03110021 CI'I'Y OF CUPERTINO ;
BUILDING DIVISION PERMIT CONTRACTORNINFORMATION
BUILDING ADDRESS: A PERFECT CLIMATE PERMIT NIS 3110021
OWNER'S NAME: 10570 S DEANZA BLVD PERMIT ISSUE DATE
ED LEE 11/04/2003
ONE: (4 0 8) 861-9545 SANITARY NO. CONTROL N0,
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
loo
LICENSEDCONTRACTORSml
R'SDECon,ofcON JobDescri tion
1 hereby affirm Inas I am licensed under provisions nr Chapter q ommcncing P
zj with Scmion7 ionJo(the Oosimes � ssir d�ar yliccnse is
,�H in mumrceu d r 6 P ACE FURNACE
p VJ Z Liccnac P Lic.M
n t� Da1C T'S D CL
A HITECTS DEC f
< I un crsta my plans shall Na used u pub is records
)c
a C Licensed Pmfcssinnal -
g OWNER-BUILDER DECLARATION
COI hcrchy affirm on 1 em cusin from Bobe Contractors Co License Law for the
COO which
ream..(Section 7071.5.Business and improve.
de nm h,no Any city s county
$ which requires a Permit m cnnslmcl,alter,imprnw,demolish,no repair any awemm 4 016
u�m prior In its issuance,also requires the applicant for such Permit file a signed statement
that he is licensed pursuant to the provisions of the Correctors License Law(Chapter 9 Sq. Ft. Floor Area Valuation
iFte (commencing with Section 7")of Division Jnr the Bu.imasand Professions Cmk)ur
y $ Nat he B Nc
exempt tefmm and the basis for the alleged exemption.Any violation of 35614024 . 00
Section 7051.5 by any applicant for a permit subjects the applicant to.civil Penally of APN Number Occupancy Type
not more than five hundred dollar,(SICK).
P Y YP
C]I,as owner of the property,or my employees with wages as their rete compcnsadon,
will do me work,and the swctum is not intended marginal fouale(See 7054,Business Required Inspections
end Professions Code:The Connector.Limine Law docs not apply to an owner of q p
property who milds or improves Nemon,and who does such work himself orthrough his
own employees,provided that such Improvements are not intended mothered for sale.It.
however,to building or improvement is sold within one year.(completion,the owner-
builder will have the burden of proving Nat he did not build or impress for purpose of
❑1,as owner of to property,am exclusively contracting with licensed contractors to
contract the project(Sec.7044,Business and Professions Cade:)The Contractor's Li.
come law docs not apply to an owner of property who builds or improves thereon,and
who contracts for such pmjeco with a conuanor(s)licensed pursuant to the Conloclors
License Law.
❑I am exempt under Sec. B A P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations: -
1 have and will maintain a Certificate of Consent to self imurc fur Worker'sComper-
sati , provided for by Section 5700 of Ire Iabm Code,for Ne performance of the
we (or which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
] the labor Code,for the performance of the work for which this permit is issued.
My War re 'o Inti Ice carrier and Polign h a
Carrier: Polity No.:
C RTIFICATE OF F.% (TION FROM WORKERS'
COMPENSAT NINSURANCE
(Th0 umbo.need not Wcomplcmd if the permit Is for one hundred dollen($10)
or less.)
I cenily,that in the performance of the work for which this Permit is issued,1 shall not
employ any person in any manners as be become subject to the Workeri Compcnsadon
Laws of California,Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
.JO foMwi ih comply with such provisions or this Permit Nall lc deemed mvokad.
Z M CONSTRUCTION LENDING AGENCY
;+ Ihereby affirm that there its conmvmion lending agency lot the performance or
7.zInc work for reathis permit is issued(Sec:J30)7,Civ.C.l �✓
Lender's Name
Z Lenders Addrtsl
J Q 1 certify Nat I have mad this application end sole that the above information is
F correct.i agree to comply with all city and county oNinances and stale laws misting to
�O building convection,and hereby authorim repesenotiws or his city m enter upon the
C above mentioned property for infection purposes.
(We)agrte to w,indemnify and keep harm) the City Cupcnino against
.Fi h liabilities,judgmenm. sin and expenses whim m. many way.acme cion mid City
U> in consequence of t STbago Permit.
�r APPLICANT U E STAN A WILL IMPLY I A N� Issued by:
SOURCE REG AT NS.
Re-roofs
Signmumor Applican Co Tamm Dem
RDD MA ALS DISCLOSURE Type of Roof
Will the appli or building occupant or handle ha.udeus materiel
az defined by Ne Cupenine 'cipal Cede.Chapter 9.13,and the Healm end Safety
Code,Section 25553(a)? All roofs shall be inspected prior to an roofing material beim
❑Yes N P P Y g g installed.
Will Iheapplicant /rotor in occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
iI hv.amn.a air canmmmanm do r d by the Bay Aura Air Quality Management all new materials for inspection.
uicl?
❑Yes
I hove mal the havaN smawls, yuimmemsunder Chapter 6.95 of the Califoo-
Iia Health I Safety Cmk,Seedon 25N JJand2555a.lundenlard thmifthe building
dem not currently have a tenant,th I my rex 'M1ilily m nodl'y Ik urc peel the
requirements which must w met ort issuanc ora enifcamof cu Signature of Applicant Date,
Owner or sum '.oda D„e All roof coverings to be Class "B” or better
CITY OF CUPERTINO Z/
FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN # 3r Date:�� � 0
Buil
P�ddr�s:
Ow[ s Name: P 'ne
C c[or: �1 Ph Lice
Conta C Phone: Cupertino Business License #:
I
Building Perrnit'Info:
Bldg ❑ Elect Plumb ❑ Mech
Job Description:
Residential Commercial ❑
For Rg�idential Inkia llations:
Attic LJ I" floor LJ 2"d floor❑
• Adhere to min set back requirement E]
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required []
Co t of Pro'ecS Typei of Construction: Occupancy(grou
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Moor Area:
New Location ❑ Re lacement
Q . if
A li a e Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAHU-AN 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
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