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05010001 (2) CITY OF CUPERTINO BmtDrncDfvlslon PERMIT: CONTRACT OR INFORMATION BUILDING ADDRESS: . . A PERFECT CLIMATE PERMIT ND05010001 7588 LO OWNER'S NAME: - PERMIT ISSUE DATE SHERRY CHEM NE: SANITARY NO. CONTROL NO. 408 861-9545 ARCHITECT/ENGINEER: BUILDING PERMIT INFO - BLDG ELECT PLUMB MECH y Op LICENSED CONTRACTOR'S DECLARATION - Job Description w❑ I Wrchy affirm that I am littiucd under poviximS of Chapter 9(commencing _ �<W u•ith5 tion] puf DivivonJof the Busi Profcuionx Code,and mylittnse is - lmm�m derreet, rJa(ry/� FURNACE REPLACEMENT Z License C (] Lia.A/ n , �`❑ Da e0elmma - `, �� ARCIi1TECTS DELLA lOt �.T ?6U ndcrsund my plans shellruued as pis mmcords .. .- �.� 3 LL G Licensed Professional - 0 OWNER-BUILDER DECLARATION J <I I mushy affirm that 1 am exempt from the Convano's Licenu Law for the n o following reason.(Section 703 1.5,Business and Proessiom Cale:Any city or county P^� which require a permit us ennswm,eller,improve,demolish,or repair any swcturt ar " prior to its issuance.also requires the applicant for such permit m File a signed statement - t�'< mar he is licensed pursuant to the pmvisimu of life Contmcmr's Liam,law(Chapter 9 _ -Sq.Ft.Floor Area ValUati00 -. FFG (commencing with Section 7")of Division 3 of the Business and Professions Critic)or to that he I,exempt therefrom and the basis for the alleged exemption.Any violation of Section]0]1.5 by am applicant for.Permit aubjcers due applicant o a Civil Penalty of 3 6Q2QQjbfber0 0 - - - -- "— Occupancy Type - - not mom than Eve hundred dollars(SSW). ❑I,azownv of the property,amy emPloycu with wags azthevmlc compcnsaton, _ willdo Nc work.end Ne swaurt is nos inteMW oronertd faraalclSee]014,Buuircaa and Prereuiaru Code:The Conuutorer a Licue Law does trot apply m in owner of Required Inspections _ pommy who Wilihi rimproes Merton,and whiiii. uchwork himselfor WCagh his .employees.provided thar ouch joh,owmenu are nos intended mofmd formic.If. - - - howeveeNebuildingorimprove ens ix sold within one car ofcompleum,the owncr- builder will have the burden of moving that be did nos Wild m improve for purpose of sale.). ❑I,as no,of Ne property,am exclusively convecting with licensed contractors to - cmuswn the pmjecs(Sec.7W.Business and Pofusions Code:)The Conuazmr's Li cense law does not apply to an owner of property who Wilds or improves themon,and. ... .. who conuacufor such projects with a convacmr(s)licensed pursuant to me Contractors License Law. 1..1�- ❑1 am exempt under Sec. .B&P C for this moon weer, Dale WORKER'S COMPENSATION DECLARATION - 1 hereby a(fno under pini ty of perjury one of dee following declarations: ❑I have and will maintain a Ceninca,of Consent o self-insure for Worker's Compen- - mton,as provided for by Section 37W of the faro Code,for the perfnrmana of the work for which this permit is issued. 71 1 have and will maintain Workcts Compensation lommana,az required by Section — - - - - 3]Wofdue Labor Code.for Neperformartee fNe work for which Nu permit is issued. - My Worke(iEnmpmmd.n insurance =r a icy nu rr am: I 3 L Ca cr 'fYkBL�� K ION Na: , CERTIFICATE OP EXEMPTIONFROM WORKERS' • COMPENSATION INSURANCE films section need not becomplaCd if to permit is(croft hundred dollars(SI W) nflcss) I r<nifv Our in Ne perfowence of the work for which this Permit is issued.I shall not employ any person in any manner am as;in become subjecuo the Workers''Compensation - Laws of California,Date Applicant NOTICE TO APPLICANT:If,after making Of.C,nili ime of Exemption,you should become subject o m the WorkCeS Capcouion provisions of the Labor Code,you must OZ forthwi th comply with such provisions or this permit shall W doomed revoked. Z O CONSTRUCTION LENDING AGENCY hw 4 I bereby alErntat Nthere is a conevu .,h,ction lending anry forth,perfurmancc of Ili 7 the work for which this permit is issued(Sec.JW].Civ.C.) W A Icndcfs Name 6, Lindeis Address U O 1 certify that I have mad this application and stain that the move information is Ty F" correct.1 agree to comply with all city and county ordinances and state laws tutoring In OU building eonswction.and hereby authotlx mpromentalics Cr this city to enter upon the r W above-mentioned property for inspection purposes. F 6. (We)agree to sale,indemni d keep humless the City of Cupenino against N iiabiliuu,jud mcn¢coau index bows which mey in any way a<cmc agunuuiO City U Z in Co.sequen sof granting oft is permit. (, APPLICA U DERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: Dale SOURCER GU ATIONS. Re-roofs pilfghournme of ApplicanUConvaz'or D te HAZARDOUS MATERIALS ISCLOSURE Type of Roof will dm applicant or fu um Wilding occupant Hort or handle hazardous material az defined by do Cupertino Municipal Code.Chapter 9.12.and the Hcaith and Safety ode,Seed,n 25s3z(,)] /la� : All roofs shall be inspected prior to any roofing material being installed. ❑Yes t a�yNa win mea n,.m or mom building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove pp s v 4uipmcn waaa ,mil hazardous air contaminants u defined by Ne Bay Area Air Quality Management all new materials for inspection. DisuicR ❑Yes /6u I have mol NcnmamRus or requimmcnts under Chapter 6.95ofNcCalifor- niaRcalth&Sarcty Code Sccuo 8 .25533andM34.1undcrsund W.,i(thc Wilding does not euro el naw a tenon that It's my osier lblllly o nosily dee occupant of dh, requiremcnta n bmvslbemc pdoru iuuanccofaccarFi aIacapaney. Signature of Applicant Date t All roof coverings to be Class"B"or better Owner Or momlircd agent ate Community Development 10300 Torre Avenue J, Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building Department JOB ADDRESS: PERMIT # 1696 ,-( D o OWNER'S NAME: h PHONE # GENERAL CONTRACTOR. FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followinginformation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical 7-Z3/5? 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 Til Owner/Contractor Sign iture Da et CITY OF CUPERTINO FURNACE/AC UF UffikTINO PERMIT APPLICATION FORM APN# D e: Building Address: 0 k Owner'$ Name: Phone #: h 09)a6O Comactor- Phone: ticense#: Phone: Cupertino Business License#: Building Permit into: Bldg ❑ Elect AD Plumb ❑ Mech Job Description: / Residential Commercial ❑ For Residential Installations: Attic ❑ I" floor ❑ 2"d floor❑ dhere to min set back requirement[] or Commercial Installations: eplacement same weight ❑ ; Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation PlanningA royal Re uired ❑ -' Cost of Project: Type of Construct P- Oc pancy P'.`ea SOa I Strapped ❑ On Platform ❑ Bonded Sq.Ft. Floor Area: New Location ❑ Replacement ❑ if ,A(p-p4abl,p Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit-> 10,000 cfrn 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 27' ��