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03070225 CITY OP CUPEM INO A.41 11 BUILDING DIVISION PERMIT CONTRACTOR�INFORMATION '`° - BUILDING ADDRESS: PERMIT N00 3 0 7 02 2 5 1 OWNER'S NAME: PERMITISSUEDATE AM MELTON DAVID NE: SANITARY NO, CONTROL NO. ARCHITECfIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH t� t� Q t� +00 LICENSED CONTRACTOR'S DECLARATION 1 [U❑ 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description =� fwmJ fZW with Section 7000).RDivision 3 ofthe Business end Profession,Code,and my license is <rn Leseamdeffect ncClREPLACE FURNAE & ADD A/C AUG 2 5 2003 in felt fina Lic.N Dale Camfaetar r$ ARCHITECTS DECLARATION 4 W 1 understand my plaru shall M used as public(,ands BUIL toF Licensed Professional �VIL®��� ]y OWNER-BUILDER DECLARATION I 1 hereby alrom that 1 am exempt from me Commmar,License law for IN OO following mature.(Section 7031.5,Business and Professions Code:Any cilyo,county 5$ which requires a Permit to construct,shot,improve,demolish or repair any structure $7600 -ZY prior in its issuance.also requires the applicant for such Permit o Bit a signed statement � shat he is licensed pursuant to be provisions of the Contractor's License law Chapter9 Sq.Ft. Floor Area Valuation $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 36908045 . 00 that he is exempt thamfrom and 0,basis for me alleged exemption.Any vimmi on off .. Section 7031.5 by any applicant for a permit subjects Be applicant he a civil penalty of APN Number Occupancy Type mot more Nan five hundred dollars(M). I,out a.,of the propcny,ormycmplaycea with wages az Bi art.compensation, will do the work,and Be vuctum i,not intended or offered for sale(Sec.70U,Business and Professions Code:The Conlncum s License Law does mot apply to an owner of 303 — ROUGH ge41005 progeny who builds or improves themon,and whodms sub work himselfor through his ll own employees,provided that such Improvements are not intended cro@red for sale.If. 304 — ROUGH ELECTRICAL however,Be building or improvement is sold within one year of completion.Ne owner. builder will lave Be WMI of proving that be did not build or improve lar purpose of 505 — FINAL ELECTRICAL i1c')' 507 — FINAL PLUMBING 65,1.as owner of the progeny,am exclusively contracting with licensed contractors to 508 — FINAL MECHANICAL comoum the pmjcct(Sec.70",Business and Peofessiaes Code:)The Commusmri Li ecru lawot apply m m owner of progeny,who Wilds or improves Nectar,and who comrac for wch pmjecO with, ontrector(s)licensed p....ad 1.the Commctor'a License law. ❑lam at nder,Sec. ,B 6 PC far thh mazon Own 4 el WORKER'S COMPENSATION DECLARA I hereby efMm under penalty of perjury ane of the in ing decimations: ' I he,and will maintain a councam of Consent to self-Insure for Worker's Com,s m salion as provided for by Section 3700 of Be labor Code,fm me performance of the work for which this permit is issued. ❑1 ban and will maintain Worker's Compensation Insurance.as required by Section .. 3700 of the labor Code,for Be perfo moons.(me work far which this permit is issued. My Workers Compensation Insurance carrier and Policy number art: Cartier: Pal icy No, _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not Mcompleted if the Permit is for one hundred dollars(g1011) or Icer.) 1 ttnify that in the performance of the work far which this Permit is issued,I Null not employ any Person in any manner ser az In Wcomc subject to the Workcra'Compensation Laws of Califofnla.Data Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become subject to the Worker a Compensation provisions or the labor Code,you must O forthwith comply with such provisions or his Permit shall be deemed revoked. ti N CONSTRUCTION LENDING AGENCY I hereby affirm that mere is a commission lending agency for me performance of Y, r7 me work fur which this permit is issued(Sec.3097,Civ.C.) - YQ Lender's Name 3 z Underi Addmas J C) 1 ttnify but 1 have reed this application and ase that the above mformuiom ix y F conch.I agree to comply with all city and county eminences and some laws relating to building conswction,and hereby amhmi¢representatives of this city to color upon me NLG "hove-mentioned pmperhy for inspection purposes. .. (Wo)agree to ars,indemnify and keep humk,s the City of Cupertino against rt, liebilitie,.j gmenu.cosu andaapcnsmwhich may in anyway accrue agaimtaid CityS6 1�a J z APPLICA yNNQ1��oUNDE1.RSTANOSIA WILL COMPLY WITH ALL NON-POINT Issued by: [e an an eq. URI gEjfULATI S/r !', I) een (/� �( /{// Re-roofs gnuurc ofApplicaHAZARDOUS MATERIALS DISCLOSURE am Type of Roof Will me applicant or future building occupant store or handle lu ardous material as donned by the Caroni.Municipal Cods,Chapter 9.11,end the Health end Safely Code.Section 15532(a)? All roofs shall be inspected prior to any roofing material being installed.❑Yes t[Nc Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove It hoaardous air contaminants az dc(ned by the Bay Arca Air Quality Management all new materials for inspection. ismiel? ❑Yes We ' ave read me havamausm call requirements under Chaplor6.95 tribe Califer. ria Hca SAt Codc,Sadom 15.15533 Rod 25534.Imusersund muifthe Wilding does not Niloontly haus a tenant that is my responsibility,to at, 'I'y the occupant of Be mgeirem which man etp t is5a Nfican Qmpancy, Signature of Applicant Date All roof coverings to be Class "B" or better wncr,tar diamond agent Dam CITY OF CUPERTINO FURNACE/AC UPEIZTINO PERMIT APPLICATION FORM APN # p Date: Building A dre s: /6a '3 c woad rZ- C � r rvo Owner's Name: Phone#: Contractor: Phone: License#: Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Plumb Mech Job Description: . � g�JM Residentiov. Commercial p 1 For Residential Installations: �tN Attic ❑ ls` floor ❑ 2"d floor dik�kdhere to min set back requirement❑ OFFor Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Dlanning ApprLval Required ❑ Cost of Projec Type of Construction: Occup y grou 9— Strapped ❑ n Platform ❑ Bonded ❑ Sq.Ft. Floor ea: New Location Replacement Qty. if licable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A1C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business Licensq BUILDING CITY VISIONNO DI PERMIT CONTRACTOR INFORMATION: BUIL PERMIT DGEWAY DR FOUR SEASONS ROOFING PERMITNo. 02060114 obSUVt!WICZ STAN AND BARBARA 645 HORNING ST 1 PHONE: SANITARY NO. CONTROL NO. q (408) 278-0330 W O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO be BLDG ELECT PLUMB MECH Z a L'J 8 y= LICENSED CONTRACTOR'S DECLARATION JO �S` n Si_❑ y )ofDhmiam n3oftheBusuncisaned under Pronsof sion$Cmr9Qommecense TEAR OFF EXIST. CEMwW' i ROOF, INSTALL 1/2 ,�h with Section I hereby 1ri Division3 of the Businessand Professions Code,and my license W1 minrmvoreeaodS lav — 40 YEAR COMP O U License Class Lic.p 3 u. Dam Contractor wt .u�0 CHITECT'S as DECLARATION o 6.tl ��® g 1 understand my plans shall be used as public records CG .N Jy} l 3 p O Licenutl Professional OWNER-BUILDER DECLARATION Crom ON JAN 3 0 2003 R I hereby x11-1 thus I am exmp,firman the Co ions C's,License Lew for the y Z Y C toll rens 5 a 1031 5 B g ( ass vn0 Profesaiom Cade Any my or case ty e. unt ❑ which re h hrce s3 seekaempt then to construct, he bas stmfoprrotshe adlelfmgocdhisehlrepair anyawn ..prior to am issuance.alsq the ploof for such proton fl statement t(cam rte g with Section 7010),olDivisian 7 of the Bulbicer'sLaw u 3`4 S,qFt:3 F.lop,rArera�4l t Y3'1( ' 3 hin hailcen pdp h'el tollgpooinions the CommLicense Law(Chaps 9 lind Pr Aioce Coo ys, ny omsian ' ,`• .8.0V.0a.0lu.a.t_i_on- 2 41'019':O b of�oEt�e,nr eany erea applicant for twn,arsthe apphram to.eir;l penal,r- APN Number '.;.t;':ii c Occupancy Type ❑1,as owner of the property,or my employees with wages az their sole compensation, 305 - FRAME ' will do the workf'and'the .,,.,a'is not Intended'or offr.d far'aale-(See 7M -- _ - Business and Professions Code:The Contractors License Law does not apply to an fired Inspeetions't '• '-'' ' owner of pr pony Who builds or improves thereon and who does such work himself 601 - ROOF TEAR OFF or through his own employeespro ldul that such improvements art not intended or - - _- -offered f ale If,howe er the ti Id '- 1 t provemenus thatwthnune'yearoY --- -- - --PLYWOODNAIL;;,,,, n completion,the ase of su owner-builder will have the h Nen of prov ng the,he d1d no,build err improve Tor Purpose at xle.). 603 - ROOF BATTENS 604---' ROOF—IN-PROGRESS-"--- ,i Olru owner of the property,am exclusively contracting with licensed convenors to con1;a project(Sec.1044,Business and Professions Cade)The Commnor's License nu Low teres not apply to en owner of pmpenewho Wilds an seimproves t to the. _end_who.commcts Lawsai.c,, e.connections)licensed pursuant.so the. _. ....._.._ .. .._._ .._. .------ .. .. .:..............__ _...._ ".`S' Commaor's License Low. , :'s;,,.Ir' � ;r:.•i;:- � `L. '. ` + ' ❑I oto exempt under Sic " - '„ •at„ _ � - B�&PCfor this mown .� r"'ll, r7 _ __ Owner'.•. '" .Dale WORKER'S COMPENSATION DECLARATION - - c IherebY affirm under penalty of perjury one of the following declarations:— / ❑ 1 have and will rnaindin'e Cmificme of Cons ervto self-insane for Worker's Compensation; as provided for by-Section 37M of,the Labor Code, for the perfumlanm of the work for which this pr m,is issued.. ` ✓ -� ❑1 have d will owimain Work 's Compeasmmn 1 surence a mquleed by Section 37W of he Labor Cuda for the performance of the work for which this point is slued M/y1 Work Ts Cpp pen non Im4rince came and P-a�l¢y upmbe/� "/•' Cunerl"!-�10.Ad' rlb� rr6cyN .�I:Gy T'�JS76tC f. r^ zy. �( sdYtrz .:.-._.�- .0 o —_ t 1' \CERTI pICAT10N OF E%EMPITON FROM.WOR _ +_t J! t a\,s.1.. f 141. . .. /t4 ITbrs section COMPENSATION INSURANCE" n •1 need not tie complomd if the permit is for one hundred dollars •1y-- ($1W)orless.7 1 -ilia ,no mouth awn er pn or sn"nah.the ort f 8come tb s pc -t t issued I ...1 _ 1 '1„t'l:ao 0 'earn nos employ any pawn m any mennef w a,o b&ome subla,m she Workers' _ n Compensa,ion'Laws of Celifomie':Demi '• ”' '-' "'• '"'- " ` •- ..ApplcauYt,. ., ., 1 ... .._ NOTICE TDAPPUCANPIL CmrmakingthCero(¢ate ofE empuon you should arta - 0 fitt e s c r�p Into, utichWorker,kin,,.sa0on provisions of the Labor Code,you most fonhsvith comply wi,u such provisions or,his permit shall be deers d model. ........... ._ _ '' 't '"CONS ns is.cON LENDING AGENCY 1 ' " a ' Ihkforereby hick thatIna 's1 .0(S leading v CI for the perl'orma a ,, t W. i1 r of the work for which,Ms permn,tstssuetl(gee J097,Crv.C 7 "" "- F Lend Name u - .-w ... _._.. . -..-_._..___ .. ..— __ ._ ._. ..-------------___—. ___... .... .._... Isnd Adders �+ 1 certify that 1 have read this epplirotion end state shauhe above mtoemdias k U co"eci.Degree m comply with all city send roun,yiordinancea end atom Iowa relating 4 = Q; mbuilding construetion:entl hcreey eothoriie'representatives of shiscitymen¢r upon ��•a.1 g� she abo a me i 'ed property f m pe do p rpt L.Pi (W)erg eta e d mvtfy and keep harsnless the Cny of Cupenlnh eoamss FFA+. InIwbil t q dgme t,cost nil expo xs h cit may any ry aerie gems aid V City m c nsegm f the 8renung of this pe 1L' APPLIC r, RS NDS AND WILL COMDLY P'Tvc Issued by: Date $Igpamrc of ApplaanuConl cm „- 1, t� Date'I :” Re-roofs I` HA$ARDOUS MATERIAL$DISCI;bSURE 1 I: ;' a°' Nfdl the appldans or futon build ng occupant aware or handle hazardous amenType of.Roof .. esdefinW by th C pen M c p I Coda Ch pm 9 12 d dm He Ith end Saf ry Code Sttu n255T3(a) t -\t\"I It '4 C:L��ka:f.'1 t) i 1 v� All roofs shall_be inspected pnor to any roofing material being Installed. _-_- �. Will Ne aPplicam orf s rebu tiling upem use cquipm �o pev sex which If a roof is iniiiII16dwitinnut first obtainingan'ins eetidn,Fa ree•to'remove iii hasard s u coniam na is m defindd by Ne Bey Area Art Quality Management P g alert"°� 1 _ all new materials f spectlon Applicant understands and veil comply with r ❑Yell - - - neer sen 5taxhe all"non-point so a tons "' 1 h e read the hazardous material r qu rcmenu oder Ch p¢ fi 9la of the / - CdRfo Health&Safety Code S u s25305 25531 d23534 1 de tend that d the W Idm d oZcu" s as¢sent,hat , B Y apo toe lnymna(y the V cup t of iremc h h mus!be to t pit r f t S cy. l• . . .. . .n- Signature f Applicant...._.. ._ _.. . . .. ... _ D to _ Own r �m a erg nt- Dam All roof coverings to be Class "B"or better ........--OFFICE-..._. ... .. .. ._ ....... .. . __. .__._...,... _ . .. .__. .