03100152 CITY OF CUPERTINO �'^"s' > +�
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
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BUILDING ADDRESS: A & H HEATING PERMITNG03100152
6 SEPTEMBER DR
OWNER'S NAME: 770 CHESTNUT ST PERMIT ISSUE DATE
CARLI ARTHUR AND BARBARA 10/21/2003
NE: - (408) 279-0722 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
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I" LICENSED CONTRACTOR'S DECLARATION
ig I hereby affirm that l am licensed under proviviam of Chapter 9(commencing Job DCSCTIPIIon
with Scc ten fyMBaf that I am licensed
N.B Incas and Pmfc.irinshaper9(co menci is _
in mnrr
ad_er t.License
fr
C REPLACE FURNACE
Co.,*
Ar
QQ Iundcrstand my plans shallbeuseJ A.Public rtaerds
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o Liccnscd Proressinnel
s OWNER-BUILDER DECLARATION
1 hereby affirm that ore exempt from the Contractor's License Law for the
.o o following reason.(Section 7W 1.5,Business and Pmfcssions ssiuns CWC:Any city or county
S$ which acquieu a Permit to construct,alter,improve,demolish,or repair any structure 2900
-ZY prior to its issuance,also requires the applicant for such permit to file a signed statement
x< that he is licensed pursuanttothePeavisionsnftheContractor''sLiccnsclaw(Charter9 Sq.Ft. Floor Area Valuation
ZF$ (commencing with Section 7")of Division 3ofthe Business and Patent
nnsCtsJe)or 36214016 . 00
O R.. Nal he is exempt therefrom old the basis far Ne alleged exemption,Any vinlmlon of
Section 7031.5 by any applicant for a perm It ubjects the applicant o a civil penally of APN Number Occupancy Type
not more than Bae handled della.(SSW).
❑I,As owner of IM progeny,or my employcu with wagu As their sole compensation,
will do fee work,and the structure is not im anded or offered for sale(Sec.7144,Buainus
and Profusions Cade:The Co macim's License law does not apply to an owner of Required Inspections
progeny who hullds or improves thereon,and who dmssuch work himselfor through his
own employees,provided that such improvements Are not intended or offered for sale.If,
however,the building or improvement is within one year of completion,the owner.
builder will Mw the burden of playing that W did not Wild or former for purpose of
.it.).
❑1,as owner of the progeny,am exclusively contracting with licensed contractors to
constrcl the project(Sec.7DW,Business and Profianons Code:)The Conaanori LF
mase law does not apply to in owner of property who Wilds or Improm thereon,and
who contracts for such projects with a contractor(s)licensed pursuant o the Contractor's
Litems Law,
❑I am eumpt under Sec. ,B&P C for this..on
1037.0�,()
ner Date
WORKER'S COMPENSATION DECLARATION
I hereby Affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Cenificalc of Consent to self-insure for Worksea Compen-
on,u provided for by Section 3700 of the Lothar Code,far the performance of the
rk for which this permit is issued.
I ban and will maintain Workeri Compensation Insurance,u required by Section of the Labor Code,for the performance or the work for which this permit is issed.
Workcrl C mpenaaOon Insurance artier an��P icy nu eb e f�U� PdlieyNa.; 0y7
CERTIFICATE OF Ls%EMP770N FROMWORKERS'
COMPENSATION INSURANCE
(This section need not bemmpleted Kthe plead is fare=hundmd drilla.(SI W1
leu.)
I salify that in the perrmmonm of the walk for which this Permit i5 issued.I shell not
employ any pe..a In any mMner as at In Weame subject to the Workar3 Gnmp tomfli n
Laws of California.Dote
Applicant
NOTICE TO APPLICANT:If,after making Onto Ccni fcate of Exemption,you should
become subject in the Worker's Com pcnsation previsions of the Labor Cade,ynu must
�O forthwi lh comply with such provisions or this permit shall he decreed myoked.
CONSTRUCTION LENDING AGENCY
I hereby cram Nat there its construction lending gency for the perfwmmlm of '
Y > Inc walk far whim this perms IS issued(Sec.3097,Cm.Ca
Lender.Name
Z Lenders Addle.
C) 1 modify that I brae read Nis application and stare that the allow information is
y contact.1s&=10 comply with all city and county ordinances and soon laws mlaling to
building construction,and hereby authoriS representatives o(NiS city to enter upon the
W 'hove-mentioned property for impaction purposes.
gy es ju agme to cove,indemnify and kith harmless the City of against
against
colZ incoiseque demenu.trading expevaswitch may in anyway accrue against aid City
nce of to trading of this parrit.
^' APPLICANT UNDERSTANDS AN WILL COMPLY WITH ALL ON- INT Issued by: Dale
SOU EREGULATIONS. "1
Re-roofs
signal ,n andatmr
HAZ
defined by NARDOUS MATERIALS DISCLOSUR Type of Roof
Will the applicant tar ruMturc Wilding occurred, mre or handle haaardoas material
Air
e Cupenim, unicipal Code,Chapter 9.12,and the Health and Safety
oJc,Sccdon 25532(a)? All roofs shall be inspected prior to an roofing material bei.
2Yas g� p p y g g installed.
win ar aPpccam or future building occupant use equipment ordcvicas whim If a roof is installed without firs[obtaining an inspection,I agree to remove
indiit hwarfor,air contaminants u defined by Ne Bay Arta Air Quality Management all new materials for inspection.
ct?
byes PaY
1 have scat the hmardnua materials requirements under Chapmr6.95 of dm Califri
it.Health&Sarcty Cud.,Sections 25515,25533 and 25534,1 understand Nell ifthe Wilding
Jo. bol cYRCnl y AAM 0 W an4 a1 Il IS my rmponsibil ty m ro d the 'capanl I the
req eadwni.nmaslbeme, ri' uanmr C.mE to an<y Signature of Applicant Dale
It Ownueamhooled.,let m All roof coverings to be Class"$" Of better
CITY OF CUPERTINO
FURNACE /AC of l
A. ''CUPERTINO PERMIT APPLICATION FORM
1:- APN # Dat
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Building Address:
$G6 S*rF)VBeR. D12. ,
<. ;. Owner's Name: Phone
CA n L ( #
1. Iw 5 - .5-54.3
Contractor: 4 ^/J License #30 Yy,d
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,: Contact: i Phone #:
A, ^'t DALE oC 7 0 7
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I} ji Applicant/Contractor: `'� PS -Ark ( W
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'r iv Building Permit Info:
Bld ' Elect Plumb ech
7^; s Job Description: nn r
Residential: Commercial:
Sq Ft Floor Area: $/SgaFt.:
Architect/Engineer: VaWation:�� _
Type of Construction: Occup ro
Y -
` .. Qty
,.' . lia le Fee ID Fee Descri tion Fee Group
BENERGY Energy BUILIDNG
BREMFURN Relocation of Furnace MECHANICAL
iY
IPAv
i' BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
4t '.
BREMRECEPT, Rec tl, Switch & Outlets ELECTRICAL
t? BSEISMICRE Seismic Fee Res BUILD)NG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit,Fees BUILIDNG
` BPLANCHK Plan Check Fee BUILIDNG
Ak BUSLIC Business License BUILIDNG
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