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05060189 (2) CITY OF CUPERTINO A BUILDING DIVISION PERMIT �CONTRACWTORINFORMATIQNN BUILDING ADDRESS: CONDITIONED AIR PERMITN005060189 OWNER'S NAME: PERMIT ISSUE DATE RAIM BISHOP 1701 LITTLE ORM­lARD �T P'l NE: SANITARY NO. CONTROL NO. (408) 291-2220 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 X00 LICENSED CONTRACTOR'S DECLARATION b 1 hemby affirm That I a.flemis sal under prnvisimu of Chapter 9(commencing Jab Description rI 'll] U in failto n7gri0ecDiviai.n Sof the Bulinus arM Professions Cade.antl my liceiveu �F!�� (I © ^�„ in �. REPLACE FURNACE & ADD A/C u, ��� I`41'� g z Li«nu Class C-40 U1.1 --pDale Gr rbC contractor 'a p'y �RcxrrECrs DECURAnoN I undersand my plain shell W used as public records tu0� Licensed Professional 7 �3' 2005 OWNER-BUILDER DECLARATION f 1 hereby alftrm that 1 am ucmpl form Ne Conuacbrs License Law for thedZ D O followingrcuoa.(Section 7031.5.Business and Protection.Cade:Any city of county m� which muina a permit to cnnnom,alter.improve,demolish.or repair any structure BUN N DM\� e7 ._ice prion.its issuance,also mquime the applicant for such permit file aligned statement XEC thin he is licensed drarrinl to the provisiona of the Contractor's Lovinic Law(Chapter 9 Sq. Ft. Floor Area Valuation xI­$ (commencing with Section 7000)of Division 3 of the Business and Profession Code7ar that he is exempt therefrom and the basis for the alleged exemption.Any violation of ewrnp� Section 7031.5 by any applicant for a permit objects the applicant to a civil penally of 36\�6I91t�i9erO0 Occupancy not more man fist hundred calls.($500). P Y Type ❑1,as owner of the property,m my employees with wages as their sole compcnsstion, will dome wank and the structures is not intended of offered for sale(Sec.7044,Business and Prefessiats Cade:The Convention's License law does Out apply ban awn,of Required Inspections property who builds orimprosss thereon,and whodoes such work himulf orlhrough his own employcu,provided mal such improvements are not intended or offered formic.IL however,Or building or improvement is sold within one year of completion.the owner. builder will raw the burden of moving mat he did not build or improve for purpose of sate I ❑1,as owner of me property,am ucluively contracting with licensed contrubn to construct the project(Sec.7041.Business and Professions Code:)The Conuamm's Li. cense law does not apply in an owner of property who Wilds or improve Nanton,and who contracts for such projects with a emaractor(s)licensed pu.uam to Be Convactar's License Law. El I am exempt under See. .B k P C for Nis mason Owner Data WORKERS COMPENSATION DECLARATION 1 hemby affirm under penalty of perjury,one of me following declarations: ❑1 have and will maintain.Cenifew of Consent a ulFinsum for Worki esCompcn- sxtion,as provided for by Section 3700 of the Lauer Code,for the Performance or me work for which this permit is issued. have and will maintain Workers Compensstion Insurance,as recruited by Section 3700 of the Labor Code,for the perionnanec of the wort for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Carticr. , fO f�n2 W. tnS• Polity No.: CERTIFICATE OFEKEMPnON FROM WORM WOR ERM �C� COMPENSATION INSURANCE (Thu smith road natbecampleud ittne Permit is(mune hundred dollars(SIM) or Ina) I ccnifv that in be pe fturrunec of me work for which oris Permit is issued.I shrill not employ any person in any manner an as to become subject to the Workers Compensation Lam of California.Dau Applicant NOTICE TO APPLICANT.If,after making Nu Cen 5cate at Exemption,you should become subject b too Worker's Compensation provisions of the Labor Code,you most z fantwith comply with such provision or this Permit shall W deemed revoked. ZO CONSTRUCTION LENDING AGENCY 'T+ I hereby affirm that mem is a construction lending agency for die performance of D:,> to work fur which this permit is issued(Sec.3097.Ci,C.) W Lender.Name G z Lenders Addicts U U p I ccnee that l have read this application and sea mal the shout:.(.muting it ' W F' cono dI agree to comply with all city and county natives of and sou laws relating e DU above-geonstructianand hereby auNonpurposeunutirrsaf this city to tour upon me ,tea above-(We).moncd 1.saw,ro,orty far emnify an keepha. (We)agree to arc,indemnify and kith harmless w City of Cupcnino against FN inconseqjudgments,coarsing Of thisuwhich may in anyway acerae against aid try U z APPLICANT NDERf to TANrting of this permit. '-" APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: Date�2 -� �r�a s�+R�e REGULATIOgS. — 3 M, — In)/4& - '1 Re-roofs g az rc of ApPlicaHUCcaffimtor AZARDOUS MATERIALS DISCLOSURE Dau Type of Roof Will the applicant or future Wilding occupant store or handle huardous material as defined by the Cupertino Municipal Code.Chapter 9.13,and die Health and Safety Code.Section 25532(x)7 ❑Yu future roofs shall be inspected prior to any roofing material being installed. f�Ka Will the applicant or ture building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove .mit haaardous air contaminants m tk6ncd by the Bay Arca Air Quality Mangcatem all new materials for inspection. Dania' C]Yes O4—No I have read the lummicus materials re,imm ants under Chapter 6.95 of the Calif.,- nia Health&SafctyC.de,Sectors 35505,35533 and 25534.1 understand that iftW Wilding docs n t cutrcntlY hem a anent Nat it a mslan Ilcy b notify the ucupvnt of Nc - —-- 619610 ray i.mTjjnuwhichmustt :1p o vanccofaCcni("neofO t.panry. SI natU ofApplican - L� Date . flA�f> J li/gS/os All roof coverings to be Class "B"or better owl int Data a - Community Development � Cu0 Torre Avenue pertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 9UPERTINO Building De artment JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # � 99, - a O GENERAL CONTRACTOR: 3;n oc, FAX # 4 $ t I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 66 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Ah 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 er/Contracto ignature Date CITY OF CUPERTINO Im as FURNACE/ACvCITY OF �-o CUPERTINO PERMIT APPLICATION FORM APN # ) PD 9 (DDate: Building Address: 1136 �Im9Coc� d Or• �,no Ca G�► '-� Owner's Name: Phone#: F, C408) Contractor: Phone: License#: C6rNLk%V0 0-0-3 co Com) �9r � � y �i 5160q Contact: Phone: Cupertino Business License #: 5 ,r\q. U'i Ila s _. SA Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech Job Description: dC\ la IC 1 t.ePiz cc,_ 00f,Y-1 . Residential Commercial ❑ For Residential Installations: Attic ❑ 1" flooi 2. 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: 3Soo . 1AURC Strapped ❑ On Platform ❑� �Bonded LJSq.Ft. Floor Area: New Location ❑ Re lacemen�y` 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 BREMAIRIIAN 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 PPERMITFEE —Plumbing Permit Issue PLUMBING / BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License V BUILDING