04040036 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORIN '�URMA' IQN
BUILDING ADDRESS: CONDITIONED AIR - PERMIT ND.04040036
111`11 T)ATPTQT WV
OWNER'S NAME: PERMR 1%UB DATE
M
NE:
SANITARY OL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p O D O O
Y00 LICENSED CONTRACTOR'S DECLARATION Job Descri tion
M 1 Mreby"m that I am licensed under provisions of Chapter 9(commencing p
with da ]0(10) fOl�un 3ofthe Bu' app Prof CcolLjodmylicenscu
M
�A` 1/ (�a�
Damnassa onde conNplor REPLACE FURNACE-ADD ASC FFRN LIE
ARCHITECTS DECLARATION APR 2-72004
1 u nd my plans shit M used Inc records
3s.0 Lcensed Professional
OW NER-BUILDER DECLARATION p±
.� 1 hereby union that 1 am exempt from the Conoocror's License Law for the BUILDING
a o following mason.(Secdon 703 L5,Business and Professions Cade:Any city or county 1lltdd EO Vtl
g E which requlros a permit m eonstrwl.altar.improv,dtmol W,u repair any structure
Fxy prior In its issuance.also requires the appliam for such permit a rile a signed stswnset
FF�0 that he is licensed pursuant to tie provision of the Contractor's Maoist Law(Chapter 9 Sq.Ft.Floor Area Valuation
d $ (commencing with Section 7000)of Division 3 ofthe Businessend ProfeudonsCade)or
R§ Out hes exempt timufroa and the basis for Ne alleged exemption.My violation of
Secdon 7031.5 by any applicant for a permit subjects Ne applicant ro a civil Penalty of 3 Mgi�l_11*170 0 Occupancy Type
not mom Nan iw hundred dolhss(55(0).
❑1,u ewer of the pre pvty,or my employees with walla u their role mmpenutloo,
will do thework end Ne awcwm la notinwlMederoRered forsaw(See.]Old,Busi••..
and Pmfeaflons Code:The Conuacvar,Lt.Law does not apply ro an owner of Required Inspections
property who b niMs or improves deacon,and who does auch work himstl f or through his
own employees,provided that such improvements am not Intended croRered for sale,If,
however.Ne building or improvement Is sold within oro year of completion.the owner
builder will have aw burden of proving Nat he did nu build or Improv Tor purpose of
sale.).
❑1,n owner of the prepeny am exclusively contracting with licensed centracmra to
coronet the projea(Sec.7044.Business and Pronevdov Code)The Contracter's Li
cerise Law dots not apply to on mwnu of pmpeny who builds or Improv Momon,and,
who contracts for such pe jets with s conoaaor(s)licensed pursuant re the Consumes
Lima.Law,
LamatemptunderSee. ,Bk PCfordismuon
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby anioo under penalty of perjury arc of the following dedaration:
I love and will formal a Certificate of Covent m sal Aname for Wodwta Compere -
aadon,as provided for by Section 3700 of die Labor Code,for the Performance of the
week for which thin permit is issued
1 have and will maintain Worker's Compensation Insurance,to required by Secdon
3700 of the labor Cade,fa they rmance of the work for which this permit Is bound.
My Wo Pen ion n ice canierand Polity
Poliq
Caw TIFIGTE OF P.7 P170N ORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foronchundrea dollar(SIM)
or lav)
I certify Itis in the pedurmance of the work for which thio Permit is issued,I shall not
employ any permn in any maancrm a to beromc subject to the Workers'Compevaion
Laws of Califomia.Dam
Appli
nt
NOTICE
NOTICE TO APPLICANT:If.Compensation
the CCsi n s Of M Exemption.you should
become romp re it Worker's Compewdon provision or Ne Lahr Code,you mon
�,'� forthwith comply with such provisions or this permit shall be dcemed rewkcd.
z CONSTRUCTION LENDING AGENCY
h4 (hereby Ify.that them iso construction lendingagmey for the pclfurmameof
the work for which this permit is issued(Sec.3097.Civ.C.)
W� Lender's Name
z Lender's Add.
V O 1 cenify that I haw read this application and soon that the oboe information is
L conte,,1 agree us comply with all city and county ordlnanees and slow Hwa relating to
p V building construction,and hereby mouton representatives ofthis city tocmerupon ft
r W above-rum oned prepsny for ivpecdon purposes
F+fY (We)agree to aw.indemnify and keep harmless the City of Cupcnino gamll
cn liabilidesjudgmun0.costs and expenses which may In any way scene a Morin CityfJz m aselsonce of the frontal of this Permit.
A ICANJWkPERSTANDS AND WILL COMPLY W!jH AL NON. DINT Issued by: Date
R GU ONS.
Re-roofs
IS ore of AppdicarMConoactor w
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future iding occupaystnmu handle hvardoot material
ss de0ned by the Cupertino Muni pal Code.CTapmr 9.11,and the BOOM and Safety
Code. 0Yc=15571(a)74N.
o All roofs shall be inspected prior to any roofing material being installed.
Will
the a7c" ilding occupant um tyuipment or ticvices which If a roof is installed without first obtaining an inspection,I agree to remove
turn Ncardnus air con s fined by the Bay Arta Air Quality Managcmcnt all new materials for inspection.
Dimia7
❑Yes
I have mad the Insulations materials mquimmsms underChapter 195 ofCalifon
nia Hellth&Safa Code,Sced.v 505,15533md15534.1undcnlondth ifttnhQ�Wildin
dots rlbt eumniyyhave a wine Nat it s my mapovibility m nosily 1hG aupNt nr Ne
w9uim ns wnicn cast he met Pdorto issuance ors Ccnincam foci c. Signature of Applicant Date
owner a ri,<atgtnt „t All roof coverings to be Class"B"or better
04/05/2004 15:27 0085591970 rlI7V'MIANAGF1ffJ�IT PAGE Bl
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t ; CphMlJX77'YMANIIGFJMEWT5EFtF![C'E5,RVCORFOttATED
6MCE COPY
Minas Yang
21103 Paalotway
Cnperdno,CA 95016
Homeowneca Asweiatfarr
NPR 012004
DearMmttn Yang: �RTINO
I am wrwm in IMPORM m kuph cs Prom Jerry Y cbn�doner in
y Yom• Ic w iAtmtl sad type of A! visibte from the
r9� _wyet Aix=+kG s�:....Wz,
mmmon area 5.peeial Case should bg ataers tp -tee
opaum rices noc adv=sdy a&a your abbots-
if you bac airy gnestions regarriieg 69 above, pkase give sac a caU at the number listed blow or
email we at awd&o ,
Sincerely, ��
COmtnuni% aann22$$¢¢IIII •S�iOeS�I11C.
C�'MtopbwFlood,Awocwnon Meng
Commons ofCupeUM Homeowners ASSOCAtiOtl
ee Hoard ofDlr MIS
Elle: 16
1935 Dry Gaels Road.S.,Gca 203 +CaMpbell CA a 95008-3631 +wire (408) 559.1977 .yx (400) S59-1970
Community Development
af
10300 Torre Avenue
Cupertino CA 95014
11 Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department,
JOB ADDR )u� PERMIT#,f�t ,2-1 X. 6
v3 � 1
OWNER'S N PHONE #
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors:
Signature D to
PIease check applicable subcontractors and complete the following information:
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
AN ile
r/Contractor Signature Date
CITY OF CUPERTINO
FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN #32/
b
Building Address:
o3
Owner's Name: Ph ne #:
MAAA cup 3-47Ye
ContraPhone: License #:
ctor
Pon - g-mit
Con act: Phone: Cupertino Business License#:
� aa33
Building`Pe it Info:
Bldg ❑ Elect ❑ /;Plumb ❑ Mec
Job Description: t,, <
Residential Commercial/
For Residential Installations:
Attic ❑ 1"floor ❑ 2nd floor❑
Adhere to min set back requirement❑
ti For Commercial Installations:
Replacement same weight ,,' dition] weight(structural-ca)
Structural Calculations re d for new installation ❑
New installation Planni Approval Required E]Co t fPro'ect: � of Construction: Oz
ccupancy group:
Strapped LJ On Platform qFloor Area:
New Location ❑
Replacemen
j . if
1' able Fee ID Fee Description Fee Group
BENERGY I Energy k
LDING
BREMFURN Relocation of Furnace HANICAL
BREMACOVER A/C Unit> 10,000 cfm HANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm HANICAL
BREMRECEPT Rec tl, Switch& Outlets CTRICAL
BSEISMICRE Seismic Fee Res LDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE lumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BU IC Business License DING
�r .