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03050153C CITY OF v BUILDING DIVISION PERMIT MI -ON . BUILDING ADDRESS: 0180 RTVTFRA Rn PERMIT NOD 3 0 5 015 3 OWNER'S NAME: "Sb PERMIT 13aU£AA7'B, 0/ z D D 3 5'AN ZUO )NE: SANITARY NO. CONTROL NO. ARCHITECTrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB hil 0 0 0 LICENSED CONTRACTOR'S DECLARATION I homey alOmt Ihet 1 am licensed under provisions of Chapter 9 tomenta ming Job De O n ��Q ,� with nese; Bneas and ProfesNom Code, and my license Is Section 70110) oM ilison 3 of liBum �`� in fell fora mde@w REPLACE FURNACE & A/C License Cies Lte. g Dam Contractor JUN 2 3 2003 ARCHITECTS DECLARATION 1 undersand my salute alull be used u public mcerds BUILDING Licensed Professional DECLARATION Oat 67 I..IJ Ltl VI UIL DI NICs lam CUILDER I hereby .(Sere that 11. exempt from tM License law for Illy following mason. (Section 7(171.5, Business and fmiturs Co encou Cade: My city or county Improve, which imu nes a permit to ennrwet alter. Improv, demolish, or repair ally simcwm prior he its iuuame, also "ones IM applicant for ouch Permit to file a signed statement then he is licensed Penman' in tho provisionsnf the Cmducure, License law (Chapter 9 Sq. Ft. Floor Area $4MOGOon (commencing with Section TOM) of Division 3 of the Business and Professions Curie) or that M h eaemin therefrom and the bash for the alleged c tereption. Any violation of 3 MIR ®et 0 0 Occupancy Type Section 7031.5 by any applicant for a Permit subjects IM applicant a a civil pally of not mom than five hundred dalhn (5300). ❑ 1, u awnv of tM proprny, a my employees with wage u their rely tompenution, — MODS will do tite aeric and Ne amucturt hnotintendedmaRemd fmnsale (Sa.]OM, Businev301 and Professions Code: TM Cuouacmr's License Law does not apply Ire ,n owner of property who builds or improves theme, andwho doessuch work himselforthrough his 3 ROUGH 3 0 - L own employees, provided Net such improvements art notinterded mo@red for We. if. 304 — ROUGH ELECTRICAL however, the building or improvement is sold within one year of cempledon, the owner. builder will have W burden of proving that he did not build or improve for purpose of 505 - FINAL ELECTRICAL cel`')' 507 - FINAL PLUMBING I, u owner of the property, am exclusively convecting with licensed contracmn in 508 - FINAL MECHANICAL o tram the projem (Sec. ]016, Business and Imitations Code:) The Contrseur's Li- Genu law does not pply in an owner of property who build, or impreves theme. and. aha contracts forsmhp 1tswIII,tramentI licensed pursuant m lite ConmacmM1 . License law. ❑ 1 em nem t untl r . B & P C for reason 1this Ow Date o�0 V CER COMPENSATION DEO RATION I hereby aiDrm under natty of perjury one of the following decimations: I have fend will mein eNfiwum(Cansenuo self-Inmmfm Workeh Compcm ntl.n, an provided for by Section 3700 of the labor Code, for gte performance of the work for which this permit is issued. ❑ 1 have and will maintain Worimes Compensation humance, as required by Section 3700 of the lobus Code, for the performance of lite work fm which this permit is issued. My Worker', Compensation Insurance carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Tfb r union mod not be completed if the Semen is for mnchundmd dollaa($100) or I.0 1 amfy that in the performance of the woh for which this permit is Issued, I shall not employ any person in any manor an u he Immune subject to lM Wodmn' Compemtion Laws of California. Dale Applicant NOTICE TO APPLICANT: IL after making this Certiftcaue of Exemption, you should become aubjm in the Worker', Compensation provisions of the ISMr Code, you muse forthwith comply with such provisions or this Permit shall k deemed revoked. CONSTRUCTION LENDING AGENCY 1 bermy a0irm that them is a construction lending agency for the pesfmmance of the .,it for which this permit is issued (Sus. 3097, Civ. C.) Lmde's Name Lender's Address I certify that I have read this application and fete that the above Information i, ' correct l agree to comply with all city and county ordinances and slate law, relating to building construction, and hereby autronic representatives of this city to enter upon the above-mentioned property for Inspection forearm (We) agree m save, indemnify and keep harmless the City of Cupertino against lubilidea,judgmcnh,eo despe. which may in say way accrue against tend City incones Lienee of he ng of this Permit. APPLI NT UND NDS AND WILL COMPLY WITH ALL NON-/POINT Issued by: Date SOURC REG T 9 ) 01 1 Re-roofs u o A VC sur Dale NAZA Ug MATERIALS DISCLOSURE Type of Roof asmaterial WIIbythe tum Wal Cumntm u de, tM Cupertino unicipal Code. Chapter 9.@, and the Health and Safety odc.ChantuomaMrbla Health Section ec io ode, (:]Y nzss3x( ❑Yes �N. All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will thy applicentor future building occupant use equipment or devices which it hazardous air contaminants as refined by tM Bay Arta Air Quality Management all new materials for inspection. Diurict7 v� �s ❑Yes YIN. I have mad the y crosritaterials requimmenu under Cha pum6.95oftMCalifor. A7� ons 25503.25333 am12553a.luMcmaM thuifdte building nh Hffaut does uiu elpriormissumccofaceniftcalcofOccu,nry.Signa[ureofApplicant Date S loegern All roof coverings to be Class "B" or better Date 0 '! • • S CRY OF CUPEZTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM APN # O� J p ?� Date: I b I o 3 Building Addres : 03$o R,vieVe, Poacl , (A. 9SD14 BREMFURN Owner's Name: 'd e a �Zu D Phone #- 408- 526-4.4.2 :7eav� Contractor: Phone: Jim Swl n 1-1,2S--1 6 6- 8 38 License #: Contact: Phone: I Cupertino Business License #: Building Permit'Info: MECHANICAL Bldg E/ect Plu mecv?Q� Job Description: BSEISMICRE po-Okp-M old FWMCkCQ C - BUILDING Residential R Commercial ❑ Elec Permit Issuance For Residential In tallations: MPERMITFEE Attic ❑ 151 floor LA 2"d floor ❑ MECHANICAL Adhere to min set back requirement ❑ Plumbing Permit Issue For Commercial Installations: BPERMFEE Replacement same weight ❑ Additional weight (structural calcs) ❑ BUILDING Structural Calculations required for new installation ❑ Plan Check Fee New installation Plann Approval Required ❑ BUSLIC oject: Type of Construction: �b Occupancy o S ap ed ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: ElRe 34o)' New Location lacemenp�, Qty. if / Ap��ble Fee ID Fee Descrintion Fee Grout) BENERGY Energy BUILDING 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 BUILDING 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 License BUILDING D