03060198 (2) a CITY OF CUPERTINO
BUILDING DIVISION PERMIT �CONTRACT.OR INrORMATION '
BUILDING ADDRESS: A & H HEATING PERMIT NO03060198
10272 T)P.NTqQN A17
OWNER'S NAME: 770 CHESTNUT ST PERMIT ISSUE DATE
Ah MIKE GIANAK
NE: (408) 279-0722 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
C�
,00 LICENSED CONTRACTOR'S
DECons of CON
£u I hereby E rue that 1 am licensed under provisions of Chapter 9(commencing Job DCSCrIp[IOD
with Scnion]IXN))nf Division 3 of the Business and Professions Code.and my license is sap r�
= in full farce andcf t. FURNACE & ASC a'""+.�51�,�
Lic<nu lass Lm.a
iFFqp Deice/I 3�Cun DEC JULa ddcrstaf�my plans ahlvl MuuJ UEpuhlic rccnrJs v/ A 2003
Jyu
k o G LiccnuJ Prnmasinnel
3 OWNER-BUILDER DECLARATION Br„�
i 1 herchy affirm BUILDING
Nat 1 am exempt from the Contractor's License Low for the
o0 following reason.(Section 703 t.5.Business and Professions Code:Any city or county
which retutres a Permit to consumer,alter,improve.demolish,or repair any structure
SZi prior In its issuance,also requires theapplicant for such Permit o rile a signed statement
a IhatheislicensedpursuanttotheprovisionsoftheContractor''sLicense aw(Chapter 9 Sq. Ft. Floor Area Valuation
h
e�$ om mencing with Section 70NE or Division 3 of the Business and Professions Code)or
y 5 Nal he Is exempt lhemfmm and the basis for the alleged exemption.Any violation of 31629061 . 00
Section 7031.5 by any applicant far a permit objects the applfcanuo it civil penalty of APN Number Occupancy Type
not mom Nan five hundred dollars(5500). P Y YP
❑1,M owner of the properly,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(See 7014,Business
and Professions Cade:The Contranors License Law door not apply to an owner of 3 0 3 - ROUGH t10DS
props ny who build.or improves thenen,and who doe uuch work himself or thmugh his J�
own employees,prodded Nat such improvements arc nal intended a offered for Ila If, 304 — ROUGH ELECTRICAL
however,the building or improvement Is Cold within one year of Completion,Ne owner.
builder will have this burden of proving do,k did not wild or improve for purpme of 505 - FINAL ELECTRICAL
"I`')' 507 - FINAL PLUMBING
❑1,sst wner the project
property, andvely contracting with liana Conuvacmam 508 - FINAL MECHANICAL
came La the es not (Sec.o an Business and ry who Wi ds or:)Tho Convenors and '
ccnselawdoorrrsuapply r man with
ofpropenY whosedpurrtmpro the
Neremt and
whocontractsLa for such projects withaconvacmr(M licensed pursuant to Ne Convvaoh
License law.
❑ I am exempt under Sec. ,B&P C for this moon
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby&from under penally of perjury ane of the following declarations:
I have and will maintain a Cenifcaue of Consent to selfdnwa for Worker's Compcn-
71327.00
ion,as provided for by Section 37M of the labor Code,for the performance of to
h for which this permit is iaood.
I have and will maintain Worker's Compensation Insurance,u required by Scnion of the labor Cade,for Ne ficdormanw of the work for which this permit is issued.
Work is Compensation Instance envier and Polity number am:
rrier.�6t CTL I f�� Policy No.:1.4
CERTIFICATE OFEKEMPnON FROM W RKERO 5
COMPENSATION INSURANCE
minsuninn need not W mm,le dif Ih.fermit b farm.hundred dollen($INE
Ices.)
I lenity that in the Performance of the work for which this Permit is issued,1 shall not
employ any person in any mother an as to become subject to the Worke,'Compcnution _
Laws of California,Date
Applicant
NOTICE TO APPLICANT:If,aper making this CertifieslC of Exemption,you should
become subject to the Worker's Compenandon Provisions of the Labor Code,you must
.J O fanhwirh comply with such Provisions nidus pc,mit,h,li be deemed revoked.
z "-' CONSTRUCTION LENDING AGENCY
Ihereb affnm Nat them its cmuwcion lendin a Y t genet tar Be perfurmen test
a rte. the work for which this permit is issued(Sec.3097,Civ,C)
Q Lender's Name
�z Lcndcr's Address ,
O Q 1 certify that I have read this application and role Nat Ne above infomoniun is
gg correct I agree to comply wit all city and county ordinances and sure laws slating to
0 building convection,and herebyauthoris sPresenmivet of this city to enter upon the
N IL1 above-mcntioncd pmpcny for inspection purposes.
LL (We).,me to save,indemnify and keep Mrmku be City of Cupertino against
cn liabilities,judgments,coats and expenses which may in any way accroc against Ito City
U ,2' in consequence of the granting of this Permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOLN®ULATIONS.
Re-roofs
Sign Signa tum of Appliam2Con actor Das
HAZARDOUS MATERI I-S DISCLOSURE Type of Roof
Will the applicant or tutus building Occupant store or handle hmusurb us material
u derined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safely
crde,schen 2ss322aI2 All roofs shall be inspected prior to an roofing material beim
❑res gtc P P Y 8 g installed.
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hanumous air contaminants u dcfined by the Bay Area Air Quality Management all new materials for inspection.
ixtrier?
E]Yes
1 have mad]Ne harsrdens materials requirements under Chapter 6.95 of the Califon
nia Health&Safety Code,Sections 25515,25533 and 25534.1 understand Nat if the Wilding
does not c...if,have a snant,that it u my resporuihility as amity use occupant of Nc
requirem&=beX
lnissuance Or.certifsa ofRetpaney. Signature of Applicant Date
Owner or aulhorind ogent' Date All roof coverings to be Class"B" or better
4 w flit f
4 CITY OF CUPERTINO l
t4FURNACE /AC 3
3 UPEkTINO PERMIT APPLICATION FORM
:APN # 3�b ' 0 �� Date: 7-- 7c9 0�
Building Address:
f loa7� DeNjsotj 4v6
Owner's Name: Phone #:
lr4RC S I �57�d� 7
S Contractor: - License# O �7oZ.
Contact: 1AL5 '1 � Phone #: ^r�
Applicant/Contractor.PDiG �� o?� loci.
Building Permit Info: 45
Bldg lect Plumb ec
'Job Description: e�
^r` Residential: Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
Construction: Occupancy Grou :
r='
Qty. if
A licable Fee ID Fee Description Fee Group
�
BENERGY Ener Fee
.. BREMFURN Relocation of Furnace MECHANICAL
f
M 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
EPERMITFEE Elec Permit Issuance ELECTRICAL i
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee ' BUILIDNG
BUSLIC Business License BUILl]�NG
ILP �8