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04060123 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT C0NTRA6T0k TNPQxtMATION BUILDING ADDRESS: A & H HEATING PERMITNO04060123 [10586 LARRY WY OWNER'S NAME: PERMIT ISSUE DATE Jilk CHEW WONG 770 CHESTNUT ST 06/15/2004 ONE: SANITARY N0, CONTROL NO. (408) 279-0722 ARCH1TECf/ENGINEER: BUILDING PERMIT INFO BO EO PLO MECH O 900 LICENSED CONTRACTOR'S DECLARATION u I hereby affirm that 1 am limned under provisional of Chapter 9(commencing Job Description with Sucdan 7")ofDiviai.O 3 of rhe Business and Profession,Codc.and my license is g�� ��pp�� 1� Inmllforcemd it [ REPLACE FURNACE & ADD �[tigNaf2t2�MMIT 5$Z License Class Lk.M nFp Dam Carl. _ ARCH CPS DEC TIN J U L 7 2004 'y9 I understand my plans shall he led u Public ocorda 7 3^W Licensed Professional OWNER-BUILDBR DECLARATION BUILDING d i I hereby affirm that I am exempt from Me CnmoclorLi 's cense V Law for the ate p o following mason.(Secuan 7031.5,Business and Professions Code:Any city or county $ which requires a permit in Construct,alum,improve,demolish,or repair any structure $8000 y prior m itsissuancc,also requires lhemplicanlforaueh permit to Blca Wmc signed nend F �< that he is licensed pursuant to the provisions of Me Contractor's Llmnm Law(Chapter 9 Sq.Ft.Floor Area Valuation u9 (commencing with Sudan 7000)of Division 3 of the Business and Profn,sions Cads)or .. that he is exempt therefrom and the baso for the alleged exemption.My violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of a Occupancy Type not mom Nan five hundred dollen(5500). ❑I,as owner Clubs,property,mmy employers with wages as their sole compensation, will do the work and theatmcl.m is notimended orofferedlorsale(Sec.7044,Business and Profession,Cade:The Conbamor's Licarue Law dna not apply to an owner of Required Inspections properly who builds or improves therein,and who does such work himself or through his own employers,provided that such improvements am not immoded or offend for wit.If. however,Ne building or improvement is mid within one year of completion.the owner. builder will have Ne burden of proving that he did not build or improve for purpose of stake.). ❑1,as Owner of the property,am exclusively contracting wish licensed comments to - Constmet the project(Sec.7044.Business and Profasians Code:)The Comecmh Lt. come law darn not apply to an owner of property who Wilds or improvn,Nemon,and who contracts for such projects with a comacmHa)licensed puna lm the Conmcmts . License Law. + ❑1 ren exempt under Sec. .B R P C(or shis moon 1(33700 wner Date - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury arc of the following declarations: I have and will maintain a Cerdfcsac of Consent m elf-Insure for Worker's Camper. non,as provided fm by Section 37M of the labor Code,for the performance of the rk for which this permit is issued. 1 have and will maintain WOrkcri Compensation Insurance,as required by Section of the Labor Code.for Ne Performance of Ne work for which this permit is issued. yWork`eersCompen,adolnsunncc anter and Polic number w: nier.4� t -1Ti7 Polity N.�� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Cnlis section read not becmnplmcJ If the permit Isforonc hundred dollars(SIM) .flus") I unify that in the performance of the work for which this permit u issued,l shall out employ any Perron in my mannerso ss to become subject to Workers'Compensation Laws of California.Dare Applicant NOTICE TO APPLICANT:If,alter making this Cmificatc of Exemption,you should become subject to the Worker's Compensation provision,of she IaWr Cad,you must .7Q forthwith comply with such provisions or this permit shall W decreed revoked. Z'••' CONSTRUCTION LENDING AGENCY [••ice I hereby affirm Nm then is a Construction lending agenry for Ne performance of C.moi she work fur which this Permit is issued(Sec.3W7,Ci,C.) Q finder's Name z Lindero Add.. U C I cmify Mut I have lead this application and slow that the above information is lLs F torten I agree to comply with all city and county onloances and sum laws minting b 0U building construction,and hereby aushmise lepresentsOws of thin city 10 enter upno be r W above-mentioned property(in inspection purposes.' F+y (We)agree to now,indemnify and keep harmless she City of CuNnom against M liabilities,judgments.costs and expenses which may in any way acme against mid City U z in consequence of the goading of this permit. APPLICANT UNDERSTANDS AND ILL COMPLY WITH ALL NON-POINT Issued by: Date OURCE REGULATIONS. Re-roofs oro o pplican"Commctor Data HAZARDOUS MATERIALSD LOSURE Type of Roof Will the applicant Or future building acupanti m e or handle hazardous mamrial as defined by the CupeAno Municipal Code.Chapter 9.13,and the Health and Safety otic,Section 25532(a)7 oY All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building Occupant as equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants u defined by Ne Bay Area Air Quality Management all new materials for inspection. istrict? ❑Yes yrvu 1 have mad the hanrdousmawdalsrequimments under Chapter,595 of the Califon ria Health&SafelyCode,Suctions 8505,25533 and 75534.1 undcrslond shatifNc building does not cally haw a scram,Nat It is my no asihility m notify the occupant of the uquireme tell mn,lbemat come ofaCcmficawof aPancy. Signature ofApplicant Date Owner ver authorized agent Dmc All roof coverings to be Class "B" or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: v PERMIT# o t v 23 OWNER'S NAME: )\J PHONE # • 27 7 7 z Z GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature V Date Please check applicable subcontractors and complete the followin information: . IZF -SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork . Cement Finishing Electrical Excavation Fencing Flooring: Carpeting • LHeatin!g m/ Wood Glazing on Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO It 6n- FURNACE /ACCITY OF CUPERTINO PERMIT APPLICATION FORM APN 't 318 Date: Building Address: 6S84 LAav Owner's Name: I Phone #: Wont G, Cont[actor: � License #: 3o ifif 7a.• _ _ASH D- cgc � Contac[: SPhone #: 71 - 07cg;L Applicant/Contractor: - Buildinu Permit info: Bldg Elect Plumb_ — Job Descripti�on: �� -- Residential: 6UjU2 - -XI-/( � ��nimercial: Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: Valuationg� Type of Consu action: Occupancy Group: O Qty. if Applicable/ Fee. 1D ,ee Descrilmion Fee Group, BENERGY Energy BUILIDNG _ �— BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Owlets ELECTRICAL _ BSEISMICRE Seismic Fee Res BUILIDNG — — -- 7 EPERMITFEE Elec Permit Issuance ELECTRICAL NIPERMITFEiE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbin� Permit Issue PLUMBING —� BPERMFEE Bldg PermitFees _ BUILIDNG BPLANCHK Plan Check Fee BUILIDNG _ BUSUC Business License BUILIDNG —i Community Development }r y 10300 Torre Avenue _ ti•; L .i*� ; Cupertino CA 95014 'Telephone(408) 777-3228 CITY OF Fax (408) 777-3333 UPER;TIN0 Puildin Ije artment JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # GENERAL'CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check a licabl'e subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork _ Cement Finishing Electrical Excavation Fencing r Flooring: Carpeting Linoleum / Wood •. Glass / Glazing Heating Insulation Landscaping Lathing l Masonry Ornamental Sheet Metal Painting / Wallpaper ` l Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock • Tile , Owner/Contractor Signature Date i a1 10/28/03 ¢ ,'