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CITY OF CUPERTINO
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INF,ORMATI,O
BUILDING DIVISION PERMIT
iCON,TRACTO„R
BUILDING ADDRESS:
M
A PERFECT CLIATE
PERMIT"°. 05080068
20213 JOSEPH CIR
OWNER'S NAME:
PERMIT ISSUE DATE
LANA VOSK
10570 S DEANZA B
0
NE:
SANITARY NO, CONTROL NO.
(408) 861-9545
nRCHITECf/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 70ky or Division J of the Business and Professions Codc. end my license is
inlut term amdermL Sg
INSTALL A/C
Limen. elm Lic. N
Dole Contncmr
ARCHITECT'S DECLARATI ds
7S
Iunderstand my phtu shell be u public records
understand
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Licensed Pmfessionol
OWNER -BUILDER DECLARATION
1 therebyaRam
rm that I am exempt fru. the Canuo', License Law for tbe
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Ge
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following mason. (Section 7031.5, Business and Profession Code: Any city Or county
ZU(tI' J
Which requires a Permit tar construct, alte, improve, demolish, or repair any su etum
T $4534
prior. its Issuanm, also requites the aPPl1muL for such permit. file a signed statement
that he is licensed lO the of NC Contractors Limmax Law (Chapter 9
Sq. Ft. Floor Area (q�y(y�pp Valuation
pursuant provisions
(commencing with Section 7000) of Division 3 of the Business and Professions Code)or
rA. it rA gp {S
Nat W u esempt therefm. and the basis for the alleged exemption. My violation of
�S• F! l'yn P'� P [•w.,.
��y
ru
Occupan"eya-Type-
Section 7031.5 by any applicant for a permit subjects to applicant to a civil penalty of
not mom Nan five hundred dollars (SSW).
O I, as, owner of 1W pmpmy, or my employees wit wages es their sole compensation,
Required Inspections
will do the work, and the swcturt is not intended oroRered forsale (Sec. )014, Business
and Pmfustioro Cmc: The Contractors Licene Law does Pmt apply m an ower of
property who Wilds or improves daemon, and who doessuch work himself or through his
own employees, provided that such improvements are not intended oroRered for sale. It,
however. Ne building or improvement is sold within one year of complcum, Ne owner.
builds, will hats 1W Wrden of proving that W did not Wild or improve for purpose of
rale.).
1, as owner of the property, am exclusively...mating with licensed mnuacmrs to
construct Ne project (Sec. 7064. Business and Pmfessioes Cade:) The ConuactoYs Li -
to law does not apply m in owner of property who Wilds or improves Oseroon, and.
who convects for such projects with o eontsactor(s) licensed pursuant m the Convector's
License law.
Fl 1 am exempt under Sec. B & P C for this reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm undo p.nlry of perjury rte of Ne fallowing declarations:
1 have and will maintain a Certificate of Catoml to Salt -insure for Weisser Compcm
sotion, m provided for by Section 37W of Ne labor Cmc, for the performance of the
for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as no,ored by Section
F11,1vuerk
of the labor Code, for Ne performance of thework for which this permit is issued.
rte Compesuauon Insurance carries and Policy atryy be'ars. I1
10 V 3 2 -
crunc . 0, vS PUBcy Na: • • 110414'32—
CERTIFICATE OF EXEMPTION FROM WORKERS'
CERTIFICATE
COMPENSATION INSURANCE
Mss section nem not W completed Mine rcr.it is mroe hundred dollars ($ 100)
or tors.)
1 certify that in the performance of the work for which this Permit is iaucd. I shall not
employ any Crum in any manner on armbecome subject to lW Workers'Compensation
Law s of California. Dam
Applicant
NOTICE TO APPLICANT: IL after making this Ccnificam of Exemption, you should
become subject to Ne Worker's Compensation provisions of the Labor Codct you most
forthwith comply with such provisions or this permit shall be deemed awaked.
CONSTRUCTION LENDING AGENCY
1 thereby alarm that dart is agency for sea performance of
s ed (Sec. 7. Ch,
L e work fur which this permit is issued (Sec. J09], Civ. CJ
Lender's Name
Lender's Addrtss
Adkm
I coolly Nu I have read this application and state that the show information is
comm 1 agree to comply with all city and county oNlnances and thus, law, .].,lot m
Wilding construction, and hereby authome representatives of this city to enter upon the
above-mentioned m,,,y for inspection pupwms
(We) agree m saw, indemnify and jump barmless the City Of CupeOino against
j liabilities, judgements. costs and expenses which may in any way accrue against said City
in consequence of the gaming of this permit.
I APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
S /&CE REGULATIONS. ,, /
/!alfa, L. -2J 9 X 27”
Re -roofs
Signatvre of ApplicandConuaclor I I Date
HAZARDOUS MATEFWS DISCLOSURE
Type of Roof
Will the applicant tar future building Occupant store or handle harudous material
tlZl bynier Me CupeNno Municipal Cmc. Chapter 9.11, and 1W Health and Safety
Co
mm. Sezss3z(a)]
❑secs
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant o uture Wilding mvpant use, equipment Or devices which
it hanolous air contaminants; as defined by the Bay Arca Air Quality Management
all new materials for inspection.
Disuicrl
❑Yes 12
Ihavemmtheh idi)usmawrialsmquimnenmunder Chapter6.95olI Califor-
ria Health&Safmycme.5eeuons 235U5.155J3and25J derstam thuiflW Wilding
�11
JA %i la /:. �v
does ret curenuy hart .=,
tenant, that it u my mxponsibEity mntify Ne occupant of Me
tdiYl y, II"
requireon wIn h Ibewelprortoicau mora niraW.f m my.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or authodsd.gent Dam
Community Development
' 10300 Torre Avenue
? `/ Cupertino CA 95014
Telephone (408) 777-3228
CITY 0, Fax (408) 777-3333
UPEkTINO
Of
Building Department
JOB ADDRE S:
PERMIT #
OWNER'S NAME: ({ Ob K
PHONE
GENERAL CONTRALTO :
FAX #
I am not using any subcontractors: Ph lug Qt' k /YeCcQ� %U
Signature 61 Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature Date
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
appsli,
CITY bF
CUPERTINO
CITY OF CUPERTINO
FURNACE/AC 6
PERMIT APPLICATION FORM
APN #Date:
F- 9 -vim
o
BUILDING
Building Add' re s:
Z%
BREMFURN
Gals r
MECHANICAL
Owner's Nam :
Phonebill#:
Q
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ntractor:
-License #:
Vo7x315
MECHANICAL
ntact:
Cupertino Business License #:
SN'VICU ILRQ
ELECTRICAL
Building Permit Info:
BSEISMICRE
Bldg ❑ Elect Plumb ❑
Mech ❑
Job Description:
EPERMITFEE
C�
ELECTRICAL
Residential N7f Commercial ❑
MPERMITFEE
For Re6dential Installations:
MECHANICAL
Attiq =�- I" floor V` 2"d floor ❑
PPERMITFEE
Adhere to min set back requirement E]
PLUMBING
For Commercial Installations:
BPERMFEE
Replacement same weight ❑ Additional weight (structural talcs) ❑
BUILDING
Structural Calculations required for new installation ❑
BPLANCHK
New installation Planning Approval Required ❑
BUILDING
Cost of Project: Type of Construction:
Occupancy group:
Strapped LJOn Platform El Bonded ❑
Sq.Ft. Floor Area:
a� ❑
New Location 14
Replacement
Qty. if
Anolicable
Fee TD
Fee nesrrintinn
FPa (:rnnn
BENERGY
Energy
BUILDING
BREMFURN
Furnace
MECHANICAL
BREMACOVER
A/C Unit > 10,000 cfm
MECHANICAL
BREMAIRHAN
A/C Units <= 10, 000 cfrn
MECHANICAL
BREMRECEPT
Rec tl, Switch & Outlets
ELECTRICAL
BSEISMICRE
Seismic Fee Res
BUILDING
/
EPERMITFEE
Elee 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