICAL
BSEISMICRE
Seismic Fee Res
BUILDING
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