03090147 (2) CITY OF CUPER'1'INO
BUILDING DIVISIONpi BMIT P—TI INFORMATI®N
honer. ``e" bY °sa ?
s BUILDINGADDRESS: A PERFECT CLIMATE """'03090147OW NER'S NAME: 10570 S DEANZA BLVD PERMIT ISSUE DATB
DANNIS LE n9l 9/2003
NE: SANITARY NO. CONTROL NO.
(408) 861-9545
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
(� (� � 0
100 LICENSED CONTRACTOR'S DECLARATION Job Description
MI I hereby affirm that I am licensed under provisions of Chapter 9(commencing p
with Scaion]IXN)) Divlsion3of NC Businuaand Profeasiam ode,end mylicensc is
n bill. antl 1pY�pp �ia
>'qi Liana Lk.N REOLACE FURNACE & A/C 1�VI'i.1�C
F- Data Contrecte
es9ARCHITECTS DECLAc, ION OCT1g 2003
Gr< (undersand my plans shallkused u CLARrtrnrds to/ 1
CH
o] Licensed Pmfessimed pq
OWNER-BUILDER DECLARATION Imam
<P I hereby affirm Thal 1 am exempt from the Contractors License Law for the
O O following mason.(Section 7131.5,Business and Profeadnms Cade:Any citym county
e$q which requires a permit to construct,alter,improve,demolish,or repair any stactum
prior to its issuance,also requires the applicant For such permit to file a signed southern
amp that he is licensed pursuant to the previsions of the Centimeter's Liecrisc Law(Chapter 9 Sq.Ft. Floor Area Valuation -
` $ (commencing with Section 7000)of Division 3 or the Business and Profaasinn Code)or
that he u exempt therefrom and Or but,for the alleged exemption.Any violation of 36217046 . 00
Section 7051.5 by any applicant fora permit subjects the applicant to a civil penury of .
not more Nen five hundred dollars($500). - '-' -- —' ' -APN Number Occupancy Type ---- -
❑1,as owner of the property.or my employees with wages as their sale compensation,
will do the work,and tk swmure is not intended or offered for sale(Sec.7044,Business 3ul — CIIOOS
and Profusion Code:The Conuanorf Lt..Law does not apply to an owner of
property who builds orimpmm thereon.and who does such work himself or through his 303 - ROUGH M CHANT AL
own employees,provided that such improvements are not intended or offered far sale.If, 304 — ROUGH ELECTRICAL
however,the building or improvement ie sold within one Ku or completion,the owner.
builder will hese the burden of proving that ho pve did not Wild or Imrofor purpose of 505 - FINAL ELECTRICAL
mm.). 507 - FINAL PLUMBING
I,construct owner a et property.am t mess d conmotimg with:)Th.C ntract r'sa Ir
toLaw does
not apply
to in wnainessandrty who
Ca orUThe Contractor's Li 508 — FINAL MECHANICAL
whoTaw docs not apply to ts owner of property who selids or improves Comen,and
who contracts for projects with a conlracmr(q licensed pursuant to the Conwetare
Licenseran Law.
0
Q 1 em exempt under Sec. ,B d:P C for this moon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following deelaralion:
Thaw and will meinuin aCeNficue of Content to salt-insert for Workers Comlen- — -
sation,as providM fm by Section 3700 of the lJber Code,for the perfmmanor of the
rk for which this permit is issued.
I haw and will maintain Worker's Compensation Insurance,n required by Section
5 00 of Ne Labor Code,far the pc rano nee or the wask for which his permit is issued,
Worker Co pen 11 quant c or and Policy num /
Cartier. liry No.:
CERTIFICATED CEM ON FROM WORKERS'
COMPENSATI NINSURANCE
(Thisaation need not k comPICWd if the)erred is forum bundred dollars(3100)
or has.)
I certify Out in the performance of the work for which this permit is issued.I shell not
employ any person in any manner an a to become subject to Workeri Comportment
ant
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Cenif¢aa of Exemption,you should
became subject to the Workers Compensation provisions of the labor Code,you must
forthwi th comply with such previsions or this permit shall k deemedrevoked,
Z O CONSTRUCTION LENDING AGENCY
I homey AMM Nat them is a emmrucdon lending agency for the performance of
Y,r the work fur which this permit is issued(Sec.ID .Co.C.)
Q Lender's Name
z Lendh Address
:) Q 1 certify Nat 1 have read this application and sole that the show information is
. (~ correct.1 agree I.comply with all city and county oin rad fate laws Totaling to
J V building construction,and hereby authniw rcpt etiwsu is city to enter Open Nc
U above-mentioned property for inpeclit,np sea.
ti (We)agree to sew,indemnify keep buret the City of Cupertino against
rn Ilabilides,judgmcnu,seas rad ex bleb I. any wy ancmcsgeinsl said City
cortsrgoenc of Ne tin .pcsm
AP CAVI'U S SAND COMPLY W17jf,A NON. Issued by:3
Date
S UR R (/IJ
Re-roofs
Signmuma Appljcw0Cmnramr f Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant lir future building occupant moa or handle hamdous material
as defined by the Coherent,Municipal Code.Chapter 9.11,and the Health and Safely
Cove,section 15531(0+ 1, All roofs shall be inspected prior to any roofing material being installed.
❑Yes M u
Will"a applicant fuw Wading aaapeml he equipment or dcviae9 wnlDn If a roof is installed without first obtaining an inspection,l agree to remove
it hayanfnu air contsminanu u dcftncd by the Bay Area Air Quality Management all new materials for inspection.
ILqui.nomm
trict7
0 Y
I have read theta ardouinhan'at,mquirc under Chapter 6.95ofNcCalifnr-
NASatelyCode ocdons15505,255 534.1 undo. dNmif the i11as
t currently h} arena til l at I'yy tbe o.ca t of the
sybkh our et t,n ytPfvr Signature of Applicant Date
Owner or waedegeot ( _! Daa All roof coverings to be Class "B" or better
CITY OF CUPERTINO 3 car 7
FURNACE/AC
CUPERT`INO PERMIT APPLICATION FORM
APN# U- ,( -� -04(va
Dater
lon
Building Ad re.-,- . r
Da
Owner's ve: Phone#:
In i
Contrac r: hone:. License#-
X15 _ -,315
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech
Job Description: VeVICQ9 �n f
Residential Commercial ❑
For Regs�ident al I�gllations:
Attic u 16` floor u 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 El
Cot of Project: Type of Co tryiction: OccuGy group
1, I
Strapp d On Platform onded Sq.Ft. Floor Area:
New Location ❑ Re lacemefit "
Qty. if
APPRo4ble Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAMHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch&Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
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