03080153 CPPV OF CUPEWrINO
BUILDING DIVISION PERMITCONTRACTOR INFORMATION
BUILDINGADDRESS: A PERFECT CLIMATE PERMITND03080153
OWNER'03 S NAME: 10570 S DEANZA BLVD PERMIT ISSUE DATE
NE: SANITARY 043/26/2. CONTROL No.
(408) 861-9545
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
io0 LICENSED CONTRACTOR'S DECLARATION
I hereby airam that 1 am licensed order provisions of Chapter 9(commencing Job Description
£i with Scours DmIivislon Sof NC B and P�roTfessions Cak,�ltlmyliccnteH ���4® �®
?<�� in full fo dd crfec �O ns 6 ADD ASC
y v�� Liccnu
k Da Cunt or F !
[ ARCHITECTED ATION ,' fj 2003
G I understand my flutishallhaused spublic records
lyU
c 4k- Licensed Prnfmsinnel n tt
03
OWNER-BUILDER m CContr ON U'LO'�G
COO I hereby affirm on 11. .Burin from theCnmractoos Limens Lew for the
COO following reason.permit
a 71DI.5,Business and Profcuioli ll.or Any city or county
$ which re9usuapermit mtroas e,pionimpmw.h Permits ore a signedetmemm
-Z< Priormits issuance.also requiem the applicant for such Permit to file asigneJ ataamcnt
mm that he is licensed pursuant the provisions or the Comracmr'sLicense Law(Chapter 9 Sq.Ft.Floor Area Valuation
a'
(commencing with Section 7")of Division Sof the B usinma and limitations Critic)or '1491 909.9 nn
that he is evempl therefrom and the basis for On alleged exemption.Any violation Of
_ Section 7071.5 by am applicant for a pend it subjects the applicant to a civil Penalty of .APN Number. __.. .._ Occupancy Type
not more than fin hundred dollars WOOD. --' -_--
❑ I.as owner of the propcny,or my employees with wages u their ante compensation, � T� �,7
will do the work,and the structure is not intended or offend for sale(Sec.704,Business 301 — ROUGH Rlt ygq LNFectlons
and Profession Code The Contractoh License Law does net appy le an owner of
prapenywho buildsorim,pummithereon,and who doessuh work himutic,through his 303 — ROUGH M CHANICAL
awn employees,provided that such improvements are not intended or offend for ale.It. 3O4 - ROUGH ELECTRICAL
however,Ne building or improvement Is sold within one year of cemPICLIOY,the owner-
builderwillhavetheburdenofpmvingdsthedidno,Wildorbarrenforpurpomof 501 — FINAL ELECTRICAL ENERGY
❑1,aitawner of the progeny,am exclusively contracting with located contractors to - 502 — FINAL PLUMBING ENERGY
construct the project(Sec.70s4,Business and Professions Cade:)no Contractors Lt' 503 - FINAL MECHANICAL ENERGY
acme Law does net pply roan owner of pmpenY who Wilds or impmws deme,and 505 — FINAL ELECTRICAL
who contracts for such pmjecu with a contrulor(s)licensed pursuant the Commutes
License L
u
rn exempt under Ste- ,BkPCfar thismuon 507 — FINAL PLUMBING
508 FINAL MECHANICAL
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under pcnxlty of perjury one of the following decluetionc
�-� I have and will maintain a Certificate of Content to at Wasurefor WOrkersCompen-
�✓ whon,as provided for by Section 37W of the Labor Code.far the performance of the
work for which this permit is issued.
Q 1 have and will maintain Workefs Compensation Insurance,u acquired by Section
3700 of the Labor Code.(or the performance of the work for which this permit is issued.
My Wo) Ca penia Inaun/p/ce artier and Po'laifgy n/ymr�a/{e%�
Co. r 1gW Po11oyA IZIO ✓,
CERTIFICATE OF EXEMPI'1 OM WORKERS'
COMPENSATION INSURANCE
v (This auction need not becompleted it the parmlt Is(maw huldnddmlan(gIm)
or less)
I malty that in the par rom acc or the work rot which this permit is issued,1 shall not
employ any person in any manner an u m became Subject n the Workers'Compensallon
Laws of California.Data
Applicant
NOTICE TO APPLICANT,If,after making this Cenilicete of Exemption,you should
hwmw object to the Workers Compensation previsions of the Labor Codc,you must
O forthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
1 hereby affirm Nat alone its construction binding agenry rte,the pmfmmmev or
.x> On.walk fur which this gamut is issued(See 3097,CO.C.)
31 0 Condo's Name
3 z Lender's Address
J C I cenify that I ban read this application and mart that the above information is
.y F correct.I agree to comply with all city and county ordinances and state laws relating to
U building construction,and hereby suthorita nprommiatiws Of this city to trait area the
J+4 above-(we)-ed property
a---for inspection kemscs.
(Wt)agree ro use,indemnity and keep harmless Ilo City o(Cepcnino aga
^(A Iiabilitiu.judgmcnLL.amand mpensm which may in any wyeccme againn said Cinst Or
..l Z inconsequence of the gaming of this Permit.
^t
APP UyNy�ER�S�ANDS AN WILL COMPLY WITH ALL N/Opp-P�OI/NT Issued by:9 Date
/'Sso EI Dz sL� � �IfYW/7 Re-roofs
4ifn'aturh of AppiicanUConanctor ea
HAZARDOUS MATERIALS DISCLOSURE Type of Roof -
Will rhe applicant or furore Wilding ocaapant note ter handle linudous m oubnol
as defined by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety
cWe scaYes am.255320)l All roofs shall be inspected prior to any roofing material being installed.
❑
Will the applicant or future building oamupim ate crluipmentardevice$which 'If a roof is installed without first obtaining an inspection,I agree to remove
7dws
it hazardous air conaminmts as defined by the Bay Area Air Quality Management all new materials for inspection.
tricR /
❑Yes HNu
IlowalmyC lo.Socmo 255D5,25533mmen534.to ChaPted6 ai dic nolN&SmI,1m de.Sccdn,cwthismy3uuIns5ilayunJourhry typ Willing
no � nattyhow tenant thou it is mymapemi ility m notifyth euPana ter Un'n , whim m bens pre < ' Signature of Applicant Date
r or utharvad upon, Date
r All roof coverings to be Class "B"or better
CITY OF CUPERTINO 3 0 80 S3
,• C _ h F F'l I K 0 PERMIT APPLICATION FORM
APN# a - o-ua �" Date: /a Ole-)-3
Building Address: J
Owner's Name: Phone#:
+r rQ CP>I
ConActor: I License #:
v 0 2 s 1
Contact: Cupertino Business License #:
Building Permit Info-
Bldg ❑ Elect Plumb ❑ Mech
Job Descript' n: �-�� 1
Residentia Com rcial ❑
For ResidentsM Yn-s-manuions.
Attic ❑ 1" floor ❑ 2"d floor ❑
Adhere to min set back requirement[-]
. For Commercial Installations:
Replafe ent same ht E] Additional weight (structural talcs) ❑
tructural Calculations re ted for new installation ❑
New installation Planning roval Required Fj
Co of Pro'ect• Type of Cons1ructionc. Occu ancy group:
On Platform U Bonded U Sq.Ft. Floor ea:
New Location ❑ Re laceme
Q • •f
Ap li a le Fee ID Fee Description Fee Group
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
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