05080205 (2) CITY OF CUPEWrINO
BUILDING DIVISION PERMIT CONTRACTORnINFORMATIQN
BUILDING ADDRESS: A PERFECT CLIMATE PERMITNOO 5 O8 O205
20666 CRAIG CT
OWNERS NAME: PERMIT ISSUE DATE
CAROLYN SCHULTZ 10570 S DEANZA BLVD 08/23/2005
ONE: SANITARY NO, CONTROL NO.
(408) 861-9545
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
=ori LICENSED CONTRACTOR'S DECLARATION
co I bereby.affirm that I am ucenacd under provisions nr Chapter 9(commencing JobDescription
11P��a
�i with Scmion]IXkB of Divisian3of the Bassin vend Professions Cade,and is I' I �I /yp �®
m mB three arta oRc 11O REPLACE FURNACE (F�f ` •,,l P`,
^'q? ucen:r e�asl s��tie.. L �1G' YsI
F❑ Co. --ts —Conhacbh L C Y
tJs ARCHITECTS DECLARATIO /
2
�d-t Iuoncrsund my plans shall be used as public memds .CT{//.yf �nOC
oats 6 1 J
C GLicensed Professional
.� 3 OWNER-BUILDER DECLARATION t�l�J) {B; ��,, {,r��S—
f I holebymaso •(Sere on I am.sumps from the C stuns o License Law for the InU j, ®� 'I 1, mCa $3 5 9 7
O O following mason.(Section 703 L5.Business and Profvium Code:Any city or county I✓�y U tau �, a
K w(v which hequims a permit or convect,alcor,improve,demolish,or.pair any structure
m-'^ poor to its issumcc.also requires the applicant for such Permit to Glc a signed statement
that he is licensed pursuant o the Provisions of the Comnctori Lima Law(Chapter 9 Sq. Ft. Floor Area Valuation
FFG (commencing with Section 7M(3)of Division 3 of the Business and Prorvions Code)or
W$ that he u exempt therefrom and de basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of Occupancy Type
not mom than five hundred dollars($50 L
❑I,as rwnu ofthe properly,m my employeas with wages W ftir solc eompenudon,
will do the work.and therstmaum Is not intended uroff mel bomb,(Sec.7 b.Businv
and Profeasimts Coda:The Comvacwrs Licetean
License Law es not apply to owmer of Required Inspections
property who bulla:or improvers themon,and who doessach work himmlfor through his
own employees,provided that such improvements art not intended oroRered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of tins propeny,am asclusivcly,contracting with limen ad contractors to
construct the project(See.](Na,Business and Professions Code:)The Contractor's Li.
cense law does not apply to an owner of property who builds or improves lhemon.and
who contracts for such projects with a mmractor(s)licemnd imon a n to the Convaaor's
_ License Law.
❑lam rcmpt under Sca. ,B&PC for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing decimations:
1 have and will maintain a Coni tette of Consent o self-insurt for Workers Compcm
rasion,as provided for by Section 37M of the labor Code,for the performance of the
work for which this Permit is issued.
1 have and will maintain Wmkcr'e Compensation Inwranw,as required by Section
or me 46th Code,for the pefmorm.of the work for which this permit is issued.
y Work�A Cnormpewtion hussuhn�,nsaysc�arrier and Polity,nQumrbbeer�am:/,��
Cartier. 1 ""I✓1'LII/Ih y/Pall,�f(d'cy No.:ltl.I I q IL�2�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
!This section cad not be completed if the permit is formne hunched dollars(SI00)
or less.)
1 Certify Not in me performartm of the work for which this Permit is issued,)shall not
employ any person in any manner Or as to become subject to the Workers'Compensation -
Laws of California.Data
Anilicam
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
.,O foMwith comply wire such Provisions Or tis permit shall be deemed revoked.
Z' CONSTRUCTION LENDING AGENCY
I hereby affirm that inert is.coosuuctinn lending agency for the larfmmanea of
x the work rut which this Permit u issued(Sec.3097.CO.C.)
1A Q Lender's Name
z Lenders Address
V p 1 certify out 1 have mad this application and state that the above information is
f" cortex I agree to comply with all city and county ordinances and sure laws misting to
O V building construction,and hereby authorise represenutives or this city to enter upon dm
r� shove-mentioned p hi eny for inspection purposes,
(We)agree m save,indemnify and trop h the City of Cupertino against
f'N Imbili0cajudgmenu.costs and expenses whitay in an ay acerae against said City
V zs permit.r
APPLICANrDS AND of the Of WILL COMPLY LTH ALL NON-POINT Issued by: Date
RC REGULATIONS.
Re-roofs
Signature of Apphcanvcontmmm Data
HAZARDOUS MATERIALS DI OSURE Type of Roof
Will the applioam or forum building mecupmr m or handle huudous maonal
as efned by On Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Code.Section 25532(:)]
Q Yes No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building am phim,use equipment or devices whim
zathe If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air contaminants as defned by Bay Area Air Quality Management all new materials for inspection.
Disvic,7
❑Yes \IAnu
Ihave&Safe,the un.Secarm25505,2als 5533an25534.under ChapmrQ95 if the Califor-
does our
&tend,Coe,whamn sea it i my responsibility
n poor,d,camp the building
Joel nor currency have a mnanr.thaz it u my mxponsihility w notify the aecupanl of the
mquim nuwhkhmustbemotpnorwissumc ncenirxamoraaup-q Signature of Applicant Date
Owner or authomcd agent p� Dam All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
� CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRE : Cq--� PERMIT #
OWNER'S NAME: Z PHONE # .;�53- (SSS
GENERAL CONTRACTO : FAX #
I am not using any subcontractors: j/,a 4 G c k•i/� ae2 �8 d
Signature Date
Please check applicable subcontractors and complete the following information:
hd SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
acavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO S gU `o 2 o S�
FURNACE/AC
4
�UPEkTINO PERMIT APPLICATION FORM
APN # Date:
fj _ -/S D5�
Building Addres • ,
�!r C C� 95a1
wner's Name: Phone #:
ar7y fiz 953 - 19<2
ntrac r: Phone: icense #:
m/ a - 5 3 58
�ontact: - Phone: Cupertino Business License #:
ply U iS-q
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech
Job Description:
Residential �Z Commercial ❑
For Residential Inst Ilations:
Attic"` I" floorX 2nd floor❑
Adhere to min set back requirement❑
For 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:
. wo
Strapped LJ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Re lacemeo
Qty. if
Applicable 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 Rec tl, Switch & Outlets ELECTRICAL
/ BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERPlumbin Permit Issue PLUMBING
BPERMFEE Bld Permit Fees BUILDING
BPLANCHK Plan Check Fee o BUILDING
BUSLIC Business License BUILDING .