03090245 lL'IPY OF CUPEWHNO
BUILDING DIVISION PERMIT "ONTRA TOR IN,F�ORRMA�TIO ,,
aU
LDING ADDRESS: A PERFECT CLIMATE PERMIT NO 03090245
OWNER'S NAME: 10570 S DEANZA ]BLVD lssuE DATa
CNE: (408) 861-9545 SANITARY N0. CONTROL N0.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
I0, LICENSED CONTRACTOR'S DECLARATION
1 C I hereby affirm rhes I am licensed under provision of Chapter Y(commencing Job D1n[[Op���®
.to Ow with Sermon7,1= f is Sof NCBusincoVP i s yliccnu i, ■y pp��■
s in full fnrec Dort If
iq� Llan I , t Lie.a PLACE FURNACE
p Dau Commcmr u1 O ff 20(4
to
ARCIIITCLTS DECLARAT N V as W
w I u JeratanJ my pions shall he used as public records
.o
u. Licensed PrOheoonal �1
30 OWNER-BUILDER DECLARATION BUILDING
<8 I hereby m'frm Nal I am cacmpl form the Conuanar'+License Law for the
p o following mason.(Section 703 IS,Business and Professions Cow:Any city or county
S_0 E which requires a permit to ennsuun,alar,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to rile a signed statement
7�a that he is licensed p....a,bs the provisions nf,hc Cmaraemr',License Law(Charter 9 Sq.Ft. Floor Area Valuation
2�$ (commencing with Section 7")of Division 3 or the Business and Profession Cndcj ser
Nat he is exempt thcmfrom and the basis for the e11a,.d amorph on.Any v..laion of
Section 7031.5 by any applicant for a permit subjects Or applicant to a civil penalty of APN Number Occupancy Type
not mom than Ew hundred dal Is.(S5W). p y YP
❑1,aowner of the pmperty,or my cmploycu with wegesu thelnolc compensetlon, �T?�Ap�?��
will do the wor"ad the swmum is not intended.,offered fonaie(See.70",Business 3 1 - ROUGH ]� WTCB dit��eCtlOnS
and Professions Code:The Contractors Lies se Law dose not apply to an owner of
property who builds or improves darream and who doessuch work himaelfor through his 303 - ROUGH M CHANICAL
own employees,provided Nat such improvements are not Intended or offered intrude.It. 3O4 — ROUGH ELECTRICAL
however.the building or improvement is mid within oro year of completion,the owner
builder will have the burden of proving Nal he did not Wild or marrow for purpose of 505 - FINAL ELECTRICAL
sale.). 507 - FINAL PLUMBING
❑ 1,as twee,of ct pmp¢ny.,Business s and convecting with Code:)The
t.
came La the es not (Sec,nano wer end Professions ds or i The Contractors Li 508 — FINAL MECHANICAL
who c Law docs not apply to an owner of pr.peny who builds or improve thrown,and
who contracts forauch projects with a contrutar(+)licensed pursuant to Uu Contnclors
License Lew.
❑1 am enempt under Sec. ,B&P C for this mason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under perally of perjury oro or the fallowing declaration:
1 have and will maintain a Cenificnu of Consent to ulf-inum for Worknh Camino
union,as provided for by Section 37W of the Labor Code,for the Mrtmou n e or the
k for wM1ich Ni+permit is issued.
haw and will moinmin Workch Compensation Insurance,as required by Section
X",
the Labor Cork,for the performance of the work for which this permit is issued.
ode rope sari own ea end Policy nu r
Carrier: .licy No.:
ERTIFICATEOFEXE ONFROMWORKCRS'
COMPENSATION INSURANCE
(TMs section need not ke completed if the Permit is for one hundred dollars(5100)
fir less)
1 cenify Not in Nc Performance of the work for which this Permit is heated,I shall not
employ any person in any manner w as to become subject to the Worker,'Compensation
Laws of Celifnmia.Data
Applicant
NOTICE TO APPLICANT:IL after making this Ccnirinm of Exemption,you should
become subject to the Worker's Compensation pmvi+ion of the Labor Cole,you must
D O forthwith comply with such provisions or this Permit shall k decreed mated.
Z N CONSTRUCTION LENDING AGENCY -
I hereby affirm Nat Vert is a conswctinn lending agency for tW perfurmanm of
Y, F�-t Nc work for which this permit 1,issued(Sec.3097,Civ.C.)
4 Q Lenders Name
Z3. Lenders Addhea
C 1 certify Nat I have read this application and two,that the.bow information is
1. Fcored.I agree to comply with all city and county oNinana,and sou laws relating to
V building construction,and hereby sulhodm opmeunuttw+of this city to came upon that
Uabove-mentioned property for inspection purposes.
(We)agree m save,indemnify and keep hannlcu the City of Cupertino against
fq liabilitiu,judgmcnu, to and eapereas which may in any way eccmc againu said City
z in C.O.qucncc oft ranting of this
APP ANTU RST A OMPLY WITH ALL NOV-POINT Issued by: Date
50 CER TIO
Re-roofs
Signature ofA I'ant,Cantrutor Oe
HAZARDOUS MATERIALS DISCLOSURE Type of ROOf
Will lheapplicam or lm bto ing.ccvput nom ar handle harardou+mamdal
u defined by the Cupenim,P1u dial Rode.Chapmr 9.13,end the Health and Safely
Code.Section 35533(e)?
❑Yc, No All roofs shall be inspected prior to any roofing material being installed.
Will rite applicant fir(wore bat' ng occupant tau cyuipmcnl or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it ha®rdous air contan, fined by Ne Bay Amo Air Quality Management all new materials for inspection.
oriel?
❑Yea Nu
I have mad the hazardous material,mquimmenotook,Chapter 6.95 of the Calif.,
nix Health&Safety Code,Sections 25505.8533 and 355341 undermnd that if the Wilding -
does not currently have a unan It is my ock unihility w noddy the mmvpwt of the
���Icquircmc/,�/yhwh mom/ee n , zona.(.Ccnirua aan Signature of Applicant Date
� All roof coverings to be Class"B"or better
�w orized cnt�omcd em
' F
CITY OF CUPERTINO z 5�
FURNACE/AC o 3J 7 o
CUPERTINO PERMIT APPLICATION FORM
APN# 3sri- I b0 l l Date: c�7 I
Building Addres : 05,qR SQGAA
l (CJJ
Owner's Name: In lX P o oY e#:
ko
Ivr I as�-
Con actor: PWe: ( I` Li nsej� S
Copct,, hone. Cupertino Business License#:
Building Permit fo:
Bldg ❑ Elect V Plumb ❑ Mech
Job Description: IGCQ 111,.P VA'S by e
Residential Commercial-k
E]
For Rg5idential I Ilations:
Attic u 1S1 floor 2nd floor❑
Adhere to min set back requirement❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structuralEl calcs)
Structural Calculations required for new installation
New installation Planning Approval Required
CostPr ect: Type of Construction: Qc1cupa�ygroup:
Strapped ❑ On Platform ❑ Bonded LJ Sq.Ft. oor Area:
New Location ❑ Re laceme
x,
Qty.jf
A 1 Fee ID Fee Description Fee Group
BENERGY Ener 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
EPERM=E Elec Permit Issuance ELECTRICAL
MPERMPI'FEE Mech Permit Issuance MECHANICAL
PPERMIfFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING