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05090207 CITY OF CUPERTINO +^ BUILDING DIVISION PERMIT r1.TION BUILDING ADDRESS: A PERFECT CLIMATE PERMIT NO.05090207 11650 UPLAND WAY • OWNER'S NAME: PERMIT ISSUE DATE TERESA RYSSEMUS 10570 S DEANZA B 09/29/2005 NE: SANITARY NO. CONTROL NO. r ('408) 861-9545 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BO ELECT PLUMB MEOCH 30o LICENSED CONTRACTOR'S DECLARATION Job Descrl tion I hereby affirm Nat I am licensed under previsions of Chapter 9(commencing p with Section 7000)ofDiviaion 3 of the Business and Profession Code.and my license u 7� in ruHforte an do If i 50 REPLACE FURNACE ,Q z 10 4 CI I3c.x " r j.oNeX% Camacmr G �/ g�gARCHTECEC IT'S DLARATION //vv a 1 understsnd my,plan shall k trades public records (' > U g Licensed Professional g OWNEmBUILDER DECLARATION 'JO 2 1 hereby resum .lion Nei 1 ren exempt from the Cantncmrs Liana Law co the `O p O following resume.(Saito]onstr t.altar. and Professions Code:Any city m county S$i2 which requires a Permit re crnsuuct,attic,imfor such demolish.t or repair any structureest ,��� 17 3 B _zy thtrmiu issuance, ensedpalmrequires theatela.of for suchpe er's Limae a. < thahnumicnwit pursuant 70tH of Divioa of Nche SuacuMSLianxmon(Chapter Sq.Ft.Floor Area yValuation O (cat he is exem with Section 70n d the Division 3 of the egad Students and on.Any Com)on Q�$ that he u exempt therefrom and the bola for Ik alleged exemption.Any violation of tJ'N Section 7031.5 by my applicant for.permit subjects the applicant at a civil penalty ofr - OccupaddyApe not more than Ow hundred dollars(550 ft ❑I,a owner of the property.army employees with wage u their mle compensAon, willdolhewor6.andthe swctumbnoti.mMdaraRertdforsak(Sa.70M,Buircu Required Inspections and Profession"Code:The Commcmes Liwan e Law donot e ns apply m an owner of q p property who b W Ids n improves thereon,end who docs aoch work himself or through his Man employees,provided thatsuch imparammnu arc main sled or offered foram.if, however,Ne building or improvement is mid within ons yaw of compleuon,Ne owrur- builder .will have the burden of proving that he did an,build or improve for purpose of sale.). ❑1.as owner of the property,am exclusively contracting with licensed cantraren to construct the project(Sec.7044,Business and Profession Cade:)The Commuter U. , sae law does nut apply to an owns of property who Whiner improse,therem,and, who contracts formch projeaa with a contractor(3)licensed pursuant m ft Conuacmra - Lkeaelaw. - ❑lamesemptunderSec. ,B&PC for this won Owner Data WORKER'S COMPENSATION DECLARATION I hereby atrium under pealty of perjury,aro of the following decimations: 1 haw and will maintain a Certificate of Conant to alf-iaum far WorkersCompm- atian,as provided for by Section 3700 of the labor Cade.for the pafmmma of Ne work for which this permit is ivied. ❑1 haw and will minors Workers Compensation Weaccom.as required by Section 3700 of Ne labm Code,for to performance of the work forwhich this permit is issued. My Workes Compensation lnsursnce carrier and Policy number ace: ,/.,._ Cartiee Policy N.6: — CERTIFICATE OF EXEMPTIONFRM WO KERS' COMPENSATION INSURANCE (This scrim meed net heompleud irthe permit is foroachundrW dollar(SIM) or mss.) I Cum(y that in the performmiec of the work for which this permit Is issued.I shall not employ any person in my at bject to the workers'Compensation Laws of California.Date Applicmt NOTICE TO APPLICANT:If,after making Nta CeNficaa of Exemption,you should become Subject an the Workers Compensation provisions of the Labor Code,you mum 0z forthwith comply with Inch pavolons or this permit shall k damell revoked. z0 CONSTRUCTION LENDING AGENCY (~� Ikrehy affirm Wt Vert is a mosuuction undingsgemy for the performance of G' the winkfor which Nu permit u 097 issued(Sec.3 ,Civ.C.) W� A Ietders Name . Z Lenders Addw U 0 1 certify that I Mw rid this application and sum that the show information Is ly P comm I agree as comply with all city and county ordinances and Tum hems claung to 0U Wilding Caatmction,and hereby,uhoria representatives of this city to mor open tie W move-mentiorad Property for inspection Pugases LL (We)agree he am,indemnify and lump humtrss Uta City of Cupertino against rA liabilities,judgments,tofu and expanses which may in my way acme gaiat said City in caaegunne of the grunting of NU Permit. ^ APPLICANT PKDPRSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date C� Re-roofs Signature,of ApplinnInConumrm D,u HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding occupmt mac m NMIc locumd a material iamlldefend by tic Cupertino Municipal Cob.Chapter 9.13.and the Health and Safety .Serum 25533(a)± �No❑YG All roofs shall be inspected prior to any roofing material being installed. will tic applicant or future Wilding occupant use equipment or devlcnwhich If a roof is installed without first obtaining an inspection,I agree to remove ha ndous air cmumianu u rimd by the Bay Area Air Quality Maesgemcnt all new materials for inspection. District?❑Yes u 1 have rotl the hmudms materials requirements under Chapter 6.95 of the Califer. nit Health&SafetyCode,Seeuau 25505,25533 and 25534.1 unmanned that lfNe Wilding does an,currently have•neutron.that it is my responsibility m notify the occupant of the now h k mina= f.catirkmco m Signature of Applicant Date 04 lir ar,whorimd,em Dau All roof coverings to be Class"B"or better Community Development 10300 Torn Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: PERMIT # 1 1n50 U \ UJLL D 2.0'7 OWNER'S NAME: QX PHONE # 8 - - 5 ,k-6 GENERAL CONTRACTOR 1 0. FAX # �d I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating ']j,3159 Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO g FURNACE/AC WUPEkTINO PERMIT APPLICATION FORM APN # 1 3 / / -l? b Date: c� Z Building Address: O er's Name: Phone #: Co actor: U Phone- License #: Ott ct, 8bt- D31S-igv Contact: Phone: Cupertino Business License#: � D£f-8'6/-9cs'fcs Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech LW Job Description: &e. OICILmd QC_'e- Residential I Commercial ❑ For Residential Installations: Attic ❑ Ig` floor 92nd floor❑ Adhere to min set back requirement❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ st of Project: Type of Construction: Occupancy group: J D .0 o Strapped On Platform Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if Applicable 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 BSEISMICOM Seismic Commercial BUILIDNG / 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