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03010140CITY OF CUPERTINO BUILDING DIVISION PERMITQTOR INFORMATION ,� . BUILDING ADDRESS: COMFORTSYSTEMSUSA PE'RMITN003010140 ERS NAME:'I'W 110 E DOUGLAS AVE PERMITIT� O/ 2 0 0 3 IF RESTAURANT ONE: (559)627-2653 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hertNet by drum 1 em licensed under provisions of Chapter 9 (comming ene - Conic, and my license w(thSec11 7 )of Dlvhi n3rfBusis Profwione CodxH in full! deffec ('� �thoC'r0nes ueenra "a - �v 4bZ1719 REPLACE EXHAUST FAN. Dau Qonlru]d, III f6fvD$,r, t XrA ARCHI'IECTSOLkRAT10N JUL 1 7 2003 T understand my plena shall be useeTublie recnrda Licensed Professional OWNER -BUILDER DECLARATION BUILDING 1 heresy .(Seto Nen 1 exempt from Uu Conunmoh License Lew for the gG' moan.ormllt](131.5,Bualter.ae Pmfwions Cr da: Any city or county so 1. care any structure which a perms era construct, alsee Improv, demolish e which its isca a sig the .pions Of forthe Conractor'ro Olein Law mumam permit prior binscensed pursuant 10 uc4w(Chapur9 thuMis licensed Purwsm tnthe dupe Sq. Ft. Floor Area $36W,atygtion 700 0) of Division 3 of Business; and Cade) or 'cine with of Division 3 einexe ane Nefieon. al eg Any vl Net he b exempt dsertrrom and the bub fm the alleged exemption. Any violation of met he erefro 33AMQ4bfn'6er00 Occupancy Type Section 7031,5 by any applicant for a permit mbjecu the APPlluh to a civil penalty of no' mart Nen five hundred dollen (SSW). ❑Lohworofdx wlNweeuuthe(Sec. erimxmy — d Inspections Lbegro,m h Budneu d Business will do dm won. andtheawctumbner's License doned for W Code: The Conuactor'a Law oma amd Profession, a. tat apply lf owner apply an an 102 — PIERS and who rt is erywh improves Nonan,ane who aresouch wonhimselfedthrough his propertywho builds _ num provided not lnunticdmoRerta If, 103 — UI-•'�ii'R tmole, howemployeu,ingorithosuchimprowm wt in .the building or impmwment is mid within on year of completion, theOwner. of builder MB have the Burda of proving Wt k ale not bWld or improv for purpose of Wflder 104 - REBAR sale')' - 105 - ANCHOR BOLTS ❑ I, as owner of the property, am exclusively contracting with licensed contractor, M 106 - SEWER & WATER mubuct the project (Sec. 7114, Business and Professions Code:) The Contractor's LI - Oman, Law does not apply uanowner ofproperty who Wii&orimprovethemon.ad, 202 — UNDERFLOOR PLUMBING contractswho for such projects with wieconuactm num (s)licenseepusedse Contractor'sLicContractor's 203 - UNDERFLOOR MECHANICAL ❑ I am exempt under Sec. .B&P C for this two' 204 - UNDERFLOOR FRAME erDate 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING WORKERS COMPENSATION DECLARATION I hereby sairm under penalty of perjury one of the following declarations: . 302. — TUB & OR SHOWER ❑ I havnand will mainulnaCeNOcomofCmwatioulf-innum for WarkeriCompen- nation, as provided for by section 37110 of the tabor Code. for the performance of the 303 - ROUGH MECHANICAL work for which this permit is issued. 304 - ROUGH ELECTRICAL have and will maintain Worker's Compensation Inmuurce. as required by Section 305 — FRAME 1%, ofthoUbor Cede, Imlhe perfocmanccaflhewwwyyakkk forwhich this permit is issued. My Worker's Com�euadon lnsum7.nin any number are: C.itiest�gnsa)Rm, Lu RILH Pry�(Nr.: 1.yf. ap17S$-oi� 306 — HOLDOWNS 307 - INSULATION CERTIFICCOMPENSATION TNFROMWOINSUR NCE RKERS' 308 — SHEETROCK Minsecdom need not be completed iflbe Permit is forowbundred dollars ($10y) 309 - EXTERIOR LATH orlesn') 310 - INTERIOR LATH 1 unify that in the performance of the work for which this Permit Is issued, I shall not ' 311 SCRATCH COAT employ any person in any muner m u to become subjem no the Workcn'Compeuadon - Laws of Celifomie. DauApplicant 313 - ROOF NAIL 501 - FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should become subject to the Workeri Compensation provisions of the Leber Coda you must 502 — FINAL PLUMBING ENERGY forthwith comply with such provisions or this permit Nall be dmmw revoked. 503 - FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency lot the Performance of 504 - FINAL BUILDING ENERGY Me work for which this permit is issued(Sec. 3DYl, Civ. C.I tendces Namc 505 - FINAL ELECTRICAL 506 - GAS TEST Lendee.Aeew 1 mnify mat 1 have had this application ant rho tho the above Information ie 507 - FINAL PLUMBING carmct, l ago to comply with all city and county ordinances and sum, lewd mining to building ernswctirn. and hereby authodm representatives of this city mentor upon the FINAL MECHAN CAL atomm-mentioned property for inspection purposes. Q 9 F I N1. (We) agree h ase, indemnify and keep hnmlw the City of Cupertino against liebilidu,judgmmns,cotu odexperuu which mayor anyway amus gains said City A NG in consequence of the Standing of this Permit. APPLICANT UNDE DS AND Will WE .AIV N -P INT Issued by:5 WORKS Date S GULA NS. Re=roofs Type of Roof , Signature rrApplicanVComractor Date HAZARDOUS MATERIALS D CLOSURE Will the applicant or future building occupant Blom or handle haardous mantled as dented N by the Cupeno Municipal Code. Chapter 9.11. and the Health and Safely .b, Most M5324)7 All roofs shall be inspected prior to any roofing material being installed. ❑ Yu If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant tax equipment or devices which emlt hazardous air contaminants an, defined by the Bay Area Air Quality Memagcmcnn all new materials for inspection. DisuicnP ` u ❑ Ya 15" 1 have mad the hoardous materials mquirtmams under Chapur6.95 of thc Califor- niaHeallh&SafetyCade,S oes 25505, and 25534.1 thhiLei one tly haw m Thal ilex y aponsihiliry , he the Mntar hor m tpdrrto ''Gerd ate a Signature of Applicant Date All roof coverings to be Class "B" or better owner nr.athrnaae ascot DateC CITY OF CUPERTINO 01 BUILDING DIVISION PERMIT BUILDING ADDRESS J 0 2 4 -� N U7QT,PP PT) COMFORT SYSTEMS USA PERMIT N003010140 OWNER'S NAME:110 E DOUGLAS AVE PERMIT LT�FS 0/ 2 0 0 3 TGIF RESIAURANT PHONE. (559)627-2653 SANITARY NO, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Secdon7 )o n of the Business d Pr,,f,.,-. Code, and my license is in full fc cc d ce,tf� REPLACE EXHAUST FAN. . —4c' License 'M ._ Date 'Z—v Contract 51 , ARCH RATION I understand my plans shat ublic records he Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to rile a signed statement that be is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area $ 3 6VA!a4tion (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of 3 1AM41iffiZer0 0 Occupancy Type Section 703U by any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). 0 1, as owner of the property, or my employees with wages as their sale compensation, lu I —V'UU d Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of 102 - PIERS property who builds or improves thereon, and who does such work himseifor through his own employees, provided that such improvements are not intended or offered for sale. If, 103 - UFER however, the building or improvement is sold within one year of completion, the owner - 104 REBAR builder will have the burden of proving that he did not build or improve for purpose of - sale.). 105 - ANCHOR BOLTS C3 1, as owner of the property, am exclusively contracting with licensed contractors to 106 - SEWER WATER construct me project (Sec. 7044, Business and Professions Code:) The Conaractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and 202 - UNDERFLOOR PLUMBING who contracts for such projects with a contractors) licensed pursuant to the Contractors 203 - UNDERFLOOR MECHANICAL License Law. 01 am exempt under Sm B & P C for this reason 204 - UNDERFLOOR FRAME Owner Date 205 - UNDERFLOOR INSULATION WORKERS COMPENSATION DECLARATION 301 - ROUGH PLUMBING I hereby affirm under penalty of perjury one of the following declarations: 302 - TUB & OR SHOWER 0 1 have and will maintain a Certificate of Consent to self -insure for Worker's Camper, sation, as provided for by Section 3700 of the Labor Code, for the performance of the 303 - ROUGH MECHANICAL work for which this permit is issued. 304 - ROUGH ELECTRICAL I have and will maintain Worker's Compensation Insurance, as required by Section 305 - FRAME 3 of the Labor Code, for the performance of thew A for which this permit is issued. My Worker's re Co 'psuartion Insurainge carrier number In No.: iWLI'l 306 - 307 - HOLDOWNS INSULATION C OICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK (This section need not be completed if the permit is for one hundred dollars ($100) 309 - EXTERIOR LATH arless.) 310 - INTERIOR LATH I certify that in the performance of the work for which this permit is issued, I shall not 311 SCRATCH COAT employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date 313 501 - ROOF NAIL - FINAL ELECTRICAL ENERGY Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must 502 - FINAL PLUMBING ENERGY forthwith comply with such provisions or this permit shall be deemed revoked. 503 - FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance or 504 - FINAL BUILDING ENERGY the work for which this permit is issued (See. 3097, Cly. CJ 505 - FINAL ELECTRICAL Lenders Name Lender's Address 506 - GAS TEST I certify that I have mad this application and state that the above information is 507 - FINAL PLUMBING correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the FINAL MECHANICAL above-mentioned Property for inspection purposes. 09 FI (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue agains said City I A NG r in consequence of the granting of this permit. APPLICANT UNDF AND Wll��C MPLY W issued by: 5 WORKS Date )DS S ( �FN&. Re roofs Type of Roof C7 HAZARDOUS MATERIALS DI CLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9,12, and the Health and Safety Code, Section 25532(a)7 , 'pNo All roofs shall be inspected prior to any roofing material being installed. 0 Yes If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes Na I have read the hazardous materials requirements underChapter6.95 of the Califor- niaHcalth & SafetyCode, Sections 25505, and 25534.112kderstano that 11 the building no' a" havey c cupim 6 the 1\ u e ��.Lbn #ncii of a Ccrfi cam 7"--""c in cup'y. Signature of Applicant Date 3ek - n-- , All roof coverings to be Class "B" or better or Date I ---J .,.c, ara'crr'.'.d agent CITY OF CUPERTINO IT CUPEkTINO ? 716 mom HIP Date: I Construction Tax Ruilding Address: Ind/OfffCo. uasi TGI FRIDAYS #1900 i Con. Tax for BQ Zone Owner's Name: "I MIR, Phone owl MAIN STREET AND MAIN Constax — Resi/Mobile BELEC1000 Contractor: as 1163 License Elec 600V > 1000A ARC COMFORT SYSTEMS USA 408539 ELECTRICAL Contact: Phone #: Edward J. Enos 510-278-4900 Investigation fee Applic,ant/Contractor: MITIGATC Fax #: OMFORT SYSTEMS SA Res. Housim Mit Fee• 5107278-4987 U /f3uilding ennit Info: MECHANICAL X VATIOU1 Bldg Elect Plumb Me In 14scription: �REPLACE • S Residential: Commerci: EXHAUST. FAN Sq.Ft. Floor Area: MWEVII I lip all-* 11 $/Sq.Ft.: Architect/Engineer: Valuation: P Type of Construction: Occupancy Gr p: 1 of 3 mom HIP Fee Group I Construction Tax Ind/OfffCo. uasi i Con. Tax for BQ Zone "I MIR, Hotel and Motel owl Constax — Resi/Mobile BELEC1000 Elec 600V <= 1000A as 1163 BELEC1001 Elec 600V > 1000A ELECTRICAL Elec Svcs 600V <=-200A ELECTRICAL Investigation fee MITIGATC Comm. Hoysing M�it. Fee 'BMITIGATR Res. Housim Mit Fee• U MECHANICAL X VATIOU1 In New Comm Electric ELECTRICAL • S New Comm Mcchacal�� .jamm New Connn Plumb MWEVII I lip all-* 11 1 of 3 CITY OF CUPERTINO PERMIT APPLICATION FORM [1 UA Fee Description rrGroup Vent Fan Single Duct "2111W 4 -- Ventilation Systems MECHANICAL I SebSpecific Wax ! r 1 Seismic .. 1 191 112 .p(.. , 1 "i Inspection 0 & 1 1 Swimmir�g ,,.•"311,12 � • iPower r 1.•' . :• d+ '' Bldg i 1219 ` a' l Temp Dist Svcs Business License 1 ��i'%"`iT.Riiti�� s •ELECTRICAL 2 i 05 Issuance • 1� 1 . Permit ee sq footI '. Address C . ' w!vali Boiler<= 100,000 Btu I BBOILER2 MAW 1=1 BBOILER3 Boiler > 500K to 1M Btu ' a! ge ' Boiler to 1.75 M Btut •' [1 UA