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03100189 (2) CI'T'Y OF CUPERTINO BUILDING DIVISION PERM CONTR'ACTn12INFQI.2MA'�N, . BUILDING ADDRESS: J & J AIR CONDITIONING PERMIT N003100189 18922 FORGE DR N OWNER'S NAME: 1280 N 10TH ST PERMIT ISSUE DATE , OBLIX 10/27/2003 NE: (408) 920-0662 SANITARY NO. CONTROL NO. ARCHITELTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH loo LICENSED CONTRACTOR'S DECLARATION' Job Description I krchy infirm that l am licensed under provisions of Charter 9(commencing P 4 � with Stolon)IX%B of Division 3 of the Business and Prurmsiuns Code.and my license is ;`i4R in tWt rry reawermct. (� _39 `l5eb`1 REPLACE 2 A/C UNITS . j viz Liccrrs�Cl.a L-2o LYc.7 j F Dam o— _ Contractor '> F:a ARCHITe uw D 1 ('C RATION 2 understand my plans shall k usd ai public accords IaU �Or^ Licensed Podeasioml g OWNER BUILDER DECLARATION j 6l I hereby affirm that l am exempt from the Contractor's License Law fur the p o following armed.(Section 7031.5.Business and Professions Code:Any coy or county 3 m a which requires a Permit it,construct,ilmr,improve,dcmoli<h.or repair any toomeare $39000 -ieprior In its issuin6e.also onto. be applicant rorsuch Permit o file a signed statement that heislicensed pursuant to the provisions or the Contractor's License Law(Chapter 9 Sq.FL Floor Area Valuation eFo (commencing wi On Section g00(B of Division 3 or the B usinces and Professions ewe)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of 31609030 . 00 Section 7331.5 by any applicant for a peril subjects the applicant to a civil penally of APN Number Occupancy Type not more than five hundred dollars(5500). ❑I.as me,or be pmp dy,or my employees with w.,a as their sole campensadoa, Will do the work.and the storm.is not imedded oro@red for sale(Sec.7060,Busincti Required Inspections and Professions Code The Cones lox's Licerme law docs e not apply to in owner of q P property who builds or improves Ncrun.end who docs such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If. however,the building m improvement is sold within one yearof comphrom.the owned builder will have the burden of proving that he did not build or improve for purpose of f "000I,as"net of One property am exclusively contracting with licensed ronoaetors In D� construct Old,project(Sec.7066.Business and Professions Code:)The Cantraeror i Li Js cerise law does not apply to an owner of progeny who Wilds or improves thereon,and, who eontmata for such projects with a conmctor(s)licensed pursuant o the Convaelor's License Law, ❑I am exempt under Sec. .R&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affix under penally of perjury ate of Ne following decl.ratiod.: 1 have and will maintain a Cenifieale of consent to self-insum for worker'sCum Pcn- saima,sm provided for by Section 37W of doe labor Code,for the performance of the work for which this permit is issued. 1 haze and will maintain Worker's Compensation Insurance,as required by section 37 ortk labor Code,foo Ne penormanec of the work for wM1ich Nis permit u issued. My SOmkefs Compensation lasuranee artier end P ,icy number art: 5Thi71 Cusp t�s,.:<P o:6'Z 71 po((' er CERTIFICATE FROM WORKERS, COMPENSATION INSURANCE (This section need not he completed if the .is is for one M1undred dollars(5100) or le¢) _I crNfy that in the performance of the work for which this Permit is issued,I shall not employ any Person in any manner an as to Weome subject o the Worker r Compensation Laws of California.But Applicant NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should a become subject o Lk Workv's Compensation provisions of the labor Grain.you must Z forthwith comply with such provisions or this permit shall W deemed revoked. �O CONSTRUCTION LENDING AGENCY I hereby,affirm that then is a consVvclinn lending agency for the prrfurman e,of thc work for which this permit is issued see.3097,Civ.C.) +1 Q Under's Name Undei s Address 2 1 certify that 1 have read this application and sue that the above ws relating is L F., buncolome 10 Comply and all City and County ordinances and emmlaad relating to U Bove-mentumed pro,and hembyautbon pe mono. atisrs of this city to=filar upon d¢ L--- W shove-mcmiuncd Propr)ny foriaspcnion pualwus. y y (Wc)agrt save,indemnify rad keep harmless the City of Capital against Z1 Liabilities.jdia";.u,ensue C,aapc . s which may in any wayaccm, i;nat said City J z in conuqucncc of the gra t%y%uft isp=rmit. G9 ^+ APPLIQANDU DER A'ND AND WILL COMPLY WITH ALL NON-POINT Issued by: Date V SOURCE G LA 1017 t 3 Re-roofs Si fA anUCp boor �/ Date HA RDOUS MATERIALS DISCLOSbRE Type of Roof W;Il the applic1 tar future building oceupantsmre or handle hamrdous material m drfined by thr ca Wino Municipal Code,Chapter 9.11.and the Health and Safety Code,Section zssu(.)P All roofs shall be inspected prior to an roofing material being installed. ❑Yea P P Y g g Will he.,,I d,or m�W;lding eccupnm oar rq n,andm orreviera whichIf a roof is installed without first obtaining an inspection,I agree to remove nit hazardous air codmminan s as dcfncd by the Bay Arca Air Quality Management all new materials for inspection. Jlslaic" Dyes,/,Oz �7 �i6o I have afthc haardt tatar'dlsrcquim=nuundcr Chaprcr6.95of NCCalifor i Heil!&Salary Calc, gRaa 5,15533 and 15536.1 undersmnd that iflk Wilding dcesingl curt(tt0 a nanL t It u my r=apomibdily,m ramify he ucupant or the re yu ttE rd M1mu mm r;nr rn i:assns na crnifirare oraap rr. Signature of Applicant Date (.0 2707 )wne fir mho aper, Dare All roof coverings to be Class"B" or better O L D C) I 50DF/DL Modu-Pec® Ph sical data _ OPERATING WEIGHT(lb) Base Unit 30003700 � 4400 .6408 8100 8485 Economizer 150 175 200 1-`2261; 250 250 Roof Curb 125 150 i 175 200 225 225 COMPRESSOR Serviceable,Hermetic No. ...Type 1 06E 2.06D 2 06D 1 2 06E 2 06EA 2 06E No. Cylinders(ea)...Rpm 4 1750 6 1750 6 1760 4, 1750 4,6 1750 6 1750 Capacity Steps I%)(Std) 50,100 19,38,57. 16,33,50, 25,50,75, 20,40.60, 16,33,50, 8281100 63,83,100 100 80,100 183,100 REFRIGERANT CHARGE Type 22;Controlled by Thermostatic ExpanK Val{ Sys 1...Sys 2(Ib) 36 — _ 23 7.5_7$26---129 0 .29 0 3_7 0':'97 v,€�1' 3 0 ;42 0 1 81 OUTDOOR AIR FANS ��-t� 'g�Jt V �7L� Direct Driven,Prwo.-I y— U No. ...Diameter(in.) 2. 30 2 30 1 3 30 3;�30,1 . 3 4 30 Nominal Cfm 14. T Igr�q 21,001) 21,0 28.000 31,000 Motor Hp...Rpm 1 11 31 .1d56� 1 1050 1 . 1050 1 1050 1 1150 CONDENSER COIL Rows...Fins/in. 3.�J 3 9 .139 _ 3 158 3 168 3 158 4 15 Total Face Area(sq ft) �3Lf ._ — "0= 490 61 C 81 6 81 26 INDOOR AIR FAN Belt Drive,Centrifugal Type No. ...Size(in.) 2 .1 x 2. 15x15 3..15x9 4 16x9 4 155,11 4 16x11 -s Max Allowable Rpm 1 1300 1300 1300 -*1- 0 1450 Standard Drive'Fan Pulley Bore r 1'be 1".fe IJz 0P o D�( 8 1"VSs Fan Pulley Pitch Diem(in.) 8 106 106 10.6 t W1jV1"if>•6 B 0 Motor Hp...Rpm 1750 7'h. 1750 10 1750 1�11750yD _ A2p 'r"25 1750 Motor Pulley Pitch Diem (in.) 9 1 A 1VV Pulley A 66 65 65 C�pD{t!si'S0 DOD .�s, 7 s Pulley 60 56 56 56 �y� 6 60 Resulting Fan Rpm V With Pulley A 1073 1073 1073 �-� 3 1111t�.k25 With Pulley S 991 925 925 �' 925 _ 1 npn r MIJM2 O tonal Drive* eu,pe8 uR' Fran Pulley Pitch Diam (in.) 80 80 8 0 S�NEUB 0, ' un .111,E 8 OinBS aN 'Itis Motor Hp-..Rpm 7'h 1750 10 1750 15 17501,I'62- `17 JU a25"1750 of, 11t630 17850 Motor Pulley Pitch Diem(in.) $Bpt 1std. • Pulleey A 63 53 53yB 56 56 56 i8 Ut531n'a1`I a1C�Wf'tt513 Peinu�' 50 Resultin Fan Rpm ,�m� Y,iiht Lit Oti Doper mo. With Pulley e p 1225 1225 1225 p119 i ai�lg n8 ItNs i't20e VA c to boao EXHAUST FAN MOTOR, No. _Hp 1 3 1 3 1 3 L3N01 P4:6 Va, 0 gt an z 3 EVAPORATOR COIL 4N"' *, Rows...Fins/in. 4 13 9 4 139 4 13 9 a0fli��104Cq:T9�rdt8 4 139 Total Face Area(sq It) 1519 17 7 24 8 aQtp dq 35 4 354 ELEC RESISTANCE HEATERS Open Nichrome Wire Elements with Multiple-Stage Control kW Sae Heating Capacities table - INDOOR AIR FILTERS No. ...Size Standard:2-in.Throwaway 6 20x25 18 16x26 9 20x25 27 16x26 9 20x25 9 20x25 6 16x26 12 16x26 21 16x25 21 16x26 Bag Type: 12-in.(Opt) 3 12x24 4 12x24 6 12x24 6 12x24 7 12x24 7 12x24 3 24x24 4 24x24 5 24x24 6 24x24 7 24x24 7 24x24 METAL GAGES - Curb 14 GA Base Reil 8 GA Corner Post Post with power opening, 12 GA;others 14 GA *Standard fen motor supplied with standard fan drive pulleys and t208/230-volt units use standard Th-hp motors 460-volt units use belts; optional fan motor supplied with optional fen drive pulleys standard 5-hp motor and optional 71h-hp motor , endbelts Other combinations are field supplied Pulley A is installed tThe 5ODLO64 optional drive is supplied with pulley A installed in unit in unit,pulley B is shipped with unit Pulley B is not supplied 484 30 Ivew cJnl TS Physical data (cont) O 48/50AO20-060 UNIT WEIGHTS BASE UNIT WEIGHTS'(lb) SUNIT 020 025 027 030 035 -.x=•040.4' 050 060 48AJD,AKD 3842 3915 4032 4182 4435 —4975 5446 7386 48AJE,AKE 3922 3995 4112 4262 4595 5135 5606 7628 48AWD,AYD 3882 3955 4072 4222 4475 5015 5486 7428 48AWE,AYE 3962 4035 4152 4302 4635 5175 5646 7678 50AJ,AK, 3642 3715 3832 3982 4120 - 4660 5131 7148 -- 50AW,AY 3720 3793 3910 4060 4313 4853 5324 7363 OPTIONS/ACCESSORIES(WEIGHT ADDERS)(Ib) Barometric Relief 300 300 300 300 300 300 300 450 Non Mod.Power Exhaust 450 450 450 450 450 450.4, 450 675 Mod.Power Exhaust 500 500 500 500 500 500 500 725 Electric Heat 110 110 110 110 110 110 110 165 cu.tuJcu.Fin Cond.Coil 220 220 220 ,r--220%R A 1220 Y1\3801'1-1\1[380 651 O.A.Hood Crate/Pkg'g 45 45 45 I I Il,45 11 1—L45 1 1,'45 1f' 11 45 45 (Less Hoods'Weight) (Packaging Only))I I I11 It I I .I f11 L 1 U(Packa&g Only) Outdoor Air HoodafFllters 170 170 170 -"' 170 `• 170 1, 170 i' 170 1 255 W 52150 'TDIt/EL CV MOTOR WEIGHTS(lb) VAV MOTOR WEIGHTS(lb) HIGH PREMIUM HIGH PREMIUM MOTOR HP UNIT VOLTAGE EFFICIENCY EFFICIENCY MOTOR HP UNIT VOLTAGE EFFICIENCY EFFICIENCY IFM IFM IFM IFM 5 HP 230/460 78 94 5 HP 230/460 125 141 575 78 92 575 163 177 10 HP 230/460 118 164 10 HP 230/460 204 250 575 118 156 575 204 242 15 HP 230/460 150 217 15 HP 230/460 238 305 575 150 220 575 240 310 20 HP 230/460 212 250 20 HP 230/460 348 386 575 212 258 575 304 350 25 HP 230/480 240 309 25 HP 230/460 377 446 575 240 319 575 375 454 30 HP 230/460 283 355MP 230/460 480 552 575 283 359 30 575 418 494 40 HP 230/460 372 415 40 HP 230/460 637 680 575 372 410 575 587 625 LEGEND Cu — Copper CV — Constant Volume HOP — Factory-installed Option HP — Horsepower IFM — Indoor-Fan Motor OA — Outdoor Air VAV — Variable Air Volume VFD — Variable Frequency Drive 'Outdoor-air hoods and fitters Included in base unft weights;Indoor-fan motors are NOT included. NOTES: 1. Base Unit Weight Includes OA hoods(economizer or outdoor air damper);does not include an indoor fan motor.ADD Indoor motor,FK)PS and Accessories for TOTAL operating we'gght. 2. VAV Motor Weights Include the Indoor motor and the VFD,compressor electric unio"%rs,VFD transducer and associated wiring. • 10 WVS®=tes0 @A+ CeC �� � 1 _ r i • y. Vh' ..ur 4s x . IINC t r _ i. Screw Fastening Systems Self-Drilling Screw Selection Guide 5.2.1 5.2.1.1 DRILL POINT SELECTION (Continued) 5.2.1.2 THREAD SELECTION Conversion Tables Metal Gauge Fraction to Decimal Thread Length Number Aluminum Sheet Fraction(in.) Decimal Always choose a fastener with sufficient threads to fully engage of Metal Equivalent(in.) in the base metal. For example: If you are fastening into 1/4" Gauge (Thickness in decimal 1/64 .015 steel,the fastener should have at least 1/4"of threads. It is help- parts of an inch) 1/32 .031 ful,but not critical,that the threads also engage in the material 000000 .5800 - 3/64 .046 being fastened.The head of the fastener provides the holding 00000 .5165 - 1/16 .062 power for the material being fastened,while the threads provide 0000 .4600 .4062 5/64 .078 the holding power in the base material. 3/32 .093 000 .4096 .375 7/64 1 .109 /Holding 00 .3648 .3437 1/8 .125 -Material Being Fastened 0 .3249 .3125 9/64 .140 1 .2893 .2812 5/32 .156 -Base Material 2 .2576 .2391 13/16 .187 \"Hold ng � .171 3 .2294 .2391 13/64 .203 i; 4 .2043 .2242 t 03 7/32 .218 5 .1819 .2092 15/64 .234 rrp"� 6 .1620 .1943 1/4 .250 Thread Pitch ig4? 7 .1443 .1793 The thickness of material being fastened and diameter of the 8 .1285 .1644 screw determine the type of thread pitch to be used. In general, 9 .1144 .1495 Screw Wire Gauge the thinner the fastened materials,the fewer the number of 10 .1019 .1345 Number of Decimal threads.The thicker the material,the greater the number of ® 11 .0907 .1196 Gauge Equivalent(in.) threads.This principle is due to two primary methods of thread engagement/holdinq power:Clamping and Threading. In light 12 .0808 .1046 #6 .138 gauge metal,the materials are actually being clamped together 13 .0720 .0897 #8 .164 by the upper and lower threads. 14 .0641 .0747 #10 .190 15 .0571 .0673 #12 .216 Clamping --- Holding #14 .242 16 .0508 .0598 17 .0493 .0538 18 .0403 .0478 19 .0359 .0418 \Holding "t ? 20 .0320 .0359 21 .0285 .0329 Therefore,the thinner the material,the coarser the thread pitch 22 .0253 .0299 must be to assure proper clamping.The thicker the material,the I{`"! ,< finer the threads must be.In very thick metal 3/e"-t/2"thick),a fine 23"'"^ '.0226' '.0269 ry ( ) 24 :_;,.;,r > • .0201 .0239 thread is adviseable.This will allow the thread to'tap'into the " 25 .0179 .0209 base material with less installation torque than a coarse thread. 26 .0159 .0179 27 .0142 .0164 1-:' 28 : .0126 .0149 Thread Engagement 29 . .0113 .0135- 30 :0100 .0120 31 .0089 .0105 32 .0080 . .0097 33 . .0071 .0090 34 0063 .0082 35 0056 0075 F 36 .0050 .0067 37 .0045 .0064 38 .0040 .0060 w' 132 Hilti Product Technical Guide 10/98 �IjG'H Screw Fastening Systems ;(Iry„ 5.2.2 Kwik-Pro Self-Drilling Screws IP9I'�d u ' ✓erage Ultimate Strengths-Pullout Average Ultimate Pullout Loads for Specialty Self-Drilling Screws );E �r C' Base Steel ThicknessScrew Head t�e' Thread Style Point 20 GA 18 GA 16 GA 14 GA 13 GA 12 GA 10 GA 5/32" 3116" 7/321 1/41" 1/2" Ib(kN) Ib(kN) Ib(kN) Ib (kN) Ib(kN) Ib (kN) Ih (kN) Ib(kN) Ib (kN) Ib (kN) Ib (kN) Ib(kN) f'rf #10-24 PWH 3 300 495 605 920 hl) (1.3) (2.2) (2.7) (4.1) #8-18 PFH 3 290 475 585 845 1070 1550 1575 (1.3) (2.1) (2.6) (3.8) (4.8) (6.9) (7.0) #12-24 PFH 4 530 780 1070 1125 1645 2120 2350 ' w/Wings (2.4) (3.5) (4.8) (5.0) (7.3) (9.4) (10.5) 1/4-20 PFH 4 605 985 1200 1450 2070 2500 3520 4120' 115} wMings (2.7) (4.4) (5.3) (6.5) (9.2) (11.1) (15.7) #12-24 HWH 4 675 880 1350 1940 2605 3195 3250' ' (3.0) (3.9) (6.0) (8.6) (11.6) (14.2) (14.5) {(" #12-24 HWH 5 740 885 1400 2010 2555 3125 3250' 3250' 3250' 141 (3.3) (3.9) (6.2) 1 (8.9) (11.4) (13.9) (14.5) (14.5) (14.5) i ' Indicates screw failed in tension before pull-out occurred. Test cannot be run for each possible combination of fastener and materials.Published tests should be used as a guide only. 'p` y Sheet metal used for the standard and specialty self-drilling screw test data is cold rolled 1010 strip steel,1/4 to 1/2 hard;R860-85, i yield strength 33 to 50 ksi. Average Ultimate Strengths-Screw Only Pullover Test It tat4l�t+n M �tet, tirA � oes Not Consider Base Material Limitations Average Ultimate Pullover Loads for Standar It:.rllling tka1 4 Torsional Tensile Shear 18 Ga 20 Ga 22 Ga 24 Ga 26 Ga Size Strength Strength Strength Fastener Ib(kN) Ib(kN) Ib(kN) Ib(kN) Ib(kN) 1' l in-Ib(Nm) Ib(kN) Ib(kN) #10-16 x 11/2'HWH " 1655 1100 1 830 750 505 4-24 14 (1.6) 750 (3.3) 490 (2.2) (7.4) (4.9) (3.7) (3.3) (2.3) 4-40 14 (1.6) 800 (3.6) 520 (2.3) #12-14 x 2'HWH 1525 1050 795 710 505 6-20 25 (2.8) 1185 (5.3) 740 (3.3) (6.8) (4.7) (3.5) (3.2) (2.3) 6-32 26 (2.9) 1200 (5.3) 790 (3.5) #12-24 x 1 1h"HWH 1440 1100 730 700 470 8-18 42 (4.8) 1575 (7.0) 1050 (4.7) (6.4) (4.9) (3.3) (3.1) (2.1)' #1/4'-14 x 2"HWH 1940 1224 950 855 600 8-32 50 (5.7) 1900 (8.5) 1265 (5.6) (8.6) 1 (5.4) (4.2) (3.8) (2.7) 10-16 61 . (6.9) 2100 (9.3) 1400 (6.2) All gauges of steel tested were 33,000 psi minimum yield strength. I 10-24 . 65 ,(7.3) 2300 (10.2) 1570 (7.0) "The washer on Hex Washer Head Screws is an integral part of the head 10-32 75 (8.5) 2700 (12.0) 1800 (8.0) and cannot be removed. I, 12-14 92 (10.4) 2800 (12.4) 1875 (8.3) Average Ultimate Pullover Loads for Special Self-Drilling Screws 12-24 100 (11.3) 3250 (14.5) 2175 (9.7) 24 Gauge Siding' 26 Gauge Siding" 1/4-14 150 (17.0) 3850 (17.1) 2590 (11.5) Fastener Ib(kN) Ib(kN) 1/4-20 168 (19.0) 4275 (19.0) 2870 (12.8) #12-14 x 11/4'Kwik-Seal'"^ 1015 850 (4.5) (3.8) #1/4-14 x 11/2"Kwik-Seal1A1 985 845 ): (4.4) (3.8) jll:u #12-24 KwikCote® 1045 _ Bonded Washer (4.7) pp Actual yield strength 61,000 psi. "Actual yield strength 106,000 psi. r. f i. lel' Hilti Product Technical Guide 10/98 135 �� m �u 7�\ 0 o v, m td 04t CD N C N (D � m x cn 0 CD cn 0 rn cn 3 0 c 0 cD Q N CITY OF CUPERTINO E-IV 01FURNACE/AC U� "� CUPERTINO PERMIT APPLICATION FORM APN# / Date: b � ? D lo � z� O3 Building Address: l8 - �2 Owner's Name: P one#: ©lZL1 Contractor: License#: Contact: Cupertino Business License #: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: ALUO A L ON S Residential ❑ Commercial For Residential Installations: Attic ❑ 1` door ❑ 2"d floor ❑ Adhere to min set back requirement❑ For Commercial Installations: Replacement same weight 'E Additional weight(structural calcs) ❑ Structural"C51'cations required for new installation ❑ N mstallatio Planning Approval red ost of P o' ct: D Type of Construction: Occupancy grou dStrpped'0 _//jOn Platform BSq.Ft. Floor Area:aaon ❑ Replacement IK Qty. if Appli e� Fee 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 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 4�6 Ds�. G5, CITY OF CUPEM INO �,= '• BUILDING Dlvls(oN PERMIT � CONTRACT� RINFORMATIOO Ns BUILDING ADDRESS: J & J AIR CONDITIONING PERMIT NOO 3100189 18922 FORGE DR N 'LR'S NAME: 1280 N 10TH ST PERMIT ISSUE DATE OBLIX 10/27/2003 PI 10 (408) 920-0662 SANITARY NO. CONTROL NO. ARCHITECT/LNGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH 0 0 0 0 X000 LICENSED CONTRACTOR'S DECLARATION Or F 1 hcrcby affirm that I am licensed Under provisions of Chaplor 9(romrrool ng Job Description ?a6 with Scmium7")ofDivision 3of the BusinessandProfessionsCode.andmyliceneis nnnn mfuafpnre acts erreat. I 3 REPLACE 2 A C UNITS �Btl�lLE� .Iyz Liceet Class t--2o LC.N q 15x8 1 sfp Dam o^ Contractor + 1 p at j ARC,{ITECI'SD RATION JAN O 8 ZOOM I ecu l understand my plans shall In used as Puhlie records U. Licensed Professional OWNER-BUILDER DECLARATION I� p 2 a i 1 hereby affirm that 1 am exempt from the Contractor's License Law I'm BUILDING the x n a 00 following reason,section 703 1.5.Business and Professions Code:Any city Or county mwhich requires a Permit to construct,altar,improve,demolish,Or repair any structure $39000 -�y prioit)us;issuance.also requires the applicant for such Permit to File a signed..Uatemem that he is licensed pursuant to the previsions of the Contractor's Licinse Law(Chapter 9 Sq. Ft. Floor Area Valuation SFO mm with Section 7"of Division 3 of the Business and Professions Codcu 3 that heeis exempt therefrom and the basis for the alleged exemption.Any violithm of 31609030 . 00 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not mom than firs hundred dollars(S50B. P Y YP ❑1,a owner of the Property,or my employees with wages as their sole compensation, will do d,e work,and the abri is not intended or offered for sale(See.7044,Business and Pmfcssiuoe Code:The Contractor;License Law cher nal apply m an owner of Required Inspections propeny who builds or improves thereon.and who does such work himself orthrough his .we employees,provided that such improvements are not intended proffered for sale.It, however,Use building or improvement is sold within one year of completion.the owner- builder will have the burden of proving that he did not Wild or improve for purpose or sato.). ❑1,as owner of the property am exclusively contracting with licensed oonnactnra to consumer the project(Sec.761,1.Business and Professions Code:)The Contnemrs Li . eme law does not apply to an owner of property who Wilds or improves themon,and who contracts for such projects with a contractors)licensed pursuant o the Contractor's License taw. ❑I em exempt under Sec. .B h P C for Nis rcazon Date WORKER'S COMPENSATION DECLARATION I herchy affirm under Penalty or perjury one ofine ollowing declarations: I pave and will maintain a CeriOamm of Consem to self-insure for Work er'sComPen- sa m,m,u provided for by Section 37M of be labN ..... or Code,for e perfof the work for which Nis permit is issued. 1 have and will maintain Wort Compmeta0on Insurance,az required by Section 37 of the Labor Code,for the pmformance of the work for which this permit is issued. My Worker's Co.pcns.00n Insurance scenic,and P licy number I. 'cr.:SlZ C j �o.:Glt 7 —}3 CERTPflON FROM WORKERS' COMPENSATION INSURANCE Croix section need not becompleted if the permit is tomos hundred dollars($100) or less.) 1 artily Nal in the performance of the wort for which this Permit is issued.l shall not employ any Person in any manner so as m become subject in the Worker'Compensation Laws of Cith omia.Dam Ainpicam NOTICE TO APPLICANT:If,after making this Coni Beata Of Exemption,you should Wcome subject to the Workers CompasmloO provisions of the Labor Code,ynu must O forthwith comply with such provisions Or this Permit shall W deemed revoked. L CONSTRUCTION LENDING AGENCY I hereby affirm that there is a eonswction lending agency for the Pmormance of La the work for which this permit is issued(See.3097,Civ.C.) tl dander's Name Undcrs Address �z 1 certify that 1 have read this application and time that the above information is y f^ correct.1 agree to comply with all city and county ordinances and sum laws relating to �O building construction.and hereby audimim¢Peesenatiscs Of Nis city to enter upon be - = a above.. I sed P Pyety for inspection Proposes. (We)agrt o sbve,indcmmry nd resp harmless the City of Cupertino against N habilid judg ns/Emtsa ceps swhich may in any way accrue asamnsaid City ;J z in ennuquene 0 tt gra n ort espermil. (may APPLIGAN U ER D. AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU ERG AT 1012-7163 Re-roofs A anVC error // W H actor MATERIALS DISCLOSORE Type of Roof Will the applic or future Wilding occupant nom or handle h,ardous material !SiJcfined by Ibe C nano Municipal Code,Chapter 9.12,and the Health and Safety Section25532(a)? All roofs shall be inspected prior to any roofing material being installed. I-1 Yet PZV Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove send haiardous air contaminants az defined by the Bay Arca Air Quality Management all new materials for inspection. District ❑Yea, I have .aNr am' sotuimmem"under Clatter 6.95 of the Califs, ria Heal �S ty ale, do 25 5.25533 and 25534.1 Understand Nat ifthe Wilding dots n tl L e it is my responsibility m notify tire occupant of Ne requi mem iehm a xmet mr brousuarou Or.cm,unctoo.1 Occupfcy. Signature of Applicant Date All roof coverings to be Class "B"or better owns tar tots'. a cn trate