04090014 (2) CITY OF CUPERTINO a^ �-'i" >K y-� r ��'r7gg'',,.-./a^��"`
BUILDING DIVISION — PERMIT
BUILDINGADDRESS: AAA FURNACE & AIR CONDITIO W°04090014
OWNER'S NAME: PERMIT ISSUEDATE
STANLEY
ONE:
SANITARY O. ONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
(� 0 7_1 0
CDC,
LIothatI CONTRACTOR'S DECLARATION lobDescri ���®
tC, thereby ter LIC NS1am ONTRAunderpmvisions ACTapo:r Y(mmmcncing
A.
`if with Section 7gMq of Division 3 of do Business and Profcssiuv Code.and my liccnu is
mO rose ane erre'' 2 WALL HEATERS
j#_ Liccnre Class Lie.a
°te `°"DELL SEP 43 2004
ARCHITECTS DECLARATION
�i I undersand my plans shall W used as public records
�yU I n
Liwnud Professional O II i1�11 ®�f9, n /�
ig OWNER-BUILDER DECLARATION U IILII� 1I\\\UNIT(\(\/\%/
Y 1 hereby affirm Lost I am exempt from the COntnaor's License Law for Loc u
80 following reason.(Smuon 7031.3,Business and Pmfessiom Code:Any city or county
.2v
$v which exports a pmmis so mnsnum,alar.improve,demolish,Or repair any structure
prior m its issuance,also requires the applicant forsuch permit e file a signed statement
< that he is licensed pursuem mthe provisiors of Loc Contmcur's License law(Chapmr9 Sq. Ft. Floor Area Valua[ton
�5m (commencing with Section7W0)of Division Sof the Busiuessand Prefossions Codclur
i $ than k u exempt thcefmm and the baso far the alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit sobjects the Applicant to a civil penalty of 3'A9I9i$`1JlMef00 Occupancy Type
not moe Nm Bre hundred dollars($500).
❑I,as owner of the properly,or my employe with wages u their sole compersation,
will do the work.and the Structure isnet metaled CAoffered for We(Sec.70Ct.Businall Required Inspections
and Profession Code:The Contractors ladors not apply to an owner of e License w q p
property who builds or impresses thereon,and whodocs such w°hhmeelf or through his
own employms.provided Lou men improvements arc oat intended oroffered for sale,IL
however,the building or improWmenl is sold within one year of compkuon,the owmr-
builder will bare the Widen of proving that the did not Wild or improve for purpose of
.to I.
951011as owner of the progeny,am exclusively COQ=Ling with licensed contractors to
comi un the preje x(Sec.7044.Business and Professions Centel The Con ismors Li-
come law door not apply to an owner of progeny who builds or improves dterton.and
Who eoovama for such pmjeca with a contnaor(s)licensed pursuant o the Conllaa0rs
License law.
1 am exempt Under Sec. B&P C for Nis moron
t . -D9 3
WOR R COMPENSATION DEC N
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain aCcnifiare of Conant to self-insure for WorkcrsCom an-
smion,m provided for by Section 3700 of the labor Code.for the performance of the
work for which Nis permit is issued.
❑1 have and will maintain Waters Compensation Irsuranse,rs mquimd by Smtwo
3700 of the labor Code,for the performance of the woh for which Nis permit is issued.
My Workers Compensation Insurance canner and Policy number arc:
Canicr: Policy No.:
CERTIFICATE OF E)rEMPDON FROM WORKERS'
COMPENSATION INSURANCE
(Ibis section nectl or hecomplc¢d if the permit is for..hundred dollars($1001
nr leu.) r
I unify that in du performance of the work for which this permit u issued.I shall not
employ any person in any manner an m to become subject to the Workmi Compereadon
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making Nis Certificate of Exemption.you should
become subject a Ne Worker's Compereatiun previsions of the later Code,you most
.J O foMwiin comply with such prom visinor Nis permiuhall W deemed evoked.
'z CONSTRUCTION LENDING AGENCY
'C+ I neaeby affirm the Item is a Corswction,lending Agency for the perfurmance of
C the work for which this permit is issued(Sec.3097.Civ.C.)
W� A Lender's Name
Z Lenders Addrtas
U Q 1 certify Nu I have mad this application and sus Load the&bow information is
ly H concn.I ogee to comply with all city and county oradves of and sate laws Loading upoL a /e
QU movongcotioned.,end hereby forid,uthmpoepesenativm of Niscity reenterupon Loc
ahovc (We)ARC propane lir cumify An purposes.
F C a caju agmc m cave.indemnify es keep harmless the City c accrue
adonis
N in
uang of this
may in any way accrue against said City
V z A APPLICANT
of the granting SNis pcimit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU TIONS.
y 0 Re-roofs
SiIi!"'
Applicant/ Onvecou e
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Wll th4'r applicant a future Wilding Occupant store a handle bar ou nownal
as dented by the Cupertino Muni'pal Code.Chapter 9.17.and the Health and Safety
ode,genion 25537a)7 All roofs shall be inspected prior to any roofing material being installed.
.y �Ycs °
). wdl the. sant or ruwm Wilding naso Ona time rat or Jevlea ween If a roof is installed without first obtaining an inspection,I agree to remove
Pp g p equipment
mit harallous air mnamimnu az,Jcfincd by Nc Hay Area Air Quality Management all new materials for inspection.
Disvin7 Axe u
1 have mal the naaardous maurials requieemcto under Chapter 6.95 of the Califon
nix HWO&SaretyCode,Smuom 25505.75533 and 8534.1 undersand Loa ifthc building
does not
to hors&uman4 Our it is my respomi hility a n°uly de Occupant Of the
tai mentsw mor
nrmi4uK ofaccrtlfeate r S Signature of Applicant Date
Owner antepd=eJa rat Date All roof coverings to be Class "B"or better
Community Development
San
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkjIN0
Building Department
JOB ADDR PERMIT #
IQ 4--cD CW4E DE ktOC l P
OWNER'S NAME: gr2j,.JJ PHO 2 3 - S
GENERAL CONTRACTOR: / FAX #
I am not using an subcontractors:
Y
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 AAA, R 2x1ACU 06 -7L 69 7
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
r/ ac r Signature Date
r CITY OF CUPERTINO
r -
v s� 1E
UPEtZTINO PERMIT APPLICATION FORM
APN # /� Date:
L
Building Address: ➢E M,t W� I� � A �(SU1 L(
w 104-50 Co2"fl= �Vhtt27uo `/+
Owner's Name: �n Phone #:
/" Si7�N�>� B2VNo 40 253 -Sl U-7
Contractor: Phone: License
fAQ Fu12a4c€ yC (4L,8) - if717 F9 71
Contact: d,* Phone:_ Cupertino Business License#:
si14r� 13auoo ('F08) 253-! '147 �
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description:
r7cR e-E 1 tC i
Residential ❑ Commercial ❑
For Residential Installations:
Attic ❑ 1" floor ❑ 2"d floor❑
dhere to min set back requirement❑
7 or Commercial Install t'
eplacement same weight Additional weight (structural calcs) ❑
Structural Calculations required for new installation El
New installat'on Planning Approval Required Fl
of P Type of Constructi n Occupancy
Strapped UJ On Platform ❑ B nded ElSq.Ft. Floor
New Location ElRe lace ent
Qty. if
AppTiqabje Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 c8n MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfrn 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 UILDING