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04030261 (2) CITY OF CUPERTINO �'��^�' "' " BUILDING DIVISION PERMIT CO NTRACTOR£INFORMATION: ES . BUILDING ADDRSITN : PAYNE HTG A/C PERMD.04030261 NER'S NAME: PERMIT ISSUE DATE JEREMY NE: SANITARY 0 OL NO. ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Most, LICENSED CONTRACTOR'S DECLARATION Job Description y V C I hereby"Tho Nat 1 am licensed under provisions of Chapter 9(commencing u with Section 7")of Division 3 or dm B anipfofessiomcode.andmybccrvcis in icenrx, me «. VJp(�S REPLACE FURNACE ^ = License CI s lv LYc.K p Dme - Contractor ARCHrtECPSDg@ RATION I rood--d my plans shall x used as public meords 3 w Licensed Professional OWNER-BUILDER DECLARATION +� M 1 hereby affirm that 1 em exempt from the Contractors License Law for the i 0 following reas on.(Section 7031.5.Business and Rofecdomu Code:Any city or county K m�+ which mquins a permit I.immod ,alter,improve,demolish,Or repair any mundane m-'^ prior to its issuance,also mquires the applicant for such permit m file a signed statement taxx'< that he is licensed pursuant to the provisions of the Contractor's License aw(Charter 9 Sq. Ft. Floor Area Valuation car (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and dm basis for the alleged exemption.Any violation of ww��n�w.,� Section 7031.5 by amy applicant for a permit subjects the applicant in civil penalty of 3 MN a VrL WearO 0 Occupancy Type not mom than raw hundred dollar(5300). ❑I,as owner of the proprny,or my employees with wages as their sole compensation, will do tlm work and the su unum is not intended or offered for sale(Sec.7(ts4,Business and Professions Code,The Contractors License law does not apply w an owner of Required Inspections property who wilds or improves Hereon,and who docs such work himself or through hu own cmployca,provided that such improvements art not intended moffemd forsale.IL however,the building or improvement is sold within one year ofsomplcdon.the owner- IJtt �� holder will have the burden of proving that he did Out build at im �I prove for purpose of N AL salt.). ❑1.as owner of the property,am a,c usively contracting with licensed contractors in MAY U 4 2004 concoct the project(Sec.7(1 Business and Professions Cade)The Contractor's Li. cesue Law dors not apply di in owner of property who builds or improves themun,and who contracts for such projects with a contracmr(s)licensed pursuant ro Ne Convectors Lkence law. BUILDING ❑I con emmpt under Sec. .B&P C for Nis moan nefDil WORKER'S COMPENSATION DECLARATION I herby affirm under pendty of perjury one of the fallowing declaralit u I have and will maintain aCenifem,of Consent o sel0insure for Worker's Compen- 1371W on,as provided for by Section 3700 of Ne labor Code.for the performance of the k for which this permit is issued. 1 have and will maindn Worker's Compensadon Insurance,ss mquired by Section of the labor Code,for the perfom otic or the work for which this permit is issued. Workers Compensation Insurance carrier and Policy number are: r.SMTP FUNDirali>$1No '1779002 X700¢ CERTIFICATE OF EXEM NFROM WORKERS COMPENSATION INSURANCE Mos,section need not he completed if the permit is re rom hundred dollars(SIM) or lists) I ccstify that in the performance of me work for which this Permit is issued.I shall not employ any person in any manner so as un become subjecuo the Worker%Compensation Laws of California.Did Applicant NOTICE To APPLICANT:IL after making this Cenifmate of Exemption,you should become subject to tx Workers Compmtsation provisions of the labor Code,you mud, Z forthwith comply with such pravisimts or this permit shall x dcemed revoked, Z O CONSTRUCTION LENDING AGENCY i-' I bemby affirm Nat them is a construction lending agency for the performance of 2'> time work for whim 091 this permit is issued(Sec.3 ,Civ.c.) LIJ Q Lenders Name a. a Lender's Address U O 1 certify Nat I have mad this application end ram Nem the eWw information is IL(•^ Model.1 agree m comply with ill city and county ordinances and mate laws relating to 0U wilding constnation,and thereby audience rePrescturves of this city in enter upon lx r D.1 above-mentioned property,for inspection Pm,aus. F N (We)agree to save,indemnify and keep handless the City of Cupertino against Iiabilida,judgments,costs and ex,mates which may in any way we=against said City U Z APPLICANTeof the mmung of UNDERSfANDSthis Permit. COMPLY WITH ALL NON-POINT Issued by: Date 'RREGULA ONS Re-roofs Sio(Applic onduch" amAZARDOUS ATERIALSDISCLOSURE Type of Roof ill Ne applicant or future Wilding oceupmt nom or handle huallous mamrial defined by Be Cupertino Municipal Code.Chapter 9.11,and the Health and Safety We.Section 255320)? All roofs shall be inspected prior to an roofing material being El Y. CR No P - P Y g g installed. Will the applicant or future wilding Occupant sac equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hwardous air conaminams as defined by the Bay Area Air Quality Management all new materials for inspection. District] j3Yea y,-V I have orad the hnand us materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 8505.25533 and 25534.1 undersand Nat if ddc wilding docs nm emnm1ly haw a mmL that m msponsibility m nody pant of Ne, ro en which muenx etp' rtaitsu eofaeemicamof0c army. Signature of Applicant Date .�'� �D � All roof coverings to be Class"B"or better cr or authomcd ag&fL I Doc y Community Development if C 10300 0ertino CA 95014 NL Telephone(408) 777-3228 jCITY OF Fax(408)777-3333 uPEI�TINO BuildingDepartment JOB ADDRES I D 3� C ee-S-o � 64 PERM o q o 30;L6 I OWNER'S NAME .f, T 1JC(<-6 K PHONE /W- ?3 - 8 GENERAL CONTRACTOR: fii FAX # 408 9YZ- h I am not using any subcontractors: 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 Z>I-AE Wrl "1,/(- 24 Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Con actor Signa e Date CITY OF CUPERTINO CTY-OF OF FURNACE/AC UPEkTINO PERMIT APPLICATION FORM APN # 3 Z 6' 3 7 ef Date: Building Address: /013(1� Owner's Name: - � Phone#: Contractor hone: eloe License#: Contact: I _ Phone: Cupertino Business License#: J t l7Ce2 Cell 010? - 8862 Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: I-UR.11AC r-- f'1;C tfu,( e rl Residential � Commercial ❑ For Residential Installations: Attic ❑ 1" floor ❑ 2"d floor❑ dhere to min set back re uirement❑ or Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ C f) i Type of Cons tru ti / Occupancy 14 Str pped ❑ On Platfo p Bonded ❑ I Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if ApplFee 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 cf n 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 BIJILDING � � z - 37