03060036 CITY OF CUPERTINO
J BUILDING DIVISION PERMIT
t,. "7�ssr haw re-
n BUILDING ADDRESS: A & H HEATING PmpMITN003060036
19201 PHIL LN
WNER'S NAME: 770 CHESTNUT ST Pmm"ISTI 4/2003
'90K FONG-YEE
NE —0 77-2— SANITARY NO. CONTROL NO.
AR CHIIBCTIENGINEER: BUILDING PERMIT INFO
BLDG LECT 'PLUMB
LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby M.that 1 ant licensed under pmviA.AS of claim,9(commencing p
with Section 70110)of Division Star am Business and Profusion.Cadt.md my license is
'1 Imm�fomemaeIf A/C (ELECTRIC CONNECTION) )
E Clea.CI _ ,� 11:.• [ 1
Dau ARCHnECI'S DECLARATION )
.� 1 understand my prism shall he used As public reused.
3 Licensed Professional ^
5� OWNER-BUILDER DECLARATION
I hereby affirm that 1 Am exempt from the Contanars License Law for ere
DO following moon.(Suction 7031.5,Business and Profession Cade:Any city or county
$ which rcqulma A permit m canstroct abet improve,demolish,or mpuir any structure
�^ prior In its issuance.also requires the applicant forsuch permiuo rile a signed statement
that he 0 licensed pursuant m the provisions of ere Canuaclor's Uce.I.-(Charter 9 Sq.Ft.Floor Area L hOn
S$ (ommmencing with Section 7000)of Division 3 of the Business and Pmfeslam Cmae)ar
gt
that he is exempt and the Whi.Tor the alleged evmptim.Aoy Molwan Of
Session 7031.5 by any Applicant for a permit mbjrcu ere applicant e A civil penury of A er Occupancy Type
not mom than five hundred dollars($500).
❑I.As awner of the property,or my employca with wages As their sale compensation. Eyt,m„l
will do to wort and theavunum u ret intended or offered rentaleY lou.Businw 303 — ROUGH f1T71� ODS
and Professions Cade: mn The ConuuLicensero
Law does t I an t owner Of
pmpenywho buildtor improvee theteon.aed who doessuch wart himmuorthroughhis 304 — ROUGH ELECTRICAL
ownemplayta,provided thstach improvements arc not Intended oroffered forsak If.
however,the bundingar improvement is sold within oro year Of complains.the owner 505 — FINAL ELECTRICAL
ulcer will have sire human of proving that le de rut bund or improve for purpose of 507 — FINAL PLUMBING
❑1,As owner u the progeny,am exclusively contracting with liaised conmctou to 508 - FINAL MECHANICAL
consumer the project(Sec.7044.Business and Professions Cade:)I.Conusura Li-
aise taw docs not apply in an owner or property who bull"or improves thereon,and,
who contracts far such pmlecu with a comormlo(I)licensed pursuant in the Contactors
Lice.law.
❑l Am exempt ander Sec. ,B A P C fm this mason
r Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury arc of the following deslarations:
❑1"wand will maintain acerdframof Consent tuselfdnsure forWorgeraCunpen-
maaan,As provided for by Sstian 3700 of the labor Code,for sire pclfomtamon of LOU
work for which this permit is issued.
❑1 haw and will mainW n Worker(Compensation Insurance,u required by Section
3700 of the tabor Code,for the performance of the work for which cis permit Is lasered.
My Warkera Compeuaam inanna carrier and Pollry number Am:
Cartier. Polity No.:Atli 14?
CERTIFICA77EE OF E%EMMON FROM WORKERS'
COMPENSATION INSURANCE
(Into scrim seed not he compleud time,permit is foram hundred dollar.(5100)
or kis)
1 curtly that in the performance of the work for which this Permit is issued,I Nall not
employ any person in my mmncrm As to become subject in use Workee Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL afar making this Cer incate of Exemption,you should
bacon a subject b the Worsen Campenation provisions of the labor Cede,you MW
OZ forthwith comply with such provisions or this permit shall be domed revised.
z y CONSTRUCTION LENDING AGENCY
Thereby affirm that dem is acowuction lending agency rot ere prerrormanee of
�.> the wank for which this permit is issued(Sec.3097,Civ.C.)
aQ Lenders Name
z Lenders Addma
U 1 ttNfy eat 1 have read this application and tut that the above Information la
IL COODCL I agree to Comply with all city ami county ordinances and sou laws relating In
O building construction,and hereby authorive rtpmsenutivU of this city to enter uPnn me
W aWvo-mend.ncd property for inspection purposes.
(We)agree to save,indemnify and keep hamtless the City of Cupertino against
y liabilities,judgments.coon and expenses which may in my wry acetate against aid City
fJT inconsegueseofthe grantingo(thispermit T
G APPLICANT UNDERSTA DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU EREGULATIONS. nn 4-
�n� Cil- m - Re-roofs
Signature of ApplicantA7 ARDur Dau
HAZARDOUS MATER ALS DISCLOSURE Type of Roof
WIII y the Cupertincant o
room Wilding e.Chantsmm sir tuedlc Health tad Safer l
As
de0ned by the Cupertino Muniripal Code.CWptr 9.11.and the Heals and Safety
man.Section 25531(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya RK.--
the applicant or futum building occupant use equipment or device.which If a roof is installed without first obtaining an inspection,I agree to remove
emit hasudnus air conuminanu u defined by the Bay Area Air Quality Management all new materials for inspection.
Dimict7
Oyu Ow.
I ham read the haardousmatrialt requirements under Chaptr6.95 arose Califor.
nia Real"Safety Cade,Suctiou25505,25533 and 25534.1 understand thatirthe building
dace oat curtcnuy have•wnanL out It w my rasponsihiliry,u notify the oceupant of set
mquirc enuwhwhmuube'9�I WiSSuanamf.0 fkAw roam ey. Signature of Applicant Date
)= yel �lA// � All roof coverings to be Class"B"or better
Owner or amhodmd Agent F Dam
CITY OF CUPERTINO
FURNACE /AC
CUPEF,TINO PERMIT APPLICATION FORM
APN # Date:
75- - o 'f
Building Address:
OR I PH 1*L
Owner's Name: AWO(4 DAA4 h Phone #,; — 1.02 \W10
Contractor: - License#:
Contac[:
H�' 4(p P 30 72.
#•
/9t.1' ho H WN N g) a 79- OA�.
Applicant/Contractor: A _V j
Building Permit Info: l
Bldg Elect Plumb c
Job Description:
Residential: ��� �yJ() �!V t9Ufze7 e� ommercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architea/Engineer: Valuation: 2-1�
Type of Construction: Occupancy Group:
Qty, if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUIL(DNG
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
EPERMIITEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG
2 0 �tJ