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04050004 (2) r. CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTORINFORMATION x$ - Bu 1LDING ADDRESS: AAA FURNACE & AIR CONDITIO ?M�14904-050004 OW NEWS NAME: PERMIT ISSUE DATE HEMER DAVIS ONE: SANITARY NO. CONTROL NO. (408) 293-4717 ARCHITECfIENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 veZ LICENSED CONTRACTOR'S DECLARATION eo lob Description ZC 1 hereby affirm Nn 1 am licensed under provisions of Chapter i(commencing p <U wispllfro nndfeeDivisionJof NC Business and Prufcuinns Cndc,andmyliccnsc r� e infullforteand ren. REPLACE FURNACE & ADD A/C I� ^�z Damns au ConLic'tractor u 'an HITECTS DELLA-� 1 understood my plana shall he used as public records MAY 17 2004 DyU ;off Licensed Pro(cssianal 3 OWNER-BUILDER DECLARATION +� 1 hereby affirm Ilial 1 am exempt from Ne Contractors License Law for the ��]�aIq�1Inp11 11IIII �1pI1 �pqyqp 1p��l�1)r3^— i 0 o following mason.(Section 7031.5,Business and Professions Code:Any city or county S V Pacer= I YGt m�+ which requires a Permit to construct.alter,imprism,demolish.or repair any structure F•Zaprior to its issuance.also mitphoes the applicator inrsu=b permit to file a signed statement that he is licensed pursuant o the provisions of the Common's Lions Law(Chapter 9 Sq.Ft.Floor Area Valuation gFo (commencing with Section 7")or Division of the B usineu and Professions Code)or y that he is exempt therefrom and the basis for On alleged exemption.Any violation of settle.7031.5 by arty appliam for apermit,.bja,u the.,If ,to a civil penally of 32+fl3I$Q rd)er00 Occupancy Type not more Than Bre hundred dome(53001. - ❑I.u owner ofthe rmpeny,or my employees with wages as their Sole=ompenullon, will do the work and the structure is notion n led or offered forsale(See.7014.Businev and Profccsiou Cade:The Comracsors Linden law does not apply in an owner of Required Inspections property who buildsar improves thereon,and whodoes suchwak himslforthrough his own employees,provided that such improvements art not intended or offered for sale.If. however.Ne building or improvement is sold within one year of completion,the awner- Wilder will have the When of proving Nat be did not Wild or improve for puryose of sok.). FI I,as owner of Ne property,am exclusively contracting with licensed eonwemrs w Wrimuct the project(Sec.7044.Business and Professions Code:)The Ci mtracwr's Li. toe law docs not apply to in owner of property who Wilds or improves themon,and who contracts for such pmjcm with a comunor(s)licensed pursuant to the Commemrs License Law, ❑ 1 oro exempt under Sec. .B&P C for this moon Owner Das WORKER'S COMPENSATION DECLARATION I hereby affum under penalty of perjury one of the following declinations: I have and will mdntain a Certificate of Cmpdml w ul(-inaum for WmkeraCompen- 737W ion,u Provided for by Section 37W of the Labor Code,for the performance of Ne rk for which this pemtit is issued. 1 have and will maintain Worker's Compensation Insurance,as required by Section of NC labor Code,for dw performance of the work for which this Permit is issued. y Workce C IPound,. I nna//artier and Policy nu her art:rrier. P" Policy N., ERTIFICA F EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This section bond not W complewd if be Permit is fororc hundred dollars(SIM) or less.) 1 anify Our in the perfomun a of the work for which this permit is issued.1 shall not employ any pcwn in any manner in u w become subject o the Workers Compensation Laws of Califomia.Date Applicant NOTICE TO APPLICANT.If.arm,making this Cci ificate of Exemption.you should become subject to the Wohera Compmuation provisions of the labor CMc,you must .JO forthwith comply with such provisions or this permit shall W deemed mvoked. Z N CONSfRUCrION LENDING AGENCY 'f+ I hereby affirm that there is a comwcaion lending agency for the performance of C' > the work for which Nis permit 0 issued(Scc.MrI.Civ,C.) 0 tenders Name- 7 z Lcndera Addmss 1 V O 1 candy that I have mad this appliauon and soon that the above information is P cortccL 1 agree to comply with all city and county ordinances and sus laws rotating to OU building consWction,and hereby auNodm mprosemtivea of this city to enter upon the 6Wi above-mentioned PMKrLy for iupecdon purposes. (We)agree to save,indemnify and keep harmless the City o(Cupertino against F"res Iiabilitles.judgmcns,costs and exper uwhich may in any waya=crue against said City fJ Z in consequence of the granting of OR Permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: di Date SOIJ�cEREGIJ�.ATIQg45._ v/Re-roofs SigggnnatuseofVApppplicartrCoonorecmr P /VDam f HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material is defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety lDiorrict? m.ElY. 512(¢)? All roofs shall be inspected prior to any roofing material being installed. Yu WilOR l the aPPlicam future building Occupant use equipment or aeri=es wdm If a roof is installed without first obtaining an inspection,I agree to remove it hamdous air worm naps ss defined by Ne-Bay Area Air Quality Management all new materials for inspection. ❑Yes I have mad the Nord uemawtiaxteltosmemounderChapter695ofthcCarter- Hcalth&Safny Cabo,Secuons 25505,255]3 and 75534.1 undcrssnd thatifthc Wilding o nos currently have a moan,that it 1s my msp insibility w notify the occupant or the uirtmens which mut be mel prior m issuance of a Cenificate of Occupant Signature of Applicant Dale / D d S O All roof coverings to be Class"B"or better uthoV eras arize agent Da •,..xi.., - Community Development 10300 Torre Avenue - ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building Department JOB ADDRESS: PERMIT # Dog �0 6,e Ess �v ,fo00 OWNER'S NAME: PHONE # GENERAL CONTRACTOR: gyp/ FAX # // 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 Heating 40 AG Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Ownjr/Conlractor Signature Date CITY OF CUPERTINO (E F URNACE/AC o s- �PEI�TINO PERMIT APPLICATION FORM Date: rT Building Address: Owner's Name: Phone #: Contractor: Phone: License #: n0 YON - Contact: Phone: Cupertino Business License#: ?- VW Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: Clean U c 3 -So—e �J Residential Co ercial ❑ For Residential Installations: Attic ❑ ls` floor ❑ 2nd 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 Approval Required ❑ Cost of Project: Type of Construction: Occupancy group: Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Re lacement Aplli4bW Fee ID Fee Description Fee Group ENERGY Energy BUILDING REMFTJRN - Relocation of Furnace MECHANICAL _ BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN AJC 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 � —o