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04070068oO z� a> 0. Q az UO OUjF F0. �z CITY OF CUPERTINO '**"*^'�.'+k,?ext[-" pz • <'' BUILDING DIVISION PER CONTRAGTMR INFORMA.TIMN BUILDING ADDRESS: - 0172 PART.P.TT PT ATLAS HEATING "'"""04070068 OWNER'S NAME: PERMIT ISSUE DATE JIM AHN NE: SANITARY NO.'114 CONTROL NO. 408 73 - ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 t� 0 LICENSED CONTRACTOR'S DECLARATION Job Descri tion /�,, p L/!1 I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Scclio ) of Division 3oftho Business Profs . Code, and license is n V11Y// in full to err O � e� l�� REPLACE FURNACE & ADD A/C License.. � Om: Contractor ARCHITECTS DEC A N V \a lundenuSrsWyplens shallWuud upube cards as. 200 '•IP+aY®e®�® 4 Licensed professional OWNER-BUIMER DECLARATION 1 hemhy affirm Nal I me exempt from On, Conuacmrs License Law for tax fallowing moron. (Section 7101.5, Business and Pmfeaimu Code: Any city or county which acquires a permit to construct. altar. Improw, demolish, or repair any structure prior m its issuance, size raqunes the applicant forsuch permit to File a signed statement Nat W is licensed pursuant to the Provisimm of the Comruwrs LIanu Law (Chapter 9 Sq. Ft. Floor Area Valuation (cam ncocing with Section 7000) of Division 3 or the Business and Professions Code) in that he is exempt thmafrom and the basis for On alleged exempdon. Any vloladon of fikerO 0 Occupancy e p y �p Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty or.10M not more Nan five hundred dollen (S500). r. ❑ I, u owner o(1W progeny, amy cmploym with wages u their ole compeneadon, Required Inspections veilldm thework,aad theawmunum,tintandedaaffeml forsala(Sec.70atilleanc.s and Profession, Code: no Conuecmr, Li.. Law does not apply to an owner of � q p property who builds or human, theman, and whmdoeaauch work himself orthmugh his own employees, pmvidcd that such improvements ism not intended artificial forule. If. however, On building ter Improvement is sold within am year of oompladon, the rowan builder will have the Wrden of proving Out M did not Wild art improve roe purpose of sale.). O I, as Owner of the properly, am exclusively contracting with licensed contractors to , convect the project (Sec. 70x1, Business and Professiams Coce:) TW Contractor's Li- , come law las not apply to an owner of progeny who W Ilia or improves thamen, and, who contacts for such projects with a contractor(s) handed pursuant in IW Cmntruacr. Lkense Law. ❑ I mm exempt under Sec. , B k P C for Nia moon Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the fallowing declarations: I have and will maimain a Certificate ofConsam m self-inaum far WorkersCompen- atian, u provided for by Section 3700 of the labor Code, for the performance of the work far which this permit is iaucd. ❑ I have and will maintain Workers Compensation Irons=, in required by Section 3700 of the Labor Code. for the performance of the work forwhich this permit a issued. M�ut m edPolleynumberem:arriPfIPONFROION INSURANCE (r ds section need noibecomplemd lithe permit is formic hundred dollen ril(p) or less.) 1 certify that in the performance of the work for which this permit Is issued, l "I not employ any person in any m camerso as to become subject to On, Worksri Compensation Laws of Celifomia. Date Applicant NOTICE TO APPLICANT: IL after making this Ccnificau, of Exemption, you should become subject m the Workers Compensation provisions of 1W labor Code, you must roMwilh comply with rah provisions ar Nis permit.hall W deemed revoked. CONSTRUCTION LENDING AGENCY I hereby aM m Nat dem is a construction lending agency for the performance of the work for which this permit is issued (See 3(N7, Ci, C.) Landers Name Lender, Add. I cenify that I have mad this application and stem that the above information is ' coneci. I agree to comply with ail city and county ordinances and auto laws miming to Wilding convection, ad hereby awhodre mpresenmises of this city in same upon Ne ahom-mentioned property for inspection purposes. (We) agree to ave, indemnify and keep harnlea the City of Cupertino against Ihdilides, judgmenu,co. end expenses which may in any way acemse against said City is conseguc a fthc rating ohhis emit' APPLIC ND STANDS OMPLY WITH LL NO DINT /^ If/ Issued by: Date SOUR GU 0 Re -roofs Type of Roof % Sign tic o art D m HAZARDOUS DISCLOSURE Will the applicant art ruture Wilding accupoin mre or handle huardous material as &food by she Cupertino Municipal Code. Chapter 9AL ad the Healdr ad Safety We, Siccdon 25532(.)7 All roofs shall be inspected to any roofing material being installed. Yea W prior If a roof is installed without first obtaining an inspection, I agree to remove d/ Will the applicant r rutum building occupant use equipment or devices which it haammis air comaminants as dcfiad by the Bay Area Air Quality Management - all new materials for Inspection. District? ❑Yes ❑N I have read the haaah rla9mquimmenuundcr Chapter 6.95 of the Califon nuH.IO&S y odc.Se Y35, 25533 anJ 2S13a.lundcrsuvd lWlifthe Wilding lar not c dy m a m Nat it is my respousibilhy m notify circ occupant of mil an a mast at prior tents, iauacc.is Ccru f u ry Signature of Applicant Date C All roof coverings to be Class "B" or better Owner sur r] ,ram, am J I It CITY OF �UPEkTINO �J JOB ADDRESS: FA Building D PERMIT # Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 nt 0.00 (o OWNER'S NAME: j rn jAchn I PHONE # 332 - 05 l GENERAL CONTRACTOR Q-� S 4 pm -V A'Z I FAX # I am not using any subcontractors: Please check applicable subcontractors and complete the following information: EA / actor ature ate 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 / actor ature ate 0 1i LJ otty. CITY OF CUPERTINO CITY OF CUPERTINO 6 670 & FURNACE/AC PERMIT APPLICATION FORM APN # ` j _ O Ener Date: oq V Building Address: ozfpsP Relocation of Furnace ate. Owner's N a: y) Phone #: a51 -oZ85 Contractor:License coo MECHANICAL #: 99 13 7 Contact: e� Ph e #: 3_95c � Applicant/Contractor: Building Permit Info: BSEISMICRE Seismic Fee Res Bldg lee lumb ec Job Descripti Residential: ` P) (Q ��1 a +-r: C W Commercial: Sq.Ft. Floor Area: ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPE ITFEE *$,/"Sq.Ft.:Architect/Engineer: Type of Constrution: G BPERMFE Bld Permit Fees Qty. if Ao6Scable Frr Ttl BENERGY Ener 100 V1VU BUILIDNG 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 BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPE ITFEE Plumbin Permit Issce PLUMBING BPERMFE Bld Permit Fees BUILIDNG BPLANCH Plan Check Fee BUILIDNG BUSLIC Business License BUILIDNG 2 / / K!�/� 7. 33