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03070070 CITY OF CUPERTINO pie t% BUILDING DIVISION PERMIT CONTRACTOR INFORMATIQN ;; BU I572 WATERFORZ DR (408) 291-2220 LDING ADDRESS: CONDITIONED AIR / PERMITNOO 3070070 OWNER'S NAME: 1701 LITTLE ORCHARD S.T. PERMIT ISSUE DATE 1i NE: - SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 I O o LICENSED CONTRACTOR'S DECLARATION ZF I hereby affirm that 1 am licensed under previsions of Chapter 9(commencing )Ob DCSCTIPIIOn yt with Section ad Iof Division?of Ne Business and PrgfCsynppLgJc.en ylicenuis in full fore'F,cffec J UI I_ll lJ llx(f/a REPLACE FURNACE & A/C x119 wlrm- ? LmanaeC _ L¢.g ywwwOw Dale rough" ARCHITEM S picI understand my plans shall u d a public records JUL + 6 2003 n g W(n Licensed Professional =0g OWNER.BUILDERDECLARATION BUILDING 'yi a f 1 hereby affirm that 1 am exempt from the Contractor's License Law for he �l C m O following reason.(Section 7031.5,Business and Professions Code:Any city or county 5 which requires a Permit to ennUma,alter,impm ant.dcmnlish,or repair any structure za Odor n its issuance,alsomquires the applicant for such permit to file a signed statement gxo (hal he is licensed pureuanuo the provisions of the Connectors License Law(Chapter 9 Sq.Ft. Floor Area Valuation it (commencing with Section]II(IU)of Division 3 of the Business and Profcasions Cole)or y 00.1 he Is exempt hemfrom and he basin for he alleged exemption.Any violation of 36617029 . 00 Settled 7031.5 by any applicant for a panon objects he applicant to a civil Penalty of APN Number Occupancy Type notmomthnFvehundreddollan(isoo). P Y YP 1,tax owner of the property,or my employees with wages as their sole compensation, will do the work,and he swcwm is not intended or offend for sale(Sec.704,.Business and Profcadons Cade:The Contractor's License Law docs not apply to an owner ofCtlons property who builds or improves hereon,and who doesauch work himself or through his 303 — ROUGH M CHANI AL own employees,provided that such improvements are not intended oroffered forsale.If, .304 — ROUGH ELECTRICAL however,the building or improvement is sold within one year of completion,the owner. builder will have he burden of proving that he did not build or improve for purpose of 505 - FINAL ELECTRICAL sok.). ❑I,as owner of the properly,am exclusively contracting with licensed contractors to 507 - FINAL PLUMBING conatmct he project(Sec.704,,Business and Professions Cade:)The Conuaclora Li. 508 — FINAL MECHANICAL cense Law does not apply to an owner of property who builds or improve tbemon,and, who contracts for such projects with a compectorDl licensed pursuant to he Contractor's License Law. ❑ I am exempt under Sec. .B&P C for his reason Owner Date WORKER'S COMPENSATION DECLARATION I hem by affirm antler penally of perjury one of the following declarations: 1 have and will maintain a Ccni icme of Consent o self-insure for WorkersCompen- workworkf as provided for by Section 77011 of he labor Code,for he performance of the for which this permit is issued. ' ❑1 have and will maintain Wurkcrs Companies ies Insurance,as required by Section 37W of NC Labor Code,for he performance of he work for which his permit is issued. My Wo eT�s impeasatun nxunn crand licynumbcra a ERTIFICAF TEOFE%EMPI'ION F ORKERS' COMPENSATION INSU ANCE (This section need not becompleted lithe permit Is forone hundred dollars(5100) or)es..) 1 certify that in the performance of the work for which this permit is issued,I shall nut employ any person in any manner m as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Extra patio,you should become subject to the Worker's Compensation provisions of he Labor Code,you must .J O forthwith comply with such provisions or his permit shall he deemed revoked. 'Z " CONSTRUCTION LENDING AGENCY ',� rN. I hereby a from hal here is a Construction lending agency for performance of lYi ti he work for which this permit is issued(Sec.7(197,Civ.C.) W Lender's Name z Lender's Addreas U 0 1 certify hat I have read this application and sale hal he be.information is LL (✓ correct.I agree to comply with all city and county oNinanees and stale laws relating to 0 V building construction.and hereby auherise mpresenalives of this ity to corer upon the W ago ove.mennoted property for inspection purposes. (We)agree to save,indemnify and keep harmless the City or Cupertino against ,,I liabilities.judgment,costs and expenses which may in any way accrue againseaid City '_�kG V z in consequence of he granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE�,�GU,,LA,TIONS. /}� t ✓" J r N -� - Re-roofs Actinium of Applusou ono cmr ase HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle ha=dous material n darned by the Cupertino Muni,pal Code.Chapter 9.12,and the Health and Safety Code,Scedon 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will he applicant, ham Ildid,deo: am use ,,ipm,nl ant devices which Ila roof is installed without first obtaining an inspection,I agree to remove it harallous air,nnwminanIs dcgnml by lube Bay Area Air Quality Managcmcm all new materials for inspection. strict? ❑Yes I have read the ha a dnos materials requirements under Chapter6.95 clubs Califor. .in lmqHealth&Safety CDM,Sections 25505,25533 and 25534.1 undersand Lha Its,building Jets not cuncnlly have a tenant,that it is my r sponsibiliry to notify the necap.1 of the - r uimmc hihmastbe porm'ss ,np_C,d, afa, ayQ ignature of Applicant Date L2Or or auhmizeed ag m 6 D�,tet All roof coverings to be Class "B" or better CITY OF CUPERTINO o3 v 7 v v 7 o FURNACE/AC OF CUPERTINO . PERMIT APPLICATION FORM APN# © Date: Building Address: QQ X573 v3K�kb(L - Owner's Name: � � Phone#:�N Contractor: Phone: I Z2� License#: U . M� ASSOC - Contact: Phone: Cupertino Business License#: -T WW1 Building Permit Info: Bldg ❑ 1 c lumb ech Job Description: Residential, M Commercial ❑ For R�e idential In tallations: Attic U I"floor U 2"d 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 Pl Required ❑ �- Cost of Proje �� oo Type of Construction: Occupancy group: . I rNeation On Platfo Bonded ❑ Sq.Ft. Floor Area: Replacement Qty. if ApplicaW Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIItHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec d, Switch &Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech ermit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING " I