04120134 (2) CITY OF CUPERTINO
amNc DIVISION - PERMIT - CONTRACTOR INFORMATION
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BURDING ADDRESS: _ " ' SCHAUMANN AIR CONDITIONING PERMIT N9b4120134
10349 CRESTON DR
OWNER'S NAME: ' PERMIT MUE DATE
TOM JORY HEATING & PLUMBING
ONE:
SANITARY NO. CONTROL NO.
(800) 986-0133
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
' BLDG ELECT' PLUMB MECH
0 0 0 0
caO, LICENSED CONmLkCTOR5 DECLARATION X' ption7 ^ Py `
-x reby rmwtlamlitteaaaan amtanrcMpter9(eammencing Job Descriptions
Fo � [J� F! - --- -
u� wiN Senion1 lB(NI) (Division 3 ofhac Buidif afdd Proreuiotueoae.,na my lieu I,
mmBfareeaye rr t vy 770?SSS� ADD A/C MENT L +tet
5 q z Liccnx Class
nen Dam/�' - n- -Conuac ar NAUM�� - - ---•- .-
ARCHITECTS DECLARATION - � �
W� 1-edmoh my plans:hart he area u_p_h aw �tJJ�UJyt
o In Licensed Proresumi nl BUY
�r/1a�y'❑ ft Try(�
0 S OR,NEm exemDE0.m One con ION '^(II Il Y �
0 1 Wrchy.(Seer on I em exempt s Rod Pf Caudow C a License Law for the U I❑rr,-
Oa following mason.(Section IIn1.5,Boafcssand improve,
deruea Code:Any city or county
E:
m which requires a permit ps ennswn,alar,impmvc,demolish,Or mPair any nronum
,a O` prior ltd its issuance,also requires the applicant for such Permit to rile a signed 50Mmenl
t < OR,Miflicensed pmennuttnmeprovisionanrthe Contractors uanaeLow(Chapter 9 - Sq.Ft. Floor Area- Valuation _
X $ (cammerrcing with Section 7")of Division 3 of the Business and Pmfnninrs GMe)or - - - - _-
•yd _ haat M is exempt drererrom and the beau for the alleged cmarpuon.My violation of
Section 7031.5 by any applicam for a permit subjects the applicant a a civil penally of 3 WwNuLllaro 0 - . _. . _ Occupancy Type
nm more duan five hundred 0.11...(SSW).
1,as owner Of the property,or my employees with wages as haer sale compensation.
will do the work,and the swan¢is not intended or offered for sale(Sec.7014,Business
and Professions Cade:The Conumun's Lithane law dao not apply x an owner of _Required Inspections
property who builds or improves thereon,and who doessuch work himselforthrough his -Own employ=.provided oar such improvements are notin¢naea oroffered for aide.If, ___--
hawever.the building or improvement is sold within one year of completion,the owner- -
bellder will Moe the human of proving oar he did not build or improve for purpose of -
sa1cJ.
D 1,as owner of the property,am exclusively contracting with licensed conuacrors to. - •. ..- -
construct the pmjem(Sec.7004,Business and Professium Coda:)The Con racmr's Li -
corse law dors not pply in an owner of property,who Wilds or improves dtemon,and
who contracts for such pmj=m with ononuaetor(a)liaosed pursuant to the Coo.ea - -
Liccnx La
❑lemaemPtunder Sec. ,B&PCfmoisomm. ,_ . . . ... .,
Owner Date
WORKER•SCOMPENSATIONDECLARATION --- -- --- "
1 hereby aRrem under,penalty of perjury one of IM following dedamio u:. _ - -
IhaveandwillmaintainaCertificamofConsenuoself-inure for Worksms Compen- -
sadon,as provided for by Smion 37M of the labor Cede.for the p fiformence of dte
work for which this permit is issued.
❑P have and will maintain Worker's Compensation Insurance,as required by Section
37M of the Labor Code,for the performance of the work for which this permit is issued. - -
My Worker's Compensation lnsurarta crania and Policy number art: --
came: P
CERTIFICATE OF EXEMPQ'ION OM WORKERS' . .
COMPENSATIO URANCE
(mu section need not W completed iflh permit u form=hundred doHaa(SIIX) _
or less.)
1 certify oat in the performance of the work roe which his permit is issued.I shall nut - -
employanypenoninanymenrlerathis to became subject to the Workers Compensation --- - - - - -_
Laws of California.Date
Applicant _ - -
NOTICE TO APPLICANT:If,after making Nis Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you moa
.JO forthwith comply with such provisinna m thin permit shall he,deemed revoked.
Z "'• CONSTRUCTION LENDING AGENCY
(~ Ihcmby.M,.Out ft.isoconstruction lendingagency to,ft Performance Of
lYi r1 ted work for which this permit is issued(Sec.3697,Civ.C.)
ft1 0 Lendcr's Nemc _
0. z Unite; Adanrss
L)0 1 Century duet 1 have mad Nis application andsea¢that the above information is
^F correct 1 agree to comply with all city and county onlinawas and athe laws¢lacing to
0U building construction,and hereby auoorirereprsenhadcs Of this city to enter upon to
Cts above-mentioned properly for irspeion purposes.
to rawn,indemnify
it
F'h liabilitim,judgments,costs and expernsuees which maaryiineany wayCity
accrue against said City
U z A APPLICANT
UNDERSTANDS
of this Permit J
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Da
SOURCE REGULA
G Re-roofs
Sign a of ApplicxVConvacmr ✓ Dem
HAZARDOUS MATERIALS DISCLOSU Type of Roof
Will the applicant or future building Occupant store or handle hazardous material
defined by IM Cupertino Municipal Code.Chapter 9.13,and tM Health and Safety
oat,SOY.35532(:)? Na - All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future budding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air co saminans as defined by Use Bay Area Air Quality Management all new materials for inspection.
Dissict?
❑Yes f�No
1 have read thehamr tiusmawrialsmquimmenuunder Chapter6.95orthe Califer
nia Heald A,Safety Code.Sectiers35505,35333am135534.1 undersuMuifo
thc Wilding �\%,//,l I� - /2- l✓l ,}{�
dors nno curcntly have s tenon that it u my rr_ Mihilily m WUfy ted MxUMt of the
'madi heron prior issuairmofaCc rcamor0mupancy. Signature Of Applicant Date
7_41
Owneror.aedagenl Date G All roof coverings to be Class "B" or better
Community Development
10300 Torre Avenue
JCupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
i� -7selzlb a
OWNER'S NAME: /J7,4�5 PHONE # -72 - 26-V
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors-1 L4) �i�i�. 12-17-0
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
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
aCIHTvo FURNACE /AC S Z
CUPEII`TINO PERMIT APPLICATION FORM
APN# 3 Z / 37 O / Date:
%Building Address:
<QS4 (Z12,5,5rnK) cLL
Owner's Name: Phone#:
L0V, i ?3 g— 0 4
Contractor: License#:
Contact: Phone#:
Applicant/Contiactor:
Building Permit Info:
Bldg Plumb ec
Job Description.
Residential: Commercial: _
Sq.Ft. Floor Area:
Architect/Engineer: Valuation: \
S �
Type of Construction: cy Grou
Qty
App ICA le Fee ID Fee Description Fee Group
BENERGY Ener -BUILIDNG
.
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 BUILIDNG
EPERMPI'FEE Elec Permit Issuance ELECTRICAL
MPERMTI'FEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG