03100018 (2) CITY OF CUPERTINO �q: .+= �,. "' -•s `�"st '!
BUILDING DIVISION PERMIT CONTRACTOR,INFORMATION is
Bu1LDING ADDRESS: ALLIED AIRE SERVICE INC PERMIT NO 03100018
1 "7 COTTONWOOD DR -
OWNER'S NAME: 661 SINCLAIR FRONTAGE RD PERMITMUE°ATE
CHRISTEN.
°NL: (408) 934-8844 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
I06 LICENSED CONTRACTOR'S DECLARATION
10¢ 1 Mreby affirm Net I un licensed under provisions of Chapter 9(commencing Job Description
i< with Section lantq of Division Sof the Bu'nessand Professi oda..:2licanseis
in full f....nd ecL
{gz ucantacma io FURNACE & A/C
I` Dao ARCHITECTS DECLARATION
J dr+y 1 understand my plant shall heated as public records
?a
'a Licensed Pmfcsdnnel -
'ta Oat I am exempt
U Opt from
DECLARATION 3
)0 0 1 hereby affirm on 1 am exempts an the Comas Ca License Lew for the
:0 O following noean,permit
t ]onsu Business and wc.de oli Code:Any city Or county
11E which requires a panto,re cnmtacL alter improve,h Permit t or a pair any asemuro -
t priors iuiouturec,also ensedprsunttrequires provisions
o rhe sucCon Permit la EenseLadetsamCnl -
<
that mencingsedpuection7 thcpmvivioion3af Conusines'aLianselsw(Chapter Code)
Sq.Ft. Floor Area Valuation
20ct
$ (co exempth Section lOW)th Division th N alleged Business and Professions Code)or
Net M1e V exempt thearrom and the basis for the alleged exemption.Any vloladon of 36917042 . 00
Section 7071.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than Eve hundred dollars($500).
❑1,as Owner of the property,or my employees with wage u their sole compensation,
will do the work,and the structure is not intended or offered fonale(Sec.7044.Business
and Professions Code:The Coruecme,Lie..Law docs at apply a en owner ofIM ctlons
property who builds orimproves theaon.and who dassuch work himselfor through his 303 - ROUGH M CHANI AL
own employees,provided that uch improvements we not intended oroffead fm tale.If. 304 — ROUGH ELECTRICAL
however,she building or improvement is sold within one year of tompletion,the marc'.
builder will have the burden of proving that he did not Wild or improve for purpose of 505 - FINAL ELECTRICAL
ielc')' 507 - FINAL PLUMBING
❑1,an owner of the property,em exclusively connecting with:)The
eeC contractors to
comeLo doesjenpplyu,an..ainruoeProcessionCoorUTheContcna,aU.nd SOS — FINAL MECHANICAL
cense ntr dao not apply c an owner of property who sed p or improves thereon,and
whocontractsLa LL for projects with a contractor(s)licensed pursuant m the ContnnoM1
0 1 room Law.
❑Ism exempt antler ga. .B At P C for this aeon
Owner Dam
WORKERS COMPENSATION DECLARATION
I heroby affirm under penalty of perjury,ant of tW following declaration:
J/ Ihan and will..Iowa a CeNEeaa or Consent o salbinum(m Worke's Compcn.
rr suion,u provided for by Section 7700 of the I�Wr Code.for the Performance of the
-1 for which this permit is Issued.
ban and will maintain Wmker's Compensation Insurance,as reyviad by Section
31
00 of the lsbor Cade,for tW performance of Ne work for which this permit is issued.
My Worker's Com pensadan Insurance terrier and Policy number am: S
Cartier: .S'• �'s-.�- Polity Na.:
CERTIFICATE OF EXEMPTION FROMORKW ERS'
COMPENSATION INSURANCE
(ThLL section need not W completed if 1W Permit Is rmoahundted dollars(SIM)
or less.)
1 ccnify that in the Performance of the work for which this Permit is issued,)shall not
employ any person in any manner an as or become subject a the Worked Compensation
Laws of California.Dem
Applicant
NOTICE TO APPLICANT:IL afar making this Ccnifaa of Exemption,you should
became Object to the Worker's COmpewtion provisions of the Ichor Cade,you must
�Q forthwith comply with such previsions Of this Permit Mll W lamed meted.
�2 CONSTRUCTION LENDING AGENCY
1 hereby affirm that Nem Is a Bonet woo.lending agency for the performance of
1'> the work for which this permit is issued(Set.7097.Civ.C.)
YLender's Name
z Lander'sAddress
;)Q I anify that I have read this application and state that the above informatiun is _
(✓ correct.l qme to comply with all city and county ordinances and state lows relating to -
0U building construction,and hereby authorise representatives ofhis city to roar upon the
>+W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and kap harmless the City of Cupertino against
r y :,a
iabilitiq,Ju mcnLL,crosu and uses Inch mason any wyacauc against said City
J z in can c of the if
( is perms
'•" A PLI UN ST N ITH ALL NON-POINT Issued by: Date
S N
�7 Re-roofs
Signuure of ApplitanVCamr Dim
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII tW applicant or(mus Wilding occupant some or handle IHeaAous material
n deft by the Cupertino Municipal Lode,Chapter 9.12,and the Health and Safety
We.
Sccdon 25532(a�NO
All roofs shall be inspected prior to any roofing material being installed.
❑Yes
J Will the applicant or future building Occupant use equlPment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hoard...air contaminants as defined by the Bay Ama Air Quality Management all new materials for inspection.
strict?
❑Yon Nu
I have road the hmsrdonsmawialsmquim=nuundcr Chepar6.95 of the Califon,
nie HcalNk Safety Cued,Sccdon 255115,25577 and 25534.1 unWmund Nat if Nt Wilding
dace not tura y he
a tenant.N 't is my ms Pnibility a notify ted ant of Ne
ayui_MO. mirnost ri wissuan faCcrsiOcaaofOcpgrV Signature of Applicant Date
Owner ser authorisd agent Rant
All roof coverings to be Class "B"or better
}0/02/2003 19: 51 5105303202 LEGALITIES INK PAGE 01
D North Bay Permit Service
1 CITY OF CUPERTINO 8988 Somerset Ave.
Ca Valley CA 94546
fCC�� i . FURNACE/AC
CITY O -- --
,4UPER N0' P :RIVIIT APPLICATION F s sy'''L3
ORM
APN# y�
3' b �. T �.1:?t��n �_Z
Date: �� 2
Building Address:
Owner's N ' Phone#:
��-
Con ct — phone; License #: "
�G� 13 '� -Lrfy 6003 s
Contact: Phone: Cupertino Business License #:
Building Permit Info: j
t
Bldg ❑ Elect Plumb Mech
Job.Description: C_/0 , G o, o oa
Q c�GP �_/—L - 2:-s—
Residential
Residential a CornMercial ❑
For.RpAidentialIn�llations: yy.�
ttic ]Sr floor 2"d floor
dhere to min,set back require „ nS�
or Commercial InstallAtions:
Replacement same weight ❑ Additional weight (structural cales) ❑
Structural Calculations requiredor new installation :❑
New installation Planning Appcc val Required El
Cost
of Project: c ' Type of Construction: Occupancy group:
Strapped LJ On Platform. L Bonded ❑ Sq.Ft. Floor Area:
New Location Re lactent
Qty. if
A licable Fee (D Fee Description Fee Group
BENERGY Energy
1. BUILDING
BREIvIFURN' Relocation of FurnaceMECHANICAL
BREMACO'Yrf R. A/C Unit> 10:000 cfm MECHANICAL
L BREMAIRH T A/C Units <= 10, 000 cfm MECHANICAL
/ BREMRHCEP ' Rec tl, Switch & Outlets ELECTRICAL
/ BSEISMICRE Seismic Fee Res BUILDING
/ EPER1vI1TFEE Elec Permit Issuance ELECTRICAL
MPERMITFE Mech Permit Issuance MECHANICAL
PPERMrFFEE' Plumbing Permit Issue PLUMBING
BPERMFEF l.: Bldg Permit Fees BUILDING .
BPLANCHK:`u . Plan Check Fee
BUILD
BUSLIC Business License BUILDING
A I