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CITY OF CUPERTINO
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TRACTOR INFORMATION:
BUILDING DIVISION PERT
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BUIL ADDRESS:
PERMIT NOO 5 0 8 019 2
20DING
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OWNER'S NAME:
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PERMIT ISSUE DATE
HOUSE OF SECHUAN
08/19/2005
ONE:
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SANITARY NO. CONTROL NO.
ARCHITEC (ENGINEER:
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BUILDING PERMIT INFO
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LICENSED CONTRACTOR'S DECLARATION
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Chapter 9 (commencing
1 hereby affiN1 am licensed under provisions of Chap
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with Salon 7000) of Division J of de Business and professions Code. and my license is
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5 TON A/C
uccn' 0 Lk. M 4 �t 2-
Date Conuamf
CONTRACTOR: HARD ROCK HEATING CO.
C ftp exu ATION
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rwmy s i�cm puhliRme
C.1.0lodProfeaamNl
OWNER -WILDER DECLARATION
I hereby affirm that 1 am ucmpi from the Contractor's License law for the
following mason. (SCedon 7M 1.5. Business and Professions Code: Any city or County
which mquirw a permit to construct. Act. improve, demolish. or repair any structure
pd., to its sanuaae, a@o requires the applicant for such permit to file aligned Ailment
that he is licensed froomottoACprovisions ofthe ConuacturiLicense Law (Chapter 9
Sq. Ft. Floor Area
Value 500
(commencing with Section 7") of Division 3 of the Buinessand Professions Codc) or
that M is exempt Acmfrom and the bub for the alleged eumption. Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
finhundred dollars
APN Number
Occupancy
p y Type
not mom than ($500).
31623093.00
Q 1, as owner ofthe pmpmy, or my employees with wages as their sole compensation,
will do the work. and Ne mrtetum is not intended oroRered forms. (Sec. 7044, Business
and Prefessiou Code: The Conmcmrs License law doss nut apply l an owner of
Required Inspections
property who builds orimprows lemon, and who doessuch wurkhimselforthrough his
own employees, provided that such improvements are not intended eroaered forsale. IL
howcwr, le building or imprevement is sold within one year of Compla6m. the owner.
builder will have the burden of proving that he did not build or improve for purlwe of
sale.).
0 h u owner of de property, am eaclusiwly contracting with licensed contranoe to
construct the project (Sec. 704,4, Business and Professions Code:) The Corrost U-
se law does not apply to an owner of propeny who wilds or improves lemon. and
who contracts for such projects with a convactor(s) licensed pursuant in use Contractors
Licence law.
p lam ae tun er Se APC for this moon
Owner• —� Dare
RKER s C�� 4PENSATION DECLARATION
1 hereby affirm antler laity of perjury ane of the following declaradom:
_
1 nam and will maintain a Certificate of Consent to self -insure for Workers Compen.
sation, as provided for by Section 37W of the labor Code, for the performance of the
work for which this permit is issued.
t] I have and will maintain Workers Compensation Insurance, as tcquired by Scction
3000 of the tabor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation insurance carrier and Policy number ae::
Carrier. Policy No.:--
o.:_CERTIFICATE
CERTIFICATEOF EXEMPTION FROM WORKERS'
,
COMPENSATION INSURANCE
(This scrim need not beeomplmed trim permit is Intone hundred dollen (5100)
or Itis.)
1 cer Av that in the performance of the work for which lis permit b issued. I shall not
employ any person in any manner an as u become subject o the Workers'Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Ccnifinu: of Eacmption, you should
become suhject to the Worker's Compensation provisions of the tabor Code, you mut
feMwith comply with such pmvisiom or this permit mall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that ft. is a mnslaninn lending agency for the perromunce of
thc work for which this permit b Dump (Ser. 3097. Civ. C.)
Lenders Name
Lender's Address
1 certify Dist 1 have read this application and Aute that thc anew information is
COMM 1 Agra to comply with ell city and county ordinances and sate laws mlating to
'
building conswcDon, and hereby mAodm mpmwnunives of this city to enter upon the
above-mentionedproperty for inspection pulpwhich cs
(We) agree m saw, indemnify and keep harmless the City of Cupertino against
liabilities, jutlgmcnts, costs and expenses which may in any boy accmc against said Cly
inconsequence of the 8 ing of is permit
APPLICANT UNDER AND AN L COMPLY WITH ON -POINT
SOU GULAT NS.
V
Issued by:%V� Date �J �9
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Re -roofs
Sie are or ApplictroCoMoscusiraic
HAZARD MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant store or handle hanrtlaus material
as defS by the Copenino Municipal Code, Chapter 9.12, and the Health and Safety
Code.
�}cs cation 23532(,>? ❑Nu
All roofs shall be inspected prior to any roofing material being installed.
/Will the applinnt or future wilding Occupant use equipment in devices which
If a roof is installed without first obtaining an inspection, I agree to remove
it hanaomaa air contaminants as tk6ned by the Bay Area Air Quality Management
all new materials for ins eCllon.
vitt?
❑Yes ®No
I have rovl the no. it. auris}s myuimmcnts-met Chapter 6.95 of thc abfrl
doHwlth6Safety Cotle,Savo 255))7253Jon, ]5�at33i.I undenly tui ding
docs ret urtently haw a since thpj t' y rospytrlility m mdry the oy t of
regal e , nienmpstb et or t ran er.certifiweero C
Slgnature OfApplican[ Date
A 1 roof coverings to be Class "B" or better
O er or aushorimd agent Dam
•
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CnY or
CUPEkTINO
CITY OF CUPERTINO
FURNACE/AC
PERMIT APPLICATION FORM
APN # 1 Z m
V
Date: I J O S
Building Address:
2000 3�vis a25 -:V,
Owner' ame:
dovsLoF
Relocation of Furnace
Phone #:
�R Ci4,qm
trAQ
6S0 2-1 4 7
Contractor: �°t$ j A
iense #:
oc rIA1
IsL1 19gZ-
Contact:
ELECTRICAL
Cupertino Business License #:
Seismic Fee Res
BUILDING
EPERMITFEE
MPERMITFEE
PPERMITFEE
BPERMFEE
BPLANCHK
Building Permit Info:
ELECTRICAL
MECHANICAL
PLUMBING
BUILDING
BUILDING
Bldg ❑ Elect ❑ Plumb ❑
Mech
Job Description:
S ro N A (L �LtIA O r
Residential ❑ Commercial
For Residential Installations:
Attic ❑ I" floor ❑ 2"d floor ❑
Adhere to min set back requirement ❑
For Commercial Installations:
Replacement same weight Additional weight (structural calcs) ❑
Structural Calculations req fired for new installation ❑
New installation Planning Approval Required
Cost of Project: Type of Construction:
Occupancy gro
Strapped On Platfo —2f __Bonded
Sq.Ft. Floor Area:
New Location ❑ Replacement --
Qty. if
Aoolicable
Far IT)
B-_
ENERGY
_ _..r.. ••
Ener
. cu a IvuP
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
MPERMITFEE
PPERMITFEE
BPERMFEE
BPLANCHK
Elec Permit Issuance
Mech Permit Issuance
Plumbin Permit Issue
Bid Permit Fees
Plan Check Fee
ELECTRICAL
MECHANICAL
PLUMBING
BUILDING
BUILDING
BUSLIC
Business License
BUILDING
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