04050007 (2) CITY OF CUPERTINO :
BUILDING DIVISION PERMIT CONTRAC"TORANFORMATIONN.-'.
BUILDING ADDRESS: ASTRO HEATING & AIR COND I ff"ITND04050007
19950 BRENDA CT
OWNER'S NAME: PERMIT ISSUE DATE
MABEL CHAN 118 ROYAL AVF, nrZo-� I?nn4
ONE: SANITARY NO. CONTROL NO.
(408) 268-8877
ARCHITEC IENGINEEB: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uo0 LICENSED CONTRACTOR'S DECLARATION
1 hemby affirm mat 1 me licensed undo provisions of Chapter 9(commencing Job Description
with Section]qNf D
))oivision3ofd,e Bassi Snd Pro uI'M ode andmyliccnseis
'aZsa in mum dderma. all ADD A/C Baa`ra
g�ipp
A��®
nP Datenw Cong or
�tj A CHITECI-SD ATION MAY �f
aty 1-t 1 undcry d my plans shall he used as tic mmrds 1 2004
M
of Licensed Professional aptpp
S Oat I am exempt
from
DECLARATION SUIL mG
Do 1 hereby Maso .(Stns that 1 1. cxcmpt from me Cocoons Cos :License Law for the IL((e tlLL//
0 o following oamus mmol(Simot ]W L5,ct.Mun3a and ate demob h.or:Any City Or structure K m which rcquiru a permit to construct.eltec improve,demolish.m repair any+wnurt
prior m iB Wrom c,al+u trquisu the applicant for much Permit 10 file a signed statement
` < that heislicensed pursuammUse provisions ofthe Contractor's UmnicLaw(ChePttt9 Sq.F[. Floor Area Valua[lon
(commencing with Section 7")of Division 3 of de Business and Professions Cauk)Or
y that he A exempt therefrom and the basis for the alleged eumpumm.Any violo On of ecxA-aaysaa,,nn
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 Gg3TuIQttIdTB)e10 0 Occupancy Type
not mom than Eve hundred dollars(S500).
❑L u owner ofshe propertccuwm noon onde wins wagea as dh,(See compensiness
will domework.ends: Contisuar's Lndedmoffered(ovale(S¢.In 7044.Business
o+
and Pro who
COde:The Cotthemars and
law dna not apply lf an owner of Required Inspections
ownreopen,whoes,provided
improves thereon,andwho d¢swch work or offered
his
own employees,the building
p ing or i m r such improvements are not intended m peered for ole.If.
however,the building or&.of roemishm within one year of completion,me .=of
builder will have the burden Of proving Nat M did not build Or improve for purpow of
rata.).
❑1,as owner of the property.am exclusively contracting with licensed contractors to
cunstmct dte pjwtt(Sec.70,14.Business and Profusions Code:)The Cm do,ew i Li-
nty law does not apply to an owner of property who builds or improves mesion.and
who contracts for such projects wins a mranow mr(s)licensed pursuant m the Contractor's
License law.
C l am exempt under Sec. ,B&PC for this mason
13700
wner Dat
WORKERS COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury one of the following d¢Ivations:
1 have and will maintain a Certificate of Consent to self-insure for WerkcriCompen-
sion,as pmvided for by Section 37W of we Labor Code,for the performance of the
ork for which this Permit is tamed.
1 have and will maintain Worker's Compensation Emotions,as required by Section
of the labor Code.far me performance of the work for which this permit is issued.
y Workcf a spetys d Inwra¢ tier and Policyamcr, licy No.:
C' i' 'OF E% M ON FRO_WO ERS
COMPENSAT INSURA
(Thu section owed not becompleted dine permit is formic hrndtvddollara($1010
or leu)
1 mot that in the performance of one work lot which this permit is issued.1 shall not
employ any person in any manner an as to become wbject to the Workcra''Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subjett to the Worker'a Compensation provisions of the labor Code,you muss -
.JO forthwith comply with such provisions or this Permit shall he.dcemed rtvnkcd.
Z" CONSTRUCTION LENDING AGENCY
,L Ihereby affirm that then is a construction lending agency for the Normenance or
a > the work for which this permit is issued(Sec.IDB?,Civ.C.)
W A Lender's Name
=Z Lender's Address
J Q 1 certify that 1 have read this application and some Net the above information is
B, F Corea 1 agree to comply with all city and county ardinasmes and some laws misting to
psi building convection.and hereby mdumire rtpruenuuvcs Of this city to enter upon the
} W above cram oxd pMNny for ormccuon purposes.
gy (We)agree m save,indemnify and keep harmless the City or Cupertino against
Hh liabilities,judgmcwa.costs and expenses which may in any way Came against said City
CJz in consequence of the gmming oft permit.
^ APP ICANT UNDERSTANDS D WILL COMPLY WITH ALL NON-POINT Issued by: Date
S E ATO 5.
Re-roofs
Si nes em pplicanJ rot e
HA DOU MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant smrc or handle h rmad..s material
as defined by the Cupertino Municipal Code.Chapter 9.12,and thc Health and Safety
Ne.seetiear 25533(a?
Year All roofs shall be inspected prior to any roofing material being installed.
❑
Will thea secantfrtrre w+ldin o¢u ant low CuUiPMCnLrot devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil hvardnus air contaminants as defined by the Bay Arca Air Quality Managcmrnl all new materials for inspection.
Disuia?
❑YesNu
I have mad the haves ors materials requirements under Chapter 6.95 of the Cahror.
iia Heal &Safer Code-sce, 25505, 33 and 2553,1.1 umkrsund that if lM building
doss crate 1 atenant that it is rtsponsihilitYunodry de a:cupant nr the
requ a t motto meetsSignature of Applicant Date
own r or authorised agent as te All roof coverings to be Class "B" or better k/
Community Development
10300 Torre Avenue
` Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: a (t PERMIT #
OWNER'S N Kl PHON1
E 22 Ll
# � - 53
GENERAL CONTRACTOR G_ FAX # —q 2
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
f Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
r/ ntra for Signature Date
CITY OF CUPERTINO
11 FURNIACE/AC
�JPEI�TINO PERMIT APPLICATION FORM
APN # Date:
689, b
Buildin4Adess:
1 ��)IfCSV.
Owner's Name: Phone#:
2 ZZ
Cntra tor: Phone: License#:
mag_
Co tac - Phone: Cupertino Business License #:
Yl 2t�
Building Pe Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job De cri tion:
ak e + l
Residential x 11Commercial ❑
For Residential Installations:
Attic ❑ I't floor ❑ 2"a floor❑
dhere to min set back requirement❑
or Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Annroval Re uired ❑ ��
Cot of Project: Type of Constructs Occu anc oup>
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qt . if
A li able Fee ID Fee Description Fee Grou
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 Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
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