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05090105CITY OF CUPERTINO >a r i�,a.�' A >"' k "� '`'`• BUILDING DIVISION PERMIT ONRACTQR INRM"fIphi; BUILDINGADDRESS: A & H HEATING PERMIT NO.05090105 10943 WILKINSON OWNER'S NAME: PERMIT ISSUE DATE Igh MARVIN SPILLMAN 770 CHESTNUT ST 09/15/2005 ONE: SANITARY NO. CONTROL NO. (408)279-0722 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O LICENSED CONTRACTOR'S DECLARATION' 1 be *(firm that I me Harmed under provisions of Chapter 9 (commencing Job Descrip on tip, 4 with Section 7000) ofDivislon l diction Buunad Professioru Code."mylicmuc 6 m 0th roma are Tac U2/Z C C REPLACE FURNACE ttl$$$ + Z �qqq License v conN G (b//�� DECORATION ll DELL EP 7 < G W used 1 undcrsunJ my Pena still W uud u public records `I 100.5 �I Licensed Professional r3 OWNER-exempt RDEC j/fr( �f'!(/f Contractors 1 heaso afftrm ober I exempt from Um Conuacmrs License taw for old JCJ f'� ,�^y p o 6 1 following moon. (Section 70313, Business and Pre. dem ns Cade: Any city or county ante alar. improve. demolish. a repair which mqulma • Permit re ares i 7r jy �, t� by' 2&5 S O <NommeningwitpunuaMothopmviviona t ed umaum I u leu do appliesof for such permit cle a l signed sutemcnR prim Ron Sq. Fe Floor Area Valuation atIna ed pursuant to the of the ense e $ t — 3ofthemanessAndProelsiw(Chodu9 (commendxempthhouSection 700d tris basis for of Al aged Business on. Alai Code) or that he a exempt tWmfrom and the baa far Ne alleged eamption Any violation of Occupancy Type Nin nby f r a per. it subjects Ne applicant to a civil penalty of not mme hundredaappplicam C3 1, an owner of the property. or my employees with wages As their sole rompenamion, Required Inspections will do the wart and the suueum is not Intended aoffered roti sake (Sac. 7044, Basin and Pnef amour Cade: The ConuKbYs LIIXNC LAw does ran apply to an owner of , property who builds or i mprowa demon, and who does auch work himself ser Mough his own employes, provided that such improvements are nothmende l motioned for ale. If. however, the building or improvement Is sold within arc year of completion. the owner. builder MR haw the burden of proving that he did tut build or improve for purpose of sold.). El 1, As owner of de property. am exclusively contracting with licensed contractors to construct the project (Sen. 7044. Bain and Professions Cade:) The Contractor's Li. cense law does not apply to an owner of property who builds or improves Narcan, ad who contracts for such projects with a contractor(&) licensed pursuant to the Comma tis License law. ❑ Iamesemptunder See .BAPCfm Thisreaon ner Dau WORKER'S COMPENSATION DECLARATION 1 hereby arum under penally of perjury one of the following declarations: 1 no.<and will maintain a Certificate o(Cansent to alf-Insum far WmInesCooper. lon. u provided for by Section 3]00 of to labor Code, for we performance of the 1031.00 rk for which this Permit is issued. 1 have ad will maintain Worker's CommmAdon Insurance, as required by Sccdon of the labor Code. for the performace of the work far which this permit is Wood. Workers C mpasation Imunms esrria ad Policy nmber am: rner. Polity No.: Al C CATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section road not WeoupleoW ifthe permit is faaro hunditd ($100) or lea.) I sonify, That In the performance of the work for which this Permit is geed, I Nall am employ any person in ay manes a n become subject lade Worken'CorepensWon Laws of C.11foo ia, Dam Applicant NOTICE TO APPLICANT: If, eller making this CeniOeau of Exemption, you should become subject to the Workers Compensation provisions of RM IoM Cade, you most forthwith comply with such provisions a this permit shall be domed revoked. O ti CONSTRUCTION LENDING AGENCY I hemby affirm that Bert is. construction lending agency for the performance of ' „>y the murk for which this permit is issued (Sec. 3097, Civ. C.) Lenders Name G , Iaeder, Address z Q I aNfy that I Mw read this application and sum that the show informadon u ' correct. 1 a{me to comply with all city and aunty ordinances and mu Iowa madng to building construction, and hereby audamne repmcamadws clads city to coot upon the L37 above-mendoned property fm inspection pughwes (We) to indemnity kap harmless de City of Cupertino against e4 agree cow, and liabilities. judgmcnu, cola And expenses which may in any wry accrue against said City In consequence of the tinting of this permit. APPLICA/�VfTT UNDE TANDS AND WILL COMPLY WITH ALL NON-POINT SOUaQE-jlNS. v., Issued by: Date /� a r \ ^ Re-roofs ol"A'// ignmumo ppllesHAZARDO Doke HAZARDOUS MATERIALSDISCLOSURE SURE Type of Roof amt material Will the a or future Wilding nom a M1aedu h eaNaa a dcrued by the Cupertino Municipal Code. Chapter 9.13. and the Heald a0 Safety Cupertino e. Chapter All"w* Section 2553]An(e)? ❑Yes All roofs shall be inspected prior to any roofing material being installed. ' If a roof is installed without first obtaining an inspection, I agree to remove will the aPpnesnt or future building occupant use equipment or devices which h hazardous air cone roam As deawd by the Bay Area Air Quality Management all new materials for inspection. uin7 ❑Ys Z No I haw real the hvardors maurlaa mqulremcros under Chapter 6.95 oflhe Caliror. nen Health @Sarctyeode, Seem" 25505.25533 and 25534.1 understand that iftho Wilding docs oat currently hew a ten t dal my mapmulblllty to entry the aau an, of the require hianmuR met d' uueearacenirieauaf euPaeyh Signature of Applicant Date —/p All roof coverings to be Class "B" or better own ter audanxed ITR te Community Developmento. 10300 Torre Avenue Cupertino CA 95014.x. -- Telephone (408) 777-3228 Fax (408) 777-3333. ' TZ -so De artment JOB ADDRESS: f 6IN3 PERMIT # 0T-0 i0ld.S- OWNER'S NAME: S(>j l rn.ir PHONE # i GENERAL CONTRACTOR: FAX # I am not using any. subcontractors: Signature Please check applicable subcontractors and complete the following information: Date . 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 CITY OF CUPERTINO c FURNACE/AC �JPEf�TIN0 PERMIT APPLICATION FORM qW APN # 5 0 8 Dater / Building Address: I Oq y ` • D / BREMFURN BREMACOVER Owner's Name: S LL wl. 1ZU t- Phone #:196 -aA 7s P Concjqtt Phone: a 79-©�AA License #: D 7aL 3 Contact: ^n, E p4E.Lp1 Phone:, 7 Cupertino Business License #: Rec ti, Switch & Outlets ELECTRICAL Building Permit Info: Seismic Fee Res Bldg ❑ Elect ❑ Plumb ,❑ / Mech kms" Seismic Commercial BUILIDNG- Job Description:,— lC-- c IX�ZoI�G� Elec Permit Issuance Mech Permit Issuance Residential Commercial ❑ / PPERMITFEE BPERMFEE For Residential In allations: ❑ floor 2nd floor ❑ PLUMBING BUILDING Attic 1" Plan Check Fee dhere to min set back requirement ❑ BUSLIC r Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ BUILDING Structural Calculations required for new installation ❑ New installation Planning Approval Required Cost of Project: 2 _55D —' Type of Construction: Occupancy group: Strapped ❑ On Platform El Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement 2 Qty. if IIve llucnnie�tinn Fee GrouD n ucavic .-w ,... BENERGY - -- — ----- ---- Ener BUILDING / BREMFURN BREMACOVER Relocation of Furnace A/C Unit > 10,000 cfm MECHANICAL MECHANICAL BREMAIRHAN A/C Units <=10, 000 cfin MECHANICAL BREMRECEPT Rec ti, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG- EPERMITFEE MPERMITFEE Elec Permit Issuance Mech Permit Issuance ELECTRICAL MECHANICAL / PPERMITFEE BPERMFEE Plumbing Permit Issue Bldg Permit Fees PLUMBING BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License Z BUILDING /6 /76W