The URL can be used to link to this page

04020133i CITY OF CUPERTINO BUILDING DIVISION PERMIT�Q�1`1tA-�QR"INI♦'f12MA'TId e ^��+., «�_ ��.. ••ate, t BUILDING ADDRESS: AAAy FURNACE & AIR CONDITIO �N'04020133 OWNER'S NAME: RWIK 1719 qTOBIR A172 PERMIT ISSUE DATE no In Q /2004 ONE: SANITARY 0. CONTROL NO. ARCHITECDf:NGINEER:BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Description 1 hereby affirm that 1 am licenced under previsions of Chapter 9 (commencing .lob with Secdon 701)(3) of Division 5 of the Business and Professions Code, and my license is Li«lore and 11 l ue.g �G iG9 CHANGE FURNACE/ADD A/C Dau Con"'we7�— ARCHMCTS DECLARATION _ I understand my plans shall W used as public ..,us Licensed Professional OWNER -BUILDER DECLARATION I herchy affirm that I am exempt from use Convector's License Law for the following reason. (Section 7031.5, Business and Profession Code: Any city or manly which requires a pmmit to construct, alter, imprew, demolish, or repair any s0uctum prior m its issuance, also requires the applicant for such permit m file a signed statement that he is licensed pursuant In the provisions of Ne Contractor's UcmY Law (Chapter 9 Sq. Ft. Floor Area Valuation (cmumeneing with Section 7") of Division 3 of the Business and Professions Code) or Nat he is exempt therefrom and the basis for use alleged exemption. Any violation of 3 2'�NJ'0�tbttr� (] Occupancy e P yTyp Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than fin hundred dollars ($50)). El 1, u owner of lho pmpmy, w my employws with wages u their sole compenmtion, will do the work, and the structure is nolinmened ora@red forage (Sec. Trim, Business Required Inspe Code: The law does ret apply lf an owner and Pocproperty venComomm's property who bei ids or ire pmvu thereon, and who ares inch work bireme f who erace, and through his is own employees, provided Natsuch improvements are ne ed If. `/ cundedoroRe=d me own . however, Ne building or Improvement is hath within one year of completion, Ne owner- builder will have the burden of proving Net he did not Wild or improve for purpose of I Cale1. // ❑ 1, a owner of the property, velyand contracting with m o :i The 's . B sinus construct Ne project (Sec. 7044, Business and Professions Code:) The CenuwNrh Lt.0 cove law dean not apply in an owner of property who Wilds or improve theater, and who contracts for such projects with a conummr(s) licensed pursuant in the Convector's License Law. ❑ 1 am exempt under Sec. . B & P C for this moon woe Data - WORKER'S COMPENSATIONDECLARATION 1 hereby affirm under penalty of perjury one of the following welmatiom: 1 have and will maintain aCeNOcata of Covent to self -insure for Worker's Compen- Jon. ss Provided for by Send.. 3700 of Ne Ia1wr Code, for Ne perfo..we of flue work for which this permit is issued. (have and will maintain Workers Compensation Insurer=, as required by Section IM70o of the Labor Code, for lie performance or the work for which this permit is issued. y Worker. Compensatioonn insurance carrier it Policy much a/rc': F .I Cartier. '2 i FL<J Polity No.: s(.Ltlr�.gt.0..�G:A �� ERTI IC!i OF- EXEMPTION FROMWOICKERS' COMPENSATION INSURANCE ' finds section wed notwcompleuJ ifthe poreft is forone hundred dollars(5100) or less) 1 woof, that in the performance of the work for which this Permit is issued, I shall nut employ any person in any mummosn of to become subject to the Workers' Compensation Laws of Calihmem. Data Applicant NOTICE TO APPLICANT: If, after making this Cenumalc or Exemption, you should become subject to the Workers Compensation provisions of Ne labor Code, you most forthwith comply with such Previsions or this permiub.11 he deemed rev.k.d. CONSTRUCTION LENDING AGENCY 1 hereby sirloin that there is a construction lending agency for the performance of " Red work for which this permit is issued (Sm. 3097, Civ, C.) Lender's New Lenders Addrea I certify that 1 have read this application end state that the show, information is correct lag= to comply with all city and county ordinances and sou laws minting in building construction. and hereby suthorim murescow iven of this city to enter upon the above-mentioned property for Inspection purposes. (we) agree to um, indemnify and hep harmless the City of Cupertino against liabilities, judgm,nts, ,sass and expense which may in my way semen against mid City in consequence of the granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOU EREGULATIONS. Re -roofs Type of Roof p l ✓kr r N BZ 1/ D34 Si sure of Appli UCon m Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or Poore building occupant store or handle hmmdous material m defied by tint Cupenire Municipal Code. Chapter 9.12. and the Health and Safety de. Sortie. 25532(a)7 All roofs shall be inspected to any roofing material being installed. ❑Yes ANO prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant orfuturebuilding occupant use equipment or devices which it hmardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection. otm7 OYe NoIhavemadthehmard 1.42.5ents sntaurials requimmmor underChapterfi.95oftheCalifor- HcolN&SafctyCodc.Scmov35YJS,25533and25534.IendcrsundNmifthc Wildingel not currently haw a tenant that his my responsihility m notify Rha occupant of the which must w met prier m issuance ore Certificate of Occupancy. Signature Of Applicant Date ...g� [/,tL,,,,,�, OL'/�" D S� All roof coverings to be Class "B" or better Owner or authorimd ag� Dam 1 \CITY OF CUPEkTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM APN #3-e6 _ /9.067 Date: oa - olf-e7 Building Address: BRENIFURN �7'/ A' _ MECHANICAL Owner's Name: Phone #: 1'e- YAZc Y 6 -Ty 7/ Contractor: Phone: AAX WeW4 License #: 0 a' 3 ;me do 71 ontact: Phone: Cupertino Business License #: %7_44 LA4 a�93'Y9 BUILDING Building Permit Info: Seismic Commercial Bldg ❑ Elect Plumb Mech Job Description: ELECTRICAL GAl 4no Mech Permit Issuance Plumbing Permit issue Residential Commercial ❑ BPERMFEE For Residential Installations: —`— Attic ❑ 1" floor ❑ 2nd floor ❑ Plan Check Fee Adhere to min set back requiremcnt ❑ BUSLIC For Commercial Installations: BUILDING Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project_ 4 j cp Type of Construction: Occupancy group: Strapped LJ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if ADDlicable Fee M k BENERGY Ener t tt'-V- BUILDING BRENIFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAI .HAN 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 PPERMITFEE Mech Permit Issuance Plumbing Permit issue MECHANICAL PLUMBING BPERMFEE Bld Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business Licen, BUILDING 4� OX, Y/