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04060059CITY OF CUPERTINO BUILDING DIVISION PERMIT Co " I ;4 ut BUILDING ADDRESS: 233 wEymnUTH T)R A H HEATING PERMIT NO0406 0 0 5 9 OWNER'S NAME: "I PERNUT ISSUE DAM BILL SEFELDY 770 CHESTNUT ST 6ZQ7/2004 NE: SANITARY NO. CONTROL NO. (408)279-0722 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG PLUMB MECH LICENSED CONTRACTOR'S DECLARATION " b d ...... of CICapte, 9 (commencing an Job Description "'! afLice.firmunder M - - A poscher.C.a'..'anybee a a�`CI1!v,'.ima3.,i",WCA, C .fith Affict zz I LIC, 'AAr_ REPLACE FURNACE MAC &�61T, 9 DUCTS L EL) D. Curt tor �O MAL 6 S DECLARAAA I understand my plans hail W used As public reconds NOV P,9� 2004 Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Low for the following reasum. Section BI] 1.5, Business and Professions Code: Any city or county which requires a permit III consumer, alus, improva, demolish. or repair any WILICLUM DI III r%IKI^ ARnn prior to its issumm. also requires be applicant for such Permit to litc a signed statement that he is licensed pursuant to the prevision of the Councesurr's License Law (Chapter 9 Sq.FLFloorAreaLiF%#1LPLof1j 1%7valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or OIL he Is exempt therefrom and the Want for due alleged exemption. Any violam , on of Section 7031.5 by arty applicant for A permit subjects the applicant to a civil Penalty of3150l?5IQ,11iaiBer00 Occupancy Type na ..I me, than hundred delta. ($500). El i.mowner cfNepmpmy.ormyomployeawith wages utheir wlccompmation. will do Ocunuls. And the $MCums I. net istooded.roffered forsale (Sec. 7044, Business and Profession, Code; The Comoselm's Liam Law does net apply M an owner of Required Inspections property who buiIds orimproves flumhon,end who does such work him selfor through his own employees, provided thatsuch Improvements me notimanded or offered formic. If, however. the building or improvement is mid within one year of completion. the owner. Wilder will have On burden of proving Out he did not Wild or Improve for purpose of sale.). 0 1, as ...I of the pmA,my, A. exclusively Communing with licensed ...Cie. I. construct the project See. 7044. Huainan and Pre(cudons Code:) The CWMACW's Lt. cense Law does not apply to an owner of property who Wilds or Improves themor, ad, who cmMRH for such pmje= with a comeactor(s) licensed pursuant to On Communes Licansa Lm ❑ 1 me exempt under Sm. B & P C for this memo on' Da Data WORKER'S COMPENSATION DECLARATION I hereby affirm under Penalty of perjury one of the, following declarations: I have and will maintain A Canificto of Consent to self-insum for Worker's Compon. ,On. AAprovided for by Section 37W of the Ube, Cool., for to performance of due work for which this permit is ismad. 01 have and will maintain Worker's Compensation Inso mance, As required by Section 3100 of the Labor Coca, for the Performance or the work for which this permit is issued. MyMy WokaMbr's Compensaion insuance usor and P liyAnIum�bM :Ca_r&E PoliyNo.MW0RKCATIFICATEOF EXEMPTION .0 ERS' COMPENSATION INSURANCE Old.sculfiran need oat thecompleted if the porrandlisformuc, hundreddolims (SIOD) or [I.) I certify Oat in due Performance of the work for which this Permit is issued, I shall not employ any recent in my manner so As in become subject to the Workers' Compensation Law, of California. Data Applicant NOTICE TO APPLICANT' . If. after making this CcAdicale of Exemption, you should become subject to OA Workers Cornpormstumn prowi.imr, of On Labor Code, You crust forthwith comply with such provision or this Permit shall the deemed reveled. CONSTRUCTION LENDING AGENCY I hereby affirm that ft. I. A untateactur. lending AS.., for the performs.. of the work for which Nis rannit is issued (S.. 3097, Civ. C.) Leader's Nem. Lender'sAdd.. I certify that I have mad this application no state dean the above information is comem I agree in comply with all city and county ordimarms and state taws relating to building construction. And hereby authorize representatives of this city to enter upon ft above-mcmdoned property for inspection purpose, (We) Agree I. saw. indemnify And keep humeleas the City of Cupertino against liabilities, judgments, costs and exporter which may in any way see= against said City in consequence of the gourifing of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH AIL NON-POINT Issued by: Date* Svc"GULATIONS. �*� Re-roofs Type of Roof A Si pPlman vc Una I ' HAZARDOUS MATERIALS DISCLOSURE Will the applicant or rut= building occupant a[= or handle hazardous material defined by the Cupertino Municipal Code. Chapter 9. 12, and the Health and Safety rada, Section 25532(.)1 ny. 2p�_ ' All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove it hazardous air contaminants a defined by the Bay Area Air Quality Management all new materials for inspection. Gimlet, 0 Yes I have read the lucencous materialsequiemecrox underChapWr6.95 ofOc Calirm- ni.Fk.lth&Sd�mft .IYCW.,6=25505.�533=d�534.lundcmdOaLifbuilding exes not cumend mo I Anent, Out it IS My rAmorkshifily W moly ft CACCuper, of the reto"ne,It cs I as, he met prior As r Ceredit foc pan. Signature of Applicant Date All roof coverings to be Class "B" or better Owncrara muffi.—I'l.ed agent V Ic Community Development 10300 Tose Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADD I am not using any subcontractors:-�4 0 �z, 6v. -7-,0Y` Signature Date Please check applicable subcontractors and complete the following infnr nfinn- SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing I am not using any subcontractors:-�4 0 �z, 6v. -7-,0Y` Signature Date Please check applicable subcontractors and complete the following infnr nfinn- Owner/Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date r CITY OF CUPERTINO FURNACE /AC b CITY OF it A lic blc Fuc ID Fee necrrintinn LUPLKI INU Yl' KIM I AJrYEl1 A 11UIN h UKM BENERGY APN #- 362- to - 0.33 Date: 2-7 —Cc( BUILIDNU Buildinc Address: _/233 U�i�t _ ----- -� � Relocation of Furnacc. Owner's Name: Phone #: � a53 -3c)75 contractor License #: k H030Ytf 7.1. contact: Phone #: ;? 79 - 07a) . MECHANICAL. Applicant/Contractor: M �( tJ��-� T — _ 6`Lr7� c*LT-11� A — -- - - -- MECHANICAL_ Building Permit Into: Reeptl, Switch & Outlets Bldgu-� Plumb Mec Job Description: Residential: Seismic Fce. Res Sq.Ft. Floor Area: $$/Sq.Ft.:-7- Architect/Engiiieer: Valu <, Type of Construction: OCell ancy Group: it A lic blc Fuc ID Fee necrrintinn BENERGY Energy BUILIDNU BREMFURN Relocation of Furnacc. _ MECHANICAL — BREMACOVER A/C Unit > 10,000 cl'm MECHANICAL. BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL_ BREMRECEPT Reeptl, Switch & Outlets ELECTRICAL.BSEISMICRE tL Seismic Fce. Res BUILmNGEPERNII'fl'1?E Elec Perinit Issuance NVERMITFEE Meeh Permit l'ssuancc MECHAN[ Al, _ PPEP.NIITFL'E Phunbin� Permit Issue PLUMBING 1 --� BPERMFEF, Blde Permit Fees BUILIDNG {j _— — BP,�ANC'HK _ I Nj BUSL[C . Phan Chcck Fee Business License BU1L[DNG BUILID_NG_ _