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03120067 ' CITY OF CUPERTINO ? _ "w - aa" ds, BUILDING DIVISION PERMIT ' �",hdN CR.�CTR 'O; 7.'IQlvx r" BUILDING ADDRESS: A PERFECT CLIMATE PERMITNO03120067 OWNER'S NAME: PERMIT ISSUE DATE Adik ONE: SANITARY QtkOLIO. ARCHIIECTENGINEER: BUILDING PERMITINFO ELECT BLDG PLUMB MECH >?O p LICENSED CONTRACTOR'S DECLARATION O I hereby affirm that I sm licensed under provisions of Chapter 9(commencing Job Description x ' with Sat 7 of Dinsion]of the Business and Profcasions Code.ew myliccnm is IZB� /11 n �© '^< in full force one �Iff�� Ij�t(�y�t� H4 License Lk.tl PREPLACE FURNACE & ADD A/C' ^e � Dao: Conuacmr A SDECLAR TI SEP 21 2004 y < I undcnunJ my tans shell he used u public records , D U 3 u.� Licensed Prolaii...1 G�f I1 p n jV3 OWNER"BUILDER DECLARATION iwK11'I�fl ®�t�AO� 1 hc¢hy a(Mn that I em exempt from Ik Conu act License IAw for inc udr v LS ��j1�j iOO following reason.(Saf.7ID1.5,Business and Prefessim.Code:Any city me county no which mrind.a pandit to construct,alter,improve,demolish.or mVale any mama. poor to lU banana.man,mqulrU[be applicant for such pCnnll to role a signed staMmCnl NmM is licensed forwam w the provisions of the Canummr'.U..Law(Chapter 9 Sq.Ft.Floor Area Valu ton $ (commencing with Section 7000)a Division 3 ofthe Business and Profusions Code)or that he i.exempt therefrom and the bask Lou the alleged exemption Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mom than five hundred dollen($500). 3 V`�e170 0 6GGUpancy Type ❑I.asowner of the propmy,mmy cmploycu with waguutheir min cempenution, will do the work,end the aWctum Is not intended moRertA r..Me(See.7014.Business and Professions Code:The ConacmruY Lie.Law does or apply to an owner Of Required Inspections progeny who builds or improv Neuron.and who does such work himself or through his Own emplayeca,provided Nn such improvements are n ttinumded confirmed forule If, however,the building or improvement is said within an/car of compledon.the owner- builder will have Ne burden of proving that he did net build or improve for purpose of talc.). ❑I.as Owner of the property,am mclmively contracting with licensed contracts,in construct the project(Sec.7044,Business and Pafessions Code:)The Conuuura Lb cause Law does not apply in an owner of property who builds or improv dragon.and, who contracts for such projects with a eonum or(U licensed pursuant in Om Contractors License Law. ❑Imneremptunderse, ,BkPCrmtim..n ^ Owner Date WORKERS COMPENSATION DECLARATION 1 hereby ahem under Easily of perjury oro of dx following declaruiom: I have and will maintain a Certificate of Consent to self-insum for Worker Compcm sm an,as provided for by Section 37W of the Labor Code.for the performance of the k for which this permit is bound. I have and will maintain Workers Composition Insurance,as required by Section M of the Libor Cade,for Ne Performance of the work for which this partial,is luted. WorkeJp Cnmpens i nlnwnn carticr and Polity num /�G/ carrier. V/rt-�kt-f Iiq No.: C FICATE OF EXEM ON FROM WO S' COMPENSATI INSURANCE (This section need at be completed it the permit is for one hundred dollars(SIM) of kss.) I unify that in the performance of the work for which this permit is issued,l shall not employ any Noon in any manrterm as in become subject in the Workeri Compensation Law.of California.Dade Applicant NOTICE TO APPLICANT:If.after making this Ctttificate of Exemption.you should become subject in the Worker's Compensation provisions of the Lather Code,you mum .J Q forthwith comply with such provisions or this permit shall be deemed revoked. Z( CONSTRUC ON LENDING AGENCY ti [-� I hereby aRrm Narrot4iacd(See.bort lending agency far Ne performanro of CL the work for which Nk pemmh k issued(Sec.3097.Civ.C.) 0.5 Tinder's Name Z fdma Address O 0 1 certify Nm 1 have gad Nis application and rote thus the above infmmnkn is It,^' torten 1 agree in comply with all city and county ordinances and gain laws mlating in 0 building construction,and hereby authorind rcprusnutiv of this city to curer upon the W awvamcnUdInt ray for bnpmismawon urposes. d (We)a8rtt cave.indemnify and keep lessdm ty of Cupertino apinst CA IiabiliJWe)gr ,costs indenifyad k syinw ey accrueagalia.d City V 7 inconsequent r rc%Holing ' per �i APPLICA U DERSTA S A ILL CO LY WITH ALL NPO Issued by: Date S G ATION . Re-roofs Signarorc of tic Conum r Dam AZAR U8 ERIALS DISCLOSURE Type of Roof Will lic..Lou fu ilding occupant mcg or handle hauffia.makrial as wEned y Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety C we.of zss3z(.>7 All roofs shall be inspected prior to any roofing material being installed. Yes u If a roof is installed without first obtaining an inspection,I agree to remove Will Nc replicant or future ilding omupam sex equipment or devices which g P g mit havardous air contaminants derincd by Ne Bay Am,Air Quality Management all new materials for inspection. Difiria7 ❑Yes No Ihavercw ndousmals.I qm ratsvnJcrChapterG95oftheGlifor- HrNhSafety ,Seedats 7550.255JJw 574.1 undcrstandthmifthe buiiJing Jas not curtem ate Not i i pct ihility m not l'y Nc oceup t of the requirements Ic mum met do iuvan of ccrdOmte of Oec Signature Of Applicant Date ow or sat cd agcm Ga All roof coverings to be Class "B"or better I CITY OF CUPERTINO («fit` FURNACE/ACCM OF CUPERTINO PERMIT APPLICATION FORM APN # O Date: Build'ng Address: ner's Name: Co tractor: Phone: en #: l Uj �7 2 ) Co a t: Phone: Cupertino Business License#:' ��-r�.e C�-3Cc.h� Building Permit Info: i Bldg El Elect Plumb F-1Mech ' Job Description: � Residential Commercial ❑ For Residential In�a Ilations: Attic ❑ 1" floor LJ 2nd floor ❑ Adhere to min set back requirement❑ • For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Re uired Cost of Pr MC y�ct: —)Z3 TypejqfCons coon: Occup cy/� ��o9 J I, Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floo ea: New Location 39 Replacement � Qty. if A a Fee ID Fee Description Fee Group BENERGY Ener&Y BUILDING BREMFURN Relocation of Furnace MECHANIC BREMACOVER A/C Unit > 10,000 cfm MECHANICAlli 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 MECHANIC EIBUSLIC RMITFEE PlumbingPermit Issue PLUMBING '{' RMFEE BldgPermitFees BUILDING ANCHK Plan Check Fee BUILDING Business License 9 BUILDING rt� SAP 31