04030200CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONT- I i MAUON-.`,,
BUILDING ADDRESS:
102'A9. PART,T?.T'r PT,
A PERFECT CLIMATE
PERMIT NO 04030200'
OWNER'S NAME:
PERMIT15EUBDATE
BILL BARTHF.T.T.
inc;7n q T)P.ANZA plizp
/2
ONE:
(4ng) s6i-qr.4c;
SANITARY Nb:— 901��IOL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
Chapter 9
Job Description
I hameby itfrion that I are licensed under prevision of (commencing
a,MScefionI(0r`J)orDivis,on3Drd.BW&1 We PmfaMkm,C:jegdTiccnscia
in fall Tome
:IVT(—�, :U-3
ADD A/C
Dam —L-q� Co'n me'"
0
If CT VATIO
phorsidiall x used as og
Licensed
OWNER-BUILDER DECLARATION
I Wriby tuffirin that Into attempt from the Contracuor's License Law for the
following am. (section 703 1.5, Business and Profession& Cale: Any city or county
which requires a Permit to consumer arm. inap.w. dernoluth. " repair my inotahme
pd., to its inumaked,.1m, requires the applicant for such inuffit to file a signed statement
Mat he is licensed pimiento to the previsions of ft Contractor's License Law (Chapter 9
Sq. Ft. Floor Area Valuation
(commencing with Section 7000) of DiMitim, 3 of [be Besides. and Profession, Code) or
that he 1. exempt thinallmor and Me basis for the alleged exemption. Any �uhmmi of
Section 7031.5 by any applicant fora Permit subjects Me optical to a civil penalty of
3 1WNftoteiro 0
Occupancy T7pse
.at .. M. tom hundred dollars ($500).
0 1, a Owner of the praperty, im my employees with wages a their sole compensation,
will do Newark, and Me structure is not intended or offered for Sol. (Sec. 7061. Business
and Preferm... Code: The Curnmeter's Licerom Law does not apply to in Owner of
Required Inspections
property, who bonds Winnows themen,and who does such work limsolforthrough his
....play.. provided Initsuch Imprommons, are nothrunded motioned forWe. if,
however, Me Wilding or improvement is mid within can your of completion, the Owner.
milder will have Me burden of proving thau he did not Wild or Improve for purpose of
.In.).
[3 1, as Owner of the property, am exclusively cantracting with licensed contracums in
construct the pmjCCE (See. 7W, Business and Professions Code:) The Cortuactor's U.
came Law does net apply in in Owner of preporty who Wilds or improws darman, ad
who contracts for such projects with a conummu(s) licensed pursuant in the Contractors
License Low,
[I I som 'mimp, under S.M. B & P C for this moon
Owner Dow
WORKER'S COMPENUTIGNDEC�RATION
I hereby a m under penalty of perjury am of the following declinations:
I how and will maintain a Carolina, of Consent to self-humn, for Wartur's Cartoon.
- inn. as provided for by Settle. 37M Of the Ube, Cade, for the poelcommen of the
work for which this permit is !wood.
❑ I low and will maintain Workers Compensation Insurance, as required by Section
OD of Me Later Coda, for the pufamocroca of the work for which this Permit is issued.
My Worker's Compensation Insurance, carrier and Policy number ani
mer. policy Na.: L
CERTI ICATEOFEXEMPTI)N WORKERS'
COMPENSATION I ANCE
(This rection mail notbaccompletedl ifft permit Is marma, hundmildollars (SIM)
or coal
I certify that in the performance of the work for which this Permit is issued. I shall not
employ any person in any manner so sit to become subject to the Warkora'Compensation
Law. of California. Data
ApaMmE
NOTICE TO APPLICANT. If. after making this Certificate of Exemption, you &houW
become subject in the Worker's Compensation proolsions of the Labor Cmk, you mum
forthwith comply with such pravisions or this Permit shall the deemed mwkd.
CONSTRUCTION LENDING AGENCY
I hereby affirm That them is a construction lending agency for the performance of
the work for Which this pewit is issued (Sec. 30117, Chi. C)
Lenaku's Name
Landic,'sAciftess
I certify that I have mad this application and morm that the show information ie
enamel. I .&Me 10 Comply With 411 city and county ordinances and state laws mining he
building construction, and hereby inathatin repremnlintiM Of also City 10 none Upon Me
alieve-nicadonad property for inspection purposes
(We) some I. ., holimardly and keep barmlems the City of Cupertino against
ifiabilidim. judgmencii, costs and espoiscus which may in my way Weeme against mid City
acomaxiticricauffficipartingafthispe ,
APPLICANT UNDERSTANDS AND L COMPLY WITH ALL NON-POINT
Issued by: Date
SOUR REGLATIONS., 1
goofs
Type of Roof
2e
�!,Z
ci ' I
re l'Applumat/Cormocid- Did. OSURE
yu HAZARDOUS MATERIALS DISe4
Will the applicant or future building occupariLillms Or handle homandmis niatchal
asdefined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code. do. Section 25532(a)?
Oyu
All roofs shall be inspected prior to any roofing material being installed.
) Will future
If a roof is installed without first obtaining an inspection, I agree to remove
the suffered 01 Writing Occupant . equipment Or de,ims Which
mit W7.uncoms air contaminants as defined by the Bay Aom Air Quality Management
all new materials for inspection.
District?
0 Yes
I mocand the huacdi)usmAWHAISmquimmonmun&rChpwr&95ofthe Califon
ni.H.Iffi&Sd.iyCadc,Sections 25505.25533mJ255N.Iun&.and that ifthe building
does not currently haw a Wants, that it is my mare i ilit, re only the occupant of Me
ui cons hi mumb7m.1 pri smarm I ritificatco Occug
Signature of Applicant Date
All roof coverings to be Class "B" or better
Loom,
) Date
I
Community Development
4 10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
*UPERTINO
Building Department
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinu infnrmnfinn-
i ?.s.
JOB ADDRVsk
�C) : 2io— q1'
IORMIT #
cru 30zo 0
BUSINESS NAME
BUSINESS LICENSE #
OWNER'S N
PHONE #
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinu infnrmnfinn-
i ?.s.
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Cf
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
0 �-
Dat
•
0
•
Sul-
MY
OF
CUPERTINO
CITY OF CUPERTINO 3 2 LS -0
FURNACE/AC ° l
PERMIT APPLICATION FORM
APN# :�?1 (v - d-(O,0(0�1
T5 ate: �lg
Building Address: -
BREMFURN
Owner'sam
3`� �"e L
P one toso
C
BREMACOVER
A/C Unit > 10,000 cfm
Coc�Qactgr t ✓YtR�� Phone:
Licen e #:
Conr r. Ph o e:
Cupertino Busingss License #:
Building Permit Info:
Rec tl, Switch & Outlets
Bldg ❑ Elect -'"E] --r Plumb ❑
Mech -13
Job Description: G
P�v D
BUILDING
Residential Qom.... Commercial ❑
Elec Permit Issuance
For Residential In �a llations:
MPERMITFEE
Attic 1:1ls` floor L 2nd floor ❑
MECHANICAL
Adhere to min set back requirement ❑
Plumbing Permit Issue
For Commercial Installations:
BPERMFEE
Replacement same weight ❑ Additional weight (structuralEl talcs)
BUILDING
Structural Calculations required for new installation El
Plan Check Fee
New installation Planning Approval Required ❑
BUSLIC
Cost of Prect: p O Type of Construction:
Occupan roup:
Strapped ❑ On Platform ❑ Bonded ❑
Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. if
Ae icable
Fee ID
Fee Deccrintinn
Fr+a (:mnn
BENERGY
Ener
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
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
I Business Licens
BUILDING