Loading...
04020050 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTUR,�INF©RMATIoN : . auILD;-il RAMPART All ATLAS HEATING INGADDRESS: PERMIT NO 04020050 4AR HER'S NAME: PERMIT ISSUE DATEJOHN WJNE: SANITARY O. 0 TROL NO. CHITEC rENGINEER: BUILDING PERMIT INFO ' BLDG ELECT PLUMB MECH I p 0 0 0 0 Y00 LICENSED CONTRACTOR'S DECLARATION Job Descri tion OFlyI hereby affirm that 1 are licensed under pmviaiou of Chapter 9(commencing p with Section 7")of Division 3 probe Buenev and Professions Code,and my license is ucalseclmno flue k__ )I p SS� REPLACE FRUNACE FINALED 3 Dam COnlranar R ITELTS D RATION : Iunderatandmy Plans Illeued Puhlic rccnrds MAR 1 2004 . sed Licensed Professional OWNER-BUILDER DECLARATION BUILDING r0I I num.(See the I am except inn she Conlncsu's e:Any c Law for the ■M= O o fallowing meson.(Section](131.5,Business and Profession Code:Any city or structure$� which rtquircs a Permit to ennuroe4 WimimPrew,demoliM,or repair any structurt i poor m ins issuance.also mquiru tM applium formch permit n file a signco stsbemcnt that heiauapursuant the nsedpursuanoprovisionsoftheContractor'sleavelaw(Chapter9 Sq.Ft. Floor Area Valuation G (commencing with Section 701 of Diviaiun 3 of the Business and Professions Consul Or $ but he la exempt therefrom and the bub for the alleged exemptlon.Any violation of Section 7031.5 by any applicant for a Permit subjects the spleens to a civil penalty of 3 FFFWPJB'f130k4M p Occupancy Type not mon Nan fin hundred dollars($500} I,uownu of ebe prepeny,or my employm wish weguuehnmle eampenmeon, will dothework.and Ne he Combnms License Offereds not epply owner of and Professions Code:The.thowe s,License Law dors ant apply lf an owoer is Required Inspections manery who builds or i d that such chicon,and who doessuch work oroff himself.,throughhis ownemployes,provided provehImprovementsarcnot intendedoroRewd for tile,If, however u buildingorimprovement iasalde did one Weld or completion,the owuery Wilds" wi0 have the burden of proving that k did rot build or impmw for purposes of ulcJ. ❑1.as Owner of the property,em exclusively contracting with licensed contractors to convect the project(Sec.7044,Buinets and Professions Code:)The Cosmacmr'a LL cense law does not apply n an owner of property who Wilda or improve themon,ad, who contracts for such projects,witha contractoRU licensed puaun in the Contractors ! License law. ❑1 am exempt undo Sec. .B&P C for this rtuan Owner Dam WORKER'S COMPENSATION DECLARATION 1 Mnby eRm under pointy of perjury ooe or she fallowing declarstlons: 1 haw and will maimute a Certificate of COnunt to wlBtuure for Worker's Compcm cation,as pmvided far by Section 3700 of the Labor Cade,for the performance of the I work for which this permit is issued. ❑I have and will maintain Workers Compensation Insurance,as required by Secdon 3700 of the labor Code.per the Performance of the work for which this permit is issued. My Woh as Cynm�pev^ati`g_o,Ipsu�nnasy�carrier and Polity numW /Q P VTr' Policy NW 7&Q(e9 6 CERTIFICATE OF EXEMPTION=WORKERS' COMPENSATION It7SUAANCE fThfs Moslem need not W completed if the Permit is for one hundred dollars(S 1IX) or los.) 1 certify that In to performance of the work for which this Permit is issued.l shall not employ any person in any manner an as to become subject to the Workers'Compemellon Laws of Caltfirmom Date Applicant NOTICE TO APPLICANT:It.arta making this Ccnifiesbe of Exemption,you should bccmne subject n the Workers Compmanion previsions of use tabor Code,you most , Oforthwith comply wish such provisions or this Permit shall bo deemed reveled. Z IP CONSTRUCTION LENDING AGENCY E4 I hetehy affirm that Nen tea construction lending agemy for the perfumunceof CLe> the wails for which this permit is issued(Sec.3097.Civ.Q i VJ Lenders Name, A.r7 z Lenders Address U 0 1 certify that 1 have mad this application and sum that the above information is W.,F correct.I agree to comply with all city and county ordinances and state laws mining to 0 U Wilding convection.and hereby authpdse representatives of this city to enter ulmn she abon-rommoned pmpeny per impaction purposes y (We)agree Ip save,indemnify and keep hannkes the City of Cupertino against .y V) liebilitio,Judgencnts,costs a nus which may in any way same against mid City f)F77 :"consequence or the mit. APPLICANT U D IL MPLY Wlui ALL NON-POINT Issued by: Date AP CE l/y Z'�' Re-roofs bear plicae Conmmor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding occupant store or handle ha xrdaus aper u defied by the Cupertino Municipal Code,Chapter 9.13.and the Heath and Safety ode. C]Y. zss3z(,)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes Na Will she applicant o future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hanardnus air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection. 7Dismict? ii'���❑Yes OLmuIhave reap the hazardous maleflus requirements under Chapter 6.95 of the Calif., 'IgHmfth&Safnycodc, uons8505,33533 ano25534.1unocrsavW thuiftM hulloing ! / lJ 7 ns cranoyA ,rit is iyto I i m i,u1y Na Pml nr tncgui `nu issu £bT `;, / , Sjpnat Ap c " Date V f./I/� .Af•, neror lh egcm rx poem All roof coverings to be Class"B"or better CITY OF CUPERTINO a FURNACE /AC CUPERTINO PERMIT APPLICATION FORM APN# Dater (7 a� O Building Address:)o� Owner's Name: Phone SD Q Contractor: License : dn37 Contact: P one#: nm -OS I Lo Applicam/Contractor: Building Permit Bldg Elect .. Plumb Mec Job Descrip 'on: . Residential: Commercial: Sq.Ft. Floor $/Sq.Ft.: Architect/Engineer: Val io . • Type of Construction: u Qty. if 4plicable— Fee ID Fee Description Fee Group BENERGY Energy BUILIDNG 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 EPERMTTFEE 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�4' 3 /72 . 37