04080132 i
CITY OF CUPERTINO "'
r. I
BUILDING DIVISION PERMIT CONTRACT,(lR INFURMATION
a
BUILDING ADDRESS: SCHAUMANN AIR CONDITIONING,
PEIeMRND.04080132
OW191 qTARRORD IDR.
NER'S NAME: PERMIT ISSUE DATE
ONE:
SANITARY OL N0.
i
ARCHITECTIENGINEER: BUILDING PERMIT INFO
E MECH
+)ori LICENSED CONTRACTOR'S DECLARATION O i
p 1 touch, from that I un licensed mule,providom of Clupmr 9(rommencing Job DeSCrlptl0
n� with Section 7")of Division 3ofthe Business and Professions Code.and my licence is
in run force and effect.
5 i ucenmClasa Liar REPLACE FURNACE ADD A/C AUV Al 2004
Dam Contractor :I
O� ARCHITECT-S DECLARATION BUILDING
®I r
Y 1 understand my plans shall W used as Public recruits
'0 Licensed Pm(cainnel
5 OWNER-BUILDER DECLARATION
.� F 1 hereby affirm that I am exempt from the Comraaoes License Law for the
cc following mason.(Scof 7001.3,Business and Professions Code:Any city or county
$ which requires a Permit on ennstruct.alk,.Improve,demolish.or¢pair my snetum
prior to its issuance.also requires the applicant for such panni,to file a signed statementS
pp G thin M is licensed pursuant to the provisions of me Conuacmr's license law(Chapter 9 Sq.Ft.Floor Area Valu ti-n ,
C� (commencing with Section 70M)of Division 3 of the Business and Professions Cak)or
$ that he is exempt therefrom and me buil for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the optical o a civil penalty of 3 0279# fA eJ O 0 Occupancy Type
not mart Nan 0w hundred dollars($300). •)
❑I,a owner of the property,tar my employees with wages as onto=is compensation,
will do the work and the struc,usc is not intended ornf(ercd for sale(Sec.7044,Business
and Professions Code:The Contractor's Licence Law it.not apply to an nwnar of Required Inspections
Property who builds orimproves thereon,and whodwssuch work himsef orthrough his i
own employees,provided that such improwmenms arc not Intended in offered for We.If.
however,the building or improvement is mid within one year of completion.the owner.
builder will have the burden of proving that ha did not Wild w improve for purpose of k
al.j.
1,as owner of the property.em exclusively contracting with licensed contractor to
construct On projem(Sec.7014.Business and ftmarmu Code:)The Contractor.U.
center law dors not apply,o an owner of property who W ills or improves thereon,ad
who convects for such projects with a contractor(s)licensed puraam ro Ne Conwctori
License Law.
❑len. pl under See .B k PC Emmis recon "i
Ow r Da
K R'S O 0 CLARATIO M
1 hereby affirm under Penalty of perjury rim of tha fallowing daclanliou:
1 have rind will maln.in.Cenifiaa df Conant to alblnsum for Workers Creation. i
motion,a provided for by Section 37011 of the Labor Code,for fie performance of fie j
work for which this permit is issued.
❑I hart and will maintain Worker's Compensation Ina ena,as acquired by Section
37W of the Lime,Cade,for the serfdmonm of the work for which this permit is hissed.
My Worker'.Compenadon Instance artier and Policy number arc: I
Cartier. Policy No.: i
CERTIFICATE OF EXEMPrION FROM WORKERS' 17
COMPENSATION INSURANCE
of issection nmtl not W completed if the permit Isfnrono hundred dollars(SIM)
CC Ica.)
I certify that in me per i mtanee of the work for which this permit is issued.I shall not
employ any person in my manner an as to become abject to tW Worlu n'Compensation
Laws of California,Date
Applicant
NOTICE TO APPLICANT:IL after making this Ceniftclm,of Exemption.you should
become subject in me Workers Compensation provisions of the Ice Wr Code,you mum
,JZ forthwith comply with such provisions or this Permit shall be deemed revoked.
„'Z,tO CONSTRUCTION LENDING AGENCY
F^ I hereby 4MM that mart is it common inn lending agency for me Performance of
G'> the work for which this permit is Wood(Sec.301 Civ.C.)
fy 0 Lenders Name
LcnJera Addma
U(] I ttnlly that 1 have mad this application and sole this the.bow information is
U. F ennttL I.gree m Comply with all city and county oNlnanas and some lan missing t0
0 building construction,and hereby sutbosive representatives drums city to color upon me
W above-mentioned publicity for inspection purposes.
(We)ague in sew,indemnify and keep harmless the City of Cupcfino against
V
liabilities,judgments.Co..fund expenses which they in any way...against aid City '
nscipsence of dam granting of this
U Z APPLIL Z UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date i
SO R REGULATIONS.
Re-roofs
t u o Applia'fam0 for Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle harmonious material
M donned by me Cupertino Municipal Code,Chapter 9.12,and the Wallis ad Safety
ode.Semon 2553298 All roofs shall be inspected nor to an roofing material being
C]yes
cit P P Y g g installed.
Will do applicant or future building occupant use equipment dr devices which If a roof is installed without first obtaining an inspection,I agree to remove
h hdvardous air conumimnu ss defined by On Bay Area Air Omlity Management all new materials for inspection.
istnct7
❑Yeses
I have mad the haaNnus materialsrequiremem3 under Chapterd.95 of the Calimry
ria Halm b.Safcty Code,Sections 25505,25533 and 15534.1 undermand thuiftM Wilding
does not currently dent a mount.that it u my responsibility m notify the aeupant of the
nequlrcmcn.which most x atpnull useeanf.camna 0facupancy. Signature of Applicant Date
n mammorivndagent D� All roof coverings to be Class "B" or better
Community Development
10300 Torre Avenue
:
CITY OfI Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: W4A LLe�t�2— PH NE #
GENERAL CONTRACTOR: rj U FAX #
C
I am not using any subcontractors: 1 ry�,d Qpm i g
V Signature Date
Please check applicable subcontractors and complete the following ' ormation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
• Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
a CITY OF CUPERTINO
FURNACE/AC bZ—
UUPERTINO PERMIT APPLICATION FORM
APN # 7 0 Date:
Z-
Building Addres§�0 ,
Owner's Name: Phone
1 LL *D
Contractor:
Contractor: Phone: License#:
C '
ContaFt: Phone: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Descriptio:
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1" floor ❑ 2"d floor❑
AIiiikkdhere to min set back requirement❑
or Commercial Installations:
eplacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New ingta.llation Planning Appr@y#12Zequired ❑, —
Cos V: Type of Cons Occupancy o
Strap ed ❑ On PYform ❑ Bonded Sq.Ft. Floor
New Location ❑ Replacement ❑
Qty 'f
A ica le Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 c$n MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMTTFEE 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 Licensej BUILDING