03120002 (2) ,CI'T'Y OF CUPERTINO11
BUILDING DIVISION PERMIT CONTRACTOR INFORMA TION, "
AUILDING ADDRESS: A PERFECT CLIMATE - PERMIT NG.03120002
-10736 LINDA VISTA D
ER'S NAME: PERMIT L59UE DATE
_.kDILLA ROBERT JR AND JUNE F 10570 S DEANZA BLVD 12/01/2003
PHONE: SANITARY NO, CONTROL NO.
(408) 861-9545
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION
i 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
with Section 70)(r of Division 3 argue Business and Professions Code,and my license is
a�e infull fmccondcffee.
REPLACE FURNACE
jq? License Class Lie. FINALE®
a r us Dale Cumracmr
ARCHITECTS DECLARATION
e I understand my plans shall he used as public records DEC
gad 6 2003
c O q Licensed Professional -
< OWNER-BUILDER DECLARATION
aZ 1 herebynaso affirm on 1 1. cusint from Nc Contractor's :Any c Law far @c .s
❑O following reason.(Section tI1J L5,Business and Professions Cade:Any city.r county
BUILDING
c m� which requires a Permit In construct.may,improve,demolish,or repair any structure ` ,Y $3200
eai prior in its issuance.also requires the applicant for such permit o Ole a signed statement ,
1 < Our he I.licensed pursuant othe provisions ofthcContractor's Liucausu Law(Chapter 9 Sq.Ft. Floor Area Valuation
11-0 (commencing with Section 70d(h of Division 3 of the Business and Professions Code)or
Q re3$
that he is exempt Ntrefrom and the basis for On alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of
not more than 11.hundred della.($500). Occupancy Type
Lmowner .and
pmprny,or oiNwagesas their sole cW,Bumio.,
will dohework,ands: he Cure is not intended Livens tar offered Larson(Sec,to ad,Business
and Profmhiobu Code:The Contractor,License law docs or apply to an owner is Required Inspections
own em who buildsorimproves thereon,and who Acessuchwork himselfedshrougb his
own employees,provided that such impmwmwithin are not ear of tl mpleeretl for owner.
builder Neaveteorimprovementissolde ntyear of completion.Neowner
builder will have sM1e burden of proving Nn he did not build or improve fur purpose of
salc.L .
1,as owner of the property,am exclusively contracting with licensed contractors to
c astrvct the project(Sec.7W,Business end Professions Code:)The Contractor's Li.
come Law docs not apply to an owner of property who builds or improves Ihemon,and
Who commas for such projects with a camracmr(s)licensed pursuant the Contractor's
License Law. '
la`mton r5 c. Bh PCf.r this�mon
i Dat Y��///�s'J—
R Ep COMPENSATOR, LARATIO�
1 hereby affirm under Penalty of Perjury one of the following declarations:
❑I have and will maintain a Ceniocme of Consent to self-insure for Worker's Cornice.
rasion,as provided for by Section 37M of dm Labor Code,for Use performance of the
work for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance,ss required by Section
3700 of the labor Code,for the performance of Ne work for which this permit is issued.
My Worker's Compensation Insurance artier and Policy number art:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not h tcompleted if she Permit is human hundred dollars(S100)
less.)
1 cenify Nal in the performance of the work for which this permit is issued.I shall not
employ any Notion in any manner so as h become subject to the Workers'Compcnsatlon
Laws of Califomia.Dam
Applicant
NOTICE TO APPLICANT:If,aper making this Cioulln a of Exemption,you should
became subject to the Worker's Compensation provisions of the labor Code,you must
=O forthwith comply with such provisions or this Permit shall he deemed revoked.
ti CONSTRUCTION LENDING AGENCY
I hereby affirm that here is a construction lending agency for the performance of
x 7 the work for which this permit is issued(Sec.3(197,Civ.C.)
WQ tender's Name
D0 Lender's Address
V 0 1 certify that 1 have read this application and sum that the above information is
W F cancer.I agree to comply with all city and county ordinances and sum laws relating to
O V building construction.and hereby submits,repreemaowa of Nis city to enter upon the
ITI ahovcmentioncd property for insisted......es.
(We)agree m save,indemnify and keep hmmleu the City of Calsodro against
Liabilities,judgment.costs and expenses which may in any way accmc against said City
V Z in cmone,m ss,of the gmming of his Permit.
APPLICA DE STAN
5 L ON ND L WITH AL NO POINT Issued by: Date
/j Re-roofs
ignewrc ofApP 10dHAZARDOUS MATERI Ise OSURE /Data Type of Roof
Will the applicant tar future building occupant store or handle hazafdous material
efined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
s❑ctlea 25532(a)7 Yea, No All roofs shall be inspected prior to any roofing material being installed.
N
Will the applicant r flare building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air commitments as dcbned by the Bay Area Air Quality Management all new materials for inspection. -
Distriet?
❑YcsNu
I haw read the outsidous malcrials requiremcass under Chapter 6.95 orthe Califor,
nia Hcalth65afctycodc,Sccdom 25505,25533 and 3d.lundcrstendthmifhc holiing
docs nm emorady haw a mnam, it is .gp illy m nosily the 'cu r of the
requirements da teas or to feC certifies a Signature of Applicant Date
/i
own . thorized anti, v, Datt All roof coverings to be Class "Bo or better
CITY OF CUPERTINO
, ' FLJRNACE/AC D3/c20j9oa
CUPEkl INO PERMIT APPLICATION FORM
APN r Date:
Building Address:
1Z> 7,-?o6
O 'Ms Name: �� GrG Phone #:
w
Cotractor: hone: License#:
_ ACL —
'IContact: Phone: Cupertino Busines icense #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech
Job Description:
Residential Commercial ❑
For Residential Installations:
Attic ❑ is` floor 2nd floor❑
Adhere to min set back requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calcuti' s required for new installation ❑
New ' stallation Pla ing Anproval Required ❑
C t of Project: Type of Construction: ' Occupancy cup:
St ed On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. 'f
A c 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
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 BUILDING