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03080058 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CON JOR INFORMATION ,, , n, a,, ; r, BUILDING ADDRESS: SCHAUMANN AIR CONDITIONINPERMIT ND03080058 19752 BIXBY DR OWNERS NAME: HEATING & PLUMBING INC PERMITLSSUEDATE SCOTT & STACEY RYDER 3 2003 ONB: (408) 428-0640 SANITARY NO. CONTROL N0. ARCHITECnENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH I� C= .06 LICENSED CONTRACTOR'S DECLARATION �i� I hereby spot.that 1 am licensed under provisions of Chapter 9(commencing Job Description tan with Section 7")of Division 3 oflhe Business and Proportions CoJgand my license is ��r� n ^ p +< mmnro.eondertem REPLACE FURNACE p \ !c 'a�t j n.- Licu Coo Lic,1t 39 cnDow Contractor ARCHITECTS DECLARATION SEP 2 . 2003 I I understand my plana shM u ell used puhlic rccards >yU f 0 Licensed Pmfessinnal 1se� OWNER-BUILDER mDECLARATION BUILDING DING 2OO 1 masa ,(firm that I am exempt from the Contractor's Co License Lew for the IDV 6. ❑O followhich re requires archon 7(13 tr Business am,am rPr,d oornns Code:Any city or county 3$ which rtyvis a a permit ac construct.alcor,ice for such deermit t fi repair any structure 91 Prio.n iutensedPaoumquircet.,Isla,ofcant for Contratorlmmcse signedcomment rm< (commencing wU Pursuant to 70thc provivions3 of the ntaiessnittmfssio(Chaptermik)or Sq.Ft. Floor Area Valuation F$ thatMIsexemitOcreion70o0)of One iasis,frnftheegedexaand on.AnyonsCnde)of 36909017 . 00 Nat he Is exempt therefrom and Ne bola far Ne alleged ezemptlon.Any violation of Section 7031.5 by any applicant for a permit ubjects the applicant to a civil penalty,or APN Number Occupancy Type not more than Bvs hundred dollars(SSW). 0 I,a owner of the pmpeny,or my employees with wages as their sole compensation, will do the we&,and the aummuw is not intended or ffered for sale(Sec.7(144,Business 3 01 — .it Professions Cads:The Contractor's Ltcenx Law Ones not apply to an owner of 3 03 — ROUGH CLIOnS property who builds orimprom thereon,and who does such work himselfor through his F1L ownemployces,provided mmauchimpamwoenusm amimended aroffosd hersaw.It. 304 — ROUGH ELECTRICAL however.the building or tmpwwmcm is told within nae year of eo.pledon.the owner. builder will have the burden of proving that he did not wild or Improve for purpose of 505 — FINAL ELECTRI CAL sale') 507 FINAL PLUMBING 01,as owner of the propcny.am exclusively contracting with licensed contract..a 508 — FINAL MECHANICAL consumer the project(Sec.7044.Business and Professions Code:)The Contractors Li. cane law two;not apply to an owner of progeny who wilds or improves thereon,and, who contracts for such projects with a contractor(a)licensed pursuant to the Consomme, License Law. ❑1 am eaempr oder Sec. .B&P C far ..on wn Dale 3 O WORKER' M ION DECLARA I hereby affirm undo naltyof rjury one of the following declarations: I hoe and will maintain a Cerdficom of Consent to self-imum for Worker's Compcm sation,u provided for by Scetion 37W of the labor Code,for the performance of the work rot which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,a required by Section 37W of the labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Imuran.emierand Policy number am: Cartier: Policy No, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (TMs rection need not beeompkewd If the Permit Is for one hundred dollars($1 00) nr leas.) 1 sanity that in the performance of the work for which this permit is issued,I shall not employ any person in any manner an as W become subject o the Workers'Compensation Laws of California.Dem r Applicant NOTICE TO APPLICANT:If,after making this Ccnificaw of Exemption,you should become subject to tum Workers Compensation provisions of the labor Code,you must .JO forthwith comply with such prnvons inor this permit be deemed.vokca. z r~co). CONSTRUCTION LENDING AGENCY [—i I hereby affirm that there is a comtruc'Iinn lending agency for the racaufmance or CG 7 the work fur which this permit u issued(Sec.3W7.Civ.C.) UA A Lender's Name z Leader(Adtlress U Q I certify Nat 1 Mw read this application and show that the above information is {A F commit.I.&me to comply with all city and county ordinances and sow laws relating to O U building comsuclion,and hereby aulhodu representatives or this city in enter upon the W shove-mentioned property for inspection purposes. (We)agree m save,indemnify and keep harmless the City of Cupertino against W liabilities,judgments.coats and expenses which mayin anyway acec againsaid City U Zin consequence of the granting or this Permit. rotr / APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date SOURCE ULATIONS. Re-roofs Oswr sesta of ApplicsHA ARDOr ATERIAIS DISCLOSURE D! Type of Roof Wdl the applicant tar future rodding..panumre orhaadw haran7uvs material u dcMetl by the Cupertino Municipal Cole,Chapter 9.12,and the Health and Safety ode.&Llcsn 35532(x)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yr. P�No Will the applicanwr future wilding Occupant uxeyuipmem orJcvices which If a roof is installed without first obtaining an inspection,I agree to remove It haudnes air contaminants a defined by the Bay Area Air Quality Management all new materials for inspection. "Ota" 0Yes �o 1 haw.aJ the wamrmsmawrials requiremcnho under Chapwr6.95 drum,Califon. nia Real"Safety Cow Scc ore 25")5,25533 m,25534.1 undcrtund thatifNs wilding does not currently haw a tenant,that it is my responsibility W notify the occupant or the rcquircmenl, ichmusrbemm Ort niaaacennraccmreawnr exPuncy. Signature of Applicant Date .amortno. o e All roof coverings to be Class "B" or better -� CITY OF CUPERTINO U ��O FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN# Date: A .JCS ust 1 ,2r�v3 Building Address: 18752 Bixb ,PrWZ �u 7'hvw CA 6(50ly Owner's Name: Phone#: 5Coit & 6+Acc 2 61CV/ C41)E)) 255--709 Contractor: License#: SGlhAIAWA A hC,k�eah(L3 XP —7'70D54 C4 M C310 Contact: Cupertino Business License #: .10tH ri M- G i ever Building Permit Info: Bldg ❑ Elect Mech Job Description: Pe [&Ce old �uYna,Ace w� a rtw a Residential NO Commercial ❑ For Residential Installations: Attic ❑ 1' floor K 2°a floor ❑ Adhere to min set back requirement[I • For Commercial Installations: Replacement samewei ht C] Additional weight(structural calcs)❑ Structural Calc anon' d r new installation ❑ New installation Planning A r al Required rl Cost of Pr sect: I I oa ' Type of Constructio Occupancy oup: r, Strapped On Platform Bonde Sq.Ft. Floor Area: New Location ❑ Re laceme Qty. if Ap a Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL BREMRECEPT Reeptl, Switch&Outlets. ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING 2 Z , /, 9-