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03120127I a F4QF 5= L �Fgggg' >6u yLL� 03 �00 i� z z Q a> Oil D. A aZ UO OF Fa r h W 575 C i CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTnR1INFORMATION'•' BUILDING ADDRESS: A PERFECT CLIMATE PERMIT No03120127 OWNE0.'S NAME: PERMrf LciSUE DATE oll ONE: SANITARY N0. ONTROL NO. C S 1- ARCHITECfIENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION IOU DDSCI'I I herehy an. that 1 am licensed under provlaians or Chapter 9 (commencing p tion with Section 70(X4 'sic o(thc Business Ad Prufcssiom ClJ9,a licenseis In full mase nd lets CCOO Licen I Lic. / REPLACE 2 FURNACES ' Date Conuazmr FiIi4LE® XITCCTS DECLARA 1 N - 1 and rxtend my plans shell be recd m public meorda - FES' 1 6 2004 LicensedPmrassmaid OWNER DECLARATION BUIexempt m fr 1 hereby .(firm that I em cxcmpt from rho Cssions os License law for the ' following mason. ns Cnde: Any city or county lar 1.0. Business and Professions permit 1 dmi mr any amueeum Which myuha a permit re construct, alma imprnw, demmnit prior in its issuance. t fie a sig Nara ensedpalso Myo the thevision of for such Conpermitmicessignednatemem pursuant License Law (ChapterCoda) of Sq. FI. Floor Area - Valuation mcneccnsed (commencing with Section ? W00)of Division 3 e 8 usitema lation or of Division J of Me Business and Pa. is campy Nem from and Ne baso for Nu and Any vi ed eamptlw. Any violation of be cts Section on LSbyaundredicaMfonpetmiuubjttuNeapplicanno,civilpenaltyof 3419"MMll cr00 Occupancy Type M03 not not mom Nan nw honored aauan (6500). P y YP ❑ 1, es owner of the property, or my employees with wages As their sole compensadan, will do Ne work. and Neawcmm is not intended or offered finale (Sec. 7044, Business and Peofamians Code: The Cowacmrs Liam( Law does nut apply to an owner of Required Inspections property who builds or improves thereon, and who does uch work himself or Nmugh his own employees, provided that such improvements arc not intended proffered formic. If. however, Ne building or improvement is sold within one year of completion, Ne owner. builder will hers Ne buNen of proving that he did not build or improve for purpose of sale.). ❑ 1, as owner of Ne property, am exclusively contracting with licensed contractors to , coNlmce Ne pmject (Sec. 7044, Bminam and Professions Code:) Trac Contractors Li. croup Law docs not apply to an sncr of property who builds or improve thereon. and who commute, for such pmjccu with a contractor(s) licensed pursuant to Ne Contractors - License Law. ❑ 1 am exempt under Sec. B & P C for this mason Owner Data WORKER'S COMPENSATION DECLARATION I hereby of on under penalty of perjury own of tie following declarations: I have and will maintain a Cenificam of Consent o self -insure for Workers Comped. xenon, as provided for by Sce ion 37W of Ne Labor Code. for Ne perfnrmance, of the rk for which this permit is issued. have and will maintain Workeh Compensation Insuraoce, as reyuimd by Section 37 of Ne labor Code, for We pertormatt o(Ne wart fm which Nis permit is issued. My Worke on nation Imumnse artier end Policy nu r art' M Cartier, Polley No.: t CERTIFICATEKE ON FROM WO EI COMPENSA INSURANCE Mos Menem Need not he completed if rte Permit 1, form= hundred dollars (SIM) nr kes) I certify that in the performance of the work for which this Permit is isswd. I shall not employ any pm oson In any Mannar an as to become subject to tint Warkers'Coropensatlon - Laws of C.lifMNA. Date Applicant NOTICE TO APPLICAN .. If. °fair making this Certificate of Exemption, you should become ahjcet to the Worker a Compamation pmvision, or the Labor Code, you must forthwith COMPLY with such provisions or this Permit hall be deemed revoked. CONSTRUC71ON LENDING AGENCY 1 hcrehy a(rrm Nat Nem its coMtructinn lending agency for Ne Performance of Ne work for which this permit Is issued (Sm. 3097, Civ. C.) Ixodes Name Underi Address 1 milify'Mat 1 have read this application and sum that Ne above infoematiun la correct. I agree m comply with all city end county ordinances and state laws relating to building construction, and hereby authors representatives of this city to enter upon the pugwses ahuvc-mentiuncd propertycosts (We) agree to saw, indemnify sod keep harmless Ne City of Cupertino against land AXP AIMnspection liabilide;judgments, eaats,nd upense, which may in anyway acerae against Mid City M consequence of a Stenting of this permit. &, APPLICANT U F-RSTANDS ILL COMPLY WITH ALL NON -POINT Issued by: Date ( I SOURC34�� E RE IONS. Re -roofs Type of Roof tumor plic for am' HAZAR ATERIAIS DISCLOSURE Ne applicant or future building wearer, iron or handle hmardous mamdai as defined by the CuMnino Men ode. Chapter 9.12, end the Health and Safety 255J2(a)? Code, El yes ❑tics Nu All roofs shall be inspected prior to any roofing material being installed. Will tc app' ant or rota building occupantusey equipment of which larim? If a roof is installed without first obtainingan inspection, I agree to remove P - g aircwmminants dcfinc0 by the Oay Area Air Quality Management A Marta all new materials for inspection. iet? ❑tics ❑ I hawread thehamolousma ialsmquimmcnuundct Chapmr6.95ofde Califor. nu Heahb&Safmy Code,Sccdwe25 25533.,,125534.1 undcrsmnd Nvif Ne Wilding does not curtendy how ask the, ie u ihillty ad badly the occupant or the yairements wni<n at he reap m issund o aceniram orawp ay. j Signature of Applicant Date All roof coverings to be Class "B" or better owbm mazr ',<d agent, oa • 0 • cm of CUPERTINO CITY OF CUPERTINO FURNACE/AC b3 Z 1-7 PERMIT APPLICATION FORM APN # 3(-2_ / `Z O 6 Energy Date: Z Building Address: 99(025t'2V✓1 {ems Relocation of Furnace Owner's Name:-' Phone #:., Conte ctor: Phone: c se #: BREMAIRHAN 7 Contact: Phone: Cupertino Business -License #: Rec tl, Switch & Outlets ELECTRICAL Building Permit Info: Seismic Fee Res Bldg ❑ Elect Plumb ❑ Mech Job Description: pkc e v,C;LC� / MPERMITFEE Mech Permit Issuance Residential j3/ Commercial ❑ PPERMITFEE For Residential Insa Mations: PLUMBING Attic ❑ 1" floor LJ 2nd floor ❑ Bldg Permit Fees Adhere to min set back requirement ❑ BPLANCHK For Commercial Installations: BUILDING Replacement same weight ❑ Additional weight (structural tales) ❑ Business License Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ CQSt of Project: o) Type of Cons cin: Oce p r Strapped LJ On Platform ❑ Bonded ❑ Sq,Ft. oor Area: New Location ❑ Re lacement � 11 Qty. if Ap4lica6t\ Fee ID Fee Description Fee Grnnn 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