05040120 (2) CITY OF CUPERTINO g''' a��ca `-'
BUILDING DIVISION PERMITCONTRACTORANFORMATION
BUILDING ADDRESS: PERMIT NO,
ANDERSON RADIANT HEATING 05040120
270 KRA.OER DR WNER'S NAME: PERMIT LSSUE DATE
E:
SANITARY OL NO.
ARCHIT111=ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
i000 LICENSED CONTRACTOR'SDECLARATION Job Description
U F 1 hereby affirm that 1 am licensed under provisions Of Chapter 9(commencing
`�' with Section]fNNB of Divlsion3Of the Busincu and Pm rssinm k dmylimn.is
e in full fore and cff,,C
>'q_ ucen Lin HYDRONIC BOILER r."r,
€p Dale e L.
7W ARCHIECDECLARATION
�rc 1 undo rsuna my plans shall be used u public records
Js
iU
30G Licensed Professional
O
3 OWNER-BUILDER DECLARATIONrqs-
'yy<� I hereby nffirm that I em exempt from rhe Convenor',License Law for the
00 fallowing Micron.(Section 7031.5.Business and Pmfessiom Cods:Any city of county
$ which requires a permit rn construct.alter,improve.demolish,or repair any structure f,
poor m its issuance,also reyuireuhe applicant for such Permit m file a signed statement s
N=< that he is licensed pursuant to the provisions of the cnnmcmr'.Licca.Law(Chapter 9 Sq.Ft.Floor Area i; Valued
rc€m (commencing with Section 71M)of Division 3 of the B usineas and Professions Code)or
Ihn he is e.mpl thcreffom and the basis for the alleged eumpdOn.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Of 3,d py,ptsITllsrfoo Occupancy Type
not mom than rive hundred dollars(5500). 7017 C�74-lS'"
❑1,u owner of the propenY•or mY emploYeo wish wages as their tele compenation,
will do the work,and the swan¢is not intended or offered for sale(Sec.7044•Business
and Professions Code:Tbe Convenor's Liccaia law does not apply to in owner of Required Inspections
propsny who build,or Improves branch,and who doessuch work himself or through his
Own employees•provided thin such improvements..or intended or offered for tele.If.
however.the building or improvement is sold within one yea,of completion,the owner.
builder will hove the burden of proving Nal he did not build or Improve for pMusa,Of
aakJ.
❑1,as Owner of Ne property,am exclusively contracting with licensed Co.....m
consumer tbe project(Sea.WU,Business and Professions Codc:)The Contractors Li.
cense Law docs not apply to in owner of property who builds or improves thereon.and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
Lkense Lew.
❑I on.,.Pt under See. ,B&P C for this reason
Owner Data
WORK ER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
an
and will maintain a Certificate of Consent mir-insure for Worker's Compen-
137M
,a$provided for by Section 3700 of the labor Code.for the performance of the _
for which this pelmfl is issued.
ave end will maintain Workers Compensation Insurance,es required by Section
of Ibe labor Code,for the performance of the work Ge which Nis permit is issued.
Slim/pen ion Insure artierendPolityi.. L Ir Policy No.: (�
CERTIFI ATEOFE PTIONFROMWORKERS'
COMPENSATION INSURANCE
(TTls section need not be completed if the Permit is for one hundred dollen($100)
or Ica,.)
I certify that in the performance of the work for which this Mrmh Is issued,I shall Mu
employ any fiction In any manner sr.0 I kCmne$Object t0 do,Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making his Certificate 01 Esemp sin,you should
become Object m the Worker's Compensation previsions of the Labe Code,you must
.J O forthwith comply with such provisions of this permit shell be deemed revoked.
z S`TI-tC CTION LENDING AGENCY
�-. Ihcmhy eRr et thcni .C.Oswcturn lending agcllCy fortbeperformann of
a the work fur whi this permit is"sued(Sec.7097,Civ.C.)
14 lendci a Nam
Z Lenders Ad
U Q I enify that 1 have r d this application and but,that the abosm Informuiim is _
Is, F correct grxm,many lhallehYandcounly ordinances and state law,relating to
0C) buildI,construction,an Cony oultrin representative,of City to enter upon the
�w W son mentioned pro y for inspection Puipmer.
( c)agree l an,indemnify and keep It in the City of Cupertino again"
F'i,t f bili0 ,' I in ts and caper., may In my way recede against said City
ncon enc fthegI'MftO curb.
APPLE UNDERST S AND WILL COMPLY WITH LL N N-POINT Issued by: Dale
SOU i GULA S. 1,w / �J/
Re-roofs
Sig r. p inGOn / Dem
HAZARDORDO US MATERI LSDISCL UR Type of Roof
auto Cupertino
fumm b(al Code.Chapter ore 9,12.handle h Health
mamotl
as once by 1 Cupertino Mun(cipal Code.Chapter 9.11.and the I+ealth.
C e,Senio 5532(.)7 /' All roofs shall be inspected prior to any roofing material being installed.
will the IPPlicrom rue lure Lwiding am uucyuipmem oracvices which If a roof is installed without first obtaining an inspection,I agree to remove
h....doul air contbminanu fine y the Bay Area Air Quality Management all new materials for inspection.
er7
❑Yes
Il evere theh materials requirements tinder Chapter fi.95ofthe Cali for-
Mullen, AS, y c 255115,35533.d25534.1undcrs.dl uifffi.Wilding
docs Irla e ant, t 1 y nattily the mcupant of the
requifemcn. bcheor" met do s$ �Isl mnracdpanly.- Signature of Applicant Date
ownnn adthndxsa a cote All roof coverings to be Class "B" or better
Q- CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
APN# 3S� C QZ DDate:6 1 �h/ 0SJ
B ildi Address: �� Mailing Ad ess (' different from building address):
Own � ` � Phone#-
G 2
Co tractor: r j License#71d,1�111
Contact: �J Phone: Cupertino Business License#:
L /1tI0em Fax:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech 0r
Job Description: /
Residential �� f5�! �H�/ // -X Commercial ❑
Sq.Ft. Floor Area: /0 OW 4 -L/ $/Sq.Ft.:
Cost ofd Ct. D Occupancy Group:
Y, v v
Type of Construction: Please check this box if the project is a
second-story addition: ❑
Project Size: Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
/ BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1 M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu . MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax-Resi/Mobile BUILDING
BELEC1000 Elec 600V <= IOOOA ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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SON-- CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain & Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREM 3USWAY Remodel Busways ELECTRICAL
BREMFDCT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace > l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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k- CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmd] Signs Add Branch ELECTRICAL
BREMSIGNS `- ` Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct _ MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD ' Scb Specific Plan BUILDING, :
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING.
BSPECIAL Special Insection BUILDING
BSWIM-• - - Swimming Pool BUILDING ,
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq footELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
NIPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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