05060016 CITY OF CUPERTINO .,• �l ,-+^t• `` ``•i•,d„
BUILDING DIVISION PERMIT C®NTRACT0I6INF' RMATIIQN '
But
ADDRESS: A & H HEATING ......05060016
71 RATMROW DR
• OWNER'S NAME: PERMIT ISSUE DATE
MU
NE: SANITARY NO. CONTROL NO.
(408) 279-079.2.
ARCHInC IENGINBER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p
Y00 LICENSED CONTRACTOR'S DECLARATION48 JobDescri hon
1 homey affirm Nu 1 Me licensed under previYau of Chapter 9(commencing p
IN Sedan 7000).f I)Msb n 3 of the Busi^wand Pulcut ms Code.and my license is
m aeoc=' and em 7 tic g -5tig - 7 RELOCATE FURNACE & ADD A/C
z�� D°tenMclw ` - c^^ REPLACE DUCTS, EXTEND GAS & ELECT
e ARCHITELTSOECLARA ION
Y 1 understand my piens shall he used M public records
G�a Licensed Pmfcssio^°I
N OWNER-BUILDER DECLARATION
0 0 1 hereby.(leer on 1 em catmpt from 0e Com.Co License Lew for the
00 following requires
a (Section 71D I.S.Business and Professions Cade:Any city or munry
$ which requirca a permit re cnnawcL slur,impmw,demolish.or mash ed nructum
Fly pdmmiuissuance,
ensedprmaml to the too,applicant for such permit mfileasLaw(umme^I
<
that
commincing with
dwprDivisiuo the oftheBuacmfiLan¢LaonsConcr9 Sq.Ft. Floor Area Valuat�eg1000
SCS (commenting with Section and the
buts
r O the eg Business and Professions vi ladende)or
IT$
that he is nxempt Ihemfrmn and Ne bob foe du alte`ed eumptlon.Any vlalLBun of
Section 7031,5 by any applicant for a permitavbjecu the appimant m a Civil Penalty of APN Number Occupancy Type
not mom than five hundred dollen($50Uk
El 1,as owner f Ne property.a my employees with wages u their sole cempensadon, 36224002 00
will do Ne wart.and Neauuctum is not Intended aortend fa We(Sec.7Da.Bud. Required Inspections
and Pmfesalons Cook:The Contractors License Lew dean not apply m an ower of q p
property who
yces.Wilds
provided
mhimrownu ha danssahwek Mmsalfor through his
owneer,thebuiProvidedmprovemimprowd witmu hin ons,
you
or offered f mannerals .
builder ,the building or improvement Is sold withinoroyeti ofwmplefortheower-
builder will have robe burden of proving Out he did not build or improve for purpose of
sou.).
❑1,asr awrur ej ct SecRny.B sinus and contracting Cod licensed romncross U. `
censwa the project(Sec.n so Business and Professionsbut Code:)The Contractor's and
cense law dura not apply m am ower of pmperty.who builds or improves Nemo^.and
Law.
whee for such projects with aeonveemrtU licensed pursuant mInk Cantrsemta
License Lew.
❑1 am uempt undo Sec. .B At P C for this moon
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby afflrm under penalty of perjury arc Clubs following decimations:
I haveand will maintains Cenificam.fCansenuoself-insure for Workers Compen.
7307.00
lan.as provided fee by Section 3700 of thee,labor Code.for the perf^rmmT of the
rk for which this pers^it is issued.
I have and will maintain Worker's Compensation Insurance,M required by Section
of the labor Code,(in Ne Performance of the work far which NU Permit is issued.
y Workers Compensation Inmrane,carrier and Poicy num r art:-MA 4G. 14) Polity Ne.: .1� --
Camber: �D
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Tots settle sed notbecemplcwd If the permit is f no^chundrtA dollars(SIM)
or le L)
1 cenify Nat in the Performance or the work for which this permit is Issued.I Nall not
employ any person In my miner M as an become subject to one Worker Compensation
Laws of California.Dau
Applicmm
NOTICE TO APPLICANT:If.&fur making Nu Ccnfficate of Exemption,you should
become subject in the Worker's Compensation provisions of Ne IaW Code%you min
.J 0 forthwith comply wit such provisions of this permit shall be deemed reversed. ._
Z„m� CONSTRUCTION LENDING AGENCY
H Ihereby M.Nat dart is a mnsoncU^n lending agency for the performance of
ai 7 the work for which this permit Is issued(Ser..3097,Civ.C.) '
WM Q Lender's Name
Lenders Md. _
L)0 1 cenlfy that I have mad this application W sum Nn Ne above information is -�
CamCL 1 agree m Comply with all city and county ordinances and Ltam lawn mlati^g to
0 building construction,and hereby amhorim repaunudvrs of this city an enter upon Ne
Ua above-memianed property for Inspection purposes.
4 (Wc)&gme to""'indemnify and keep hurries,the City of Caperton agaimt
IA liabilities,judgments.cosu sod expenses which may In my my°Casae against said City ,
V 7 In consequence of the graming of this Permit.
Fl APPLIC NT UNDERSTANDS D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC GULATIONS. ,�)
G-Z_0J Re-roofs
Signature of ApplicanVConusemr Dam
HAZARDOUS MATEIUA91DISCLOSURE Type of Roof
Will Ne applicam or fal9m building aecupanutou or handle harucous material
Mok!I jd by the Cu
penino Municipal Code,Chapter 9.13,and robe Health and Safety
mde,seunn'5533(q? All roofs shall be inspected prior to any roofing material being installed.
C]Yns o
Will the appi'am or fulum building occupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
.mit havrdne air conuminmu M de d by Om Bay Area Air Quality Management all new materials for inspection.
District?
❑Yea Nu
I have mad the h,amdesmaterials requirements under Chapter&95 oldie Califor.
nia Kco W A SafemyCode,SeCU=25305,25533 Md 25534.1 understood that if the building
J.not carcully haw a"am.thal k u my rraa��po Will ennmily tie occupanl of der
rinihich in"reyuimm awhichmustbemmpriormissuancb ACe c Occup er. ignatureofApplicant Date
d All roof coverings to be Class"B"or better
Gave,m uthoriosd agent V Dau
a
CommunityDevelopmetit" Y`
10300 Torre Avenue '
Cupertino CA 95014 '
' Telephone(408) 777-3228
r: 'y Fax (408) 777-3333
F ITY, F',
UREVINO
sc,
, ._
Building De artment
h i =.
JOB AQDRE S: PERMIT #
{OWNER'S NAME: G ' PHONE # 2 .5Z- f5Z -
i;
'1; y
i.GENERALCONTRACTOR: FAX # 4iiG52-' 7 - /O,! 7
13!
t
q4-,;; I am not using any subcontractors:
Date
!Plea'se check a licable subcontractors and complete the following information:
.' SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
y" Cement Finislung
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
r 1. Glass / Glazing {
Heating
Insulation
'„g ?
Landscaping
P g
Lathing
Masonry
t.
Ornamental Sheet Metal i
Ort : Painting / Wallpaper
Paving
!; ! Plastering
Plumbing
r.•?, Roofing
Septic Tank J 1
Sheet Metal
F� -
r Sheet Rock
Tile
Owner/Contractor Signature Date
.10/28/03 1j > j
1 !
CITY OF CUPERTINO
FURNACE /AC
I F
UPEkTINO PERMIT APPLICATION FORM
7APN # Date:
3(09, C2Lf 00
?m Building Address:
7�7
3
Owner's Name: Phone #:
0q'502
17Contractor, License #30 If(f 7oL
t:,,
Phone
Contact-
DALS
k ,i
Applicant/Contractor
Building Permit Info:
BldElectMech
Plumb
Job Description: IZ 6Lo ev4,-7-r-- /v6-4-) eC=7-at!E-
Residential: lomi -rcial: 2-201VI-7- (24go
-Sq.FtFloor Area: $/Sq.Ft.:
Arc hi t ec VE i i g i neer: Valuation:
ype, of Construction: Occupancy Group:
Qty. if
Applicable Fee ID Te,, Doscriptioll Fee 01-OLIP
BENERGY Energy BUILIDNG
BREMFURN Relocation of Urnace MECHANICAL
BREMACOVER A/C Unit > 10,000 din MECHANICAL
§REMAIRHAN AJC Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Recptl, Switch & Outlets ELECTRICAL
--BSEISMICRE, Seismic Foc Res BUILIDNG
EPERMrrFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mcch Permit Issuance MECHANICAL
PPERMITFEE. Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSL[C Business License BUILIDNG
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