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03110133CITY OF CUPERTINO'' BUILDING DIVISION PERMIT - 'CON,TRAC�'TOR�INFdRMATION v Ou LDING ADDRESS: ATLAS HEATING PERMIT NO 03110133 0165 VICKSBURG DR OWNER'S NAME: PERMIT ISSUE DATE ALT GYGER 155 SAN LAZARO AVE11/21/2003 ONE: SANITARY NO, CONTROL NO. (408)739-0516 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MPRH • LICENSED CONTRACTOR'S DECLARATION milm h.mc, 9(,murccnx Ihcrgbyc).r Job Description lMIIem licensed underpmviofessofs Code r9(commencing that edmcyp in Professions is $CI W, (, my - with annafthe nd ini�`Isc°cIe c jp {. L1C '� 13:1 R ALE® REPLACE FURNACE & WATER H Date1A Cu Imetar RCIHTECrS�PYE D 2 1 DEC 4 ZOOV .ARATION 1 undgpmld my plans sha11 he used as pudic menrda Licensed Professional OWNER -BUILDER DECLARATION L 1Y BUILDING I hereby affirm that Ne Conuamoo License Law far to n I a.em . exempt srat. an (Section ] on L3, Business and Pmfeuinns GWr: Any city or wanly which re uir sa which s a permit re s aaq ire parvo, nr repair any manure Z 3 Q 0 prior In s l esedpalsont to the pro vision or for such Permit to rile a signet statement its issuance, ins the h Perm t t of dm that be(emnamneirg wit pursuant )) Sq. Ft. Floor Area Valuation he Bminam ul Pa.flaw(Chap¢r9 of Division n of the innSQulc) car exe and exe with Salton ]land) on. An that a is exempt tartfmm and 0m besis far she Jlegcd exemption. Any violation of that he is We ged 3 @NrKififfial00 Occupancy Type p y yp Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of .at mom Ian Eve hundred dollars (5500). ❑ the pmperry,m with wngesuale Required Inspections dowork. will do the wons and thuwmum to not s IS . 044,B sins, isnoti mead n Liecod , Law doered t apply to in, water of and Professions Cade The Contractor', law docs not apply lf rat owner of property who builds or improves thereon, and who doessuchwork himself or through hit andwho such improvementstae nmsandedmplefied for rne.IL m owner, mebuipmg or i pr however, Ne building m improvement is sold within aro yea of wmple for the owner- , builder will haw dm galea of proving that a did not build or improve far purpose of talc.), 1, as owner of the progeny, am exclusively comreading with licensed common to CanSINCI the projml. (Sec. 7(N44, Business and Professions Dade:) The L•CnVSCmit U. cense Law does not apply to in owner of property who builds or improves Uemon, and, who contracts for such projects with a conlrxtar(s) licensed pursuant to the Contractor's License Law. ❑ 1 un exempt under Sec. . B & P C for this nation Owner Dna WORKER'S COMPENSATIONDECLARATION 1 hereby affirm under penally of perjury one of the following declarations: have and will maintain a Cc rilleme of Consent m self-insum for Worker's Compere sn, u provided for by Section 3]00 of the labor Code, for the performance of the (or which Nis permit is issued. 1wmk have and will maintain Wmkcr's COMOCOW1011 Insurance, as required by Section of the Lobar Coda, for the perfarmm ce of Ne work for which this permit is rutted. Wmkerl Cn motion hnntt carrierand P trey nu bar ex:FROM��=6Y.Y CERTIF ATEOFEXEM INSURANCE WORKERS' COMPENSATIO INSURANCE met section need nm he completed Rise Permit ts for one hundred dollars ($11X0 , nr Ica.) I ccnify that in the perrarmance of the work for which this permit is isswd, 1 &hall not employ any person in any manner so as m hecome subject to the Workers' Compensation _ Laws of California, Data Applicant NOTICE TO APPLICANT: IL after making this Cur ilium of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall he deemed mvnked, - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a cunsumeinn leading agency Porto resider we of the .,it fur which this permit h issued (Sex. 3097, Civ. C.) Lender's Name Lcndcla Address I ccnify Nat 1 ban rend this application and mute Nat Ne above information is Correct. 1 agree to Comply with all city and county calibrates and mute laws bidding to Wilding construction. and hereby autharbe bpresemativeS Of Nim city m color Upon the above-mentioned property (or inspection pvriwses. (We) agree to can, indemnify and kap harmless the City of Cupertino against liubi lilies, judgments, costs and expenses which may in any way attuo against said City in consequence of Ne gaming of this permit. APP NIGER NDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOU CE E LATIO'r �S � VIVO ' f � A.l Xil40 U V �'fi7 Re -roofs Type of Roof Woman, O(ApplicanUConmoun Data HAZARDOU MATERIALS DISCLOSURE Will the applicant or future building Occupant tore or handle Wandous material as defined by the Cupertino Municipal Code. Capter 9.12, and the Health and Safely ale, Section 25512(x)] Ya All roofs shall be inspected prior to any roofing material being installed. tomildin, If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or f occayant tax equipment ardevices, which it hamalous air conmminmu, as dcfncd by the Bay Area Air Qual ity Management all new materials for inspection. isuict? El Yes �NO I have bad the hmardnms materials mquiremenu under Chapter E 95 or the Califor f nie Health &Seely Code, Sections 25505.25533 and 25534.1 understood that if the Wi Wing Anatu�� d bare a Conant, that it u my rexponsih hly m notify tie taeupx bgddern u hmuu m priorwissu cc a fa CcrdOcam Of Oce ancy. Date � All roof coverings to be Class "B" or better o agent r raalnariaA Data 7 CITY OP CUPEI�TINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM APN #Date: S� ct-0-00 S Energy �_a I-03 Building Address: 0 6 16 5 Relocation of Furnace MECHANICAL Owner's Name: A/C Unit > 10,000 cfm Phone #:.�^ ��$y Contractor: U Phone: A/C Units <= 10, 000 cfm MECHANICAL License 37 Contact: P one Seismic Fee Res Cupertino Business License #: BSEISMICOM Seismic Commercial BUILIDNG r6 BHffdingermit Info: ELECTRICAL MPERMITFEE BId Elect ❑ Plum_b . M chA< . JobD eription: PLUMBING BPERMFEE Residential ❑ Commercial ❑ BUILDING BPLANCHK Plan Check Fee BUILDING BUS41C Business Li nse WALDINQ For Residential Installations: V1 I Attic ❑ 1" floor ❑ 2nd floor ❑ Adhere to min set back requirement[] For Commercial Installations: Replacement same weight ❑ Additional weight (structural talcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of ect: Type of Construction: Occupant gr`o Strapped I ❑On Platform ❑ Bonded ElSq.Ft. Flo � New Location ElRe laceme Qty. if SJ ADDhca6le, Fee M RPP T)Pcrrinfinn Aoo r_v^11 . 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 B1d8 Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUS41C Business Li nse WALDINQ to ,