05080004 (2) -CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INEORMATI0N
BUILDING ADDRESS: VALLEY HEATING & COOLING PERMIT N005080004
10670 MORENGO DR
W NER'S NAME: PERMIT ISSUE DATE
RUPAL AYER 1171 N 4 TH ST 08/01/2005
NE: SANITARY NO. CONTROL NO.
(408) 294-6290
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
ioo LICENSED CONTRACTORS DECLARATION Job Description
U C 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P
b with Section 700X))of Division 3 ofdrt Bosinessard Pmfcssiom Code.and my license is
^ n in full fora and effect. REACTIVATE ORIG. #04050178
5y,(? LiceDtax class Lk.N NO NEW PERMIT ISSUED/PAID HALF OF PERMIT FEES
As shall uan DECLARATION
I understand my plans shell W used as public ree.rds
JOU
�o�' Licensed Professional
OWNER-BUILDER DECLARATION
I I hereby affirm Out I am esempt from Ne Cmaranays License Law for the
00 following mason.(Section 7(n1.5,Business and Prefcsmons Code:Any city of county
<$ which requires a Permit m construct,alter.improve,demolish,or repair any structure
prim m its issuance.also rcquims the applicant forsuch perenil in file a signed statement
££
that Wislicensed pursuant tothe povisiotuofthe Contractors Licens,Law(Chapter 9 Sq. Ft. Floor Area Valu imd3314
Y�0 (commencing withSection 700(Yof Division 3 of the Business and Professions Cache)of
test he is exempt therefrom and the basis for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant an a civil penalty of APN Number Occupancy
not more than five hundred dollars(ssao). 37534058 . 00
P y Type
0 i,as owner of the property,or my employees with wages as Nair sate compensation,
will do the work and dm stroc.m is not intended or offered for antic(Sec.7044,But.
and Pmfessiom Code:The Contractor's Lung es not apply to an law doOwner of Required Inspections
property who Wilds orimprovest thereon,and whoduessuchwarkhi ose f m through his
own employees.Provided that such improvements art notimanded meiated formic.If.
however.Ne building or impmvement is sold within one year of completion,the owner.
Wilder will have the burden of proving test he did not Wild or improve for puTose of
rale.).
❑1,u awrcr of ct Sec.70•.am B.elusively contracting with licensed rnntmctors U.construct La the es jet(Sec.o an Business and Rowho Wilds
Cade.)The Contemns Li- �+
come law dors not apply m is owner of progeny who Wilda or impmws Neuron,and
who contracts forsuch pmleats with aeonuacmKa3liangd pursuam m Ne ConwctaYs
License law.
0 lam exempt under Sec. ,B&PCfar Nuresson
1370K)
ner Data \
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury oro of the following dalentiom: ,
(have and will maintains irmcd. teof Covermglf-insure fm Worker's Compen- --7
ion,.provided for by Section 3700 of the Vhor Code.for Nc PoKormana of the yA G-e27z_—/Y_
work for which this permit is issued.
1 have and will maintain Workcri Compensation Insurance.ss required by Section d�
ofthe labor Code,fm Ne performance of Ne work for which Nis permit is issued WOrke.Compemation Inm .carnia and Policy numberrtier: Policy No, •\V,rte
CERTIFICATE OF EKEMPI70N FROM WORKERS'
COMPENSATION INSURANCE
(Thissection reed not W campIcted lithe permit is for one hundreddollars($100)
orless.)
1 cemfv that in Ne performance of the work for which this Permit's issued.l shall not
employ any person in any roamer an ss to becomc.bject to the Warkerf Compensation
Lava of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Worker's Compen.00n provisions of tW Labor Code,you must
.,Z forthwith comply with such Provision or this Permit shall be deamed revalued.
z CONSTRUCTION LENDING AGENCY
[-. I thereby WTI.Nat there is a cm jinn Lending sgercy for the perfmonam.of
C4 the work for which Nis permit is issued(Sec.3097,Civ.C.)
!21 Q Lender's Name
Under's Addreas
V O I anify Nat 1 have read This application and sun,Nat tho show information is
FConnect 1 qra to comply with all city and county ordinances and sesta Is"mixing to
O V building construction.and hereby authorim repnesenulives of this city to order upon the
V2 aho.e-mentioned property far inspection puryegs
(We)Agra to saw.indemnify and keep harmless the City of Cupertino against
Z in Conseqs.uence
of thecosuang of this esmit. phyla anyway acauc agalnn said City
V z A APPLICANT
of DERST Nof this permit
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT tissued by: Date
SOURCE REGULATIONS,
Re-roofs
Signature of ApphcanUConuanor pate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store or handle hatallous material
as defined by the Coincide.Municipal Code,Chapter 9.12,and the Health and Safety
Mo.Section 25532(4)? All roofs shall be inspected prior to an roofing material beim
❑Yea ❑NO P p y g being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will Ne applicant or future Wilding occupant use equipment or devices which P
It harardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
iwict?
Dyer ONo
I have mal the Wardousmaerials requirements under Chapur6.95 aide Califar.
ria Health&Sdcty COdc,Sections 25505.25533 and 25534.1 undersand thaifthe Wilding
does Wt cumenlly haw a um.4 Na it u my responsibility m notify the occupant of the
requitenenu which mug W met poor w issuance of a Certifeau of Occupancy. Signature Of Applicant Oafs
Owner or authorixeJ.,.I p,u All roof coverings to be Class"B"or better
CITY OF CUPERTIN( b oS'a17��
FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM t.��° '�
APN# c/
Date:
Building Address: 0
U 110 2�pJG� C'
Owner's Nv Phone #:
�� �{ )s
Contractor: License #: z!�) 6
Contact: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description:
11,E i�� s pt Y 2 67 C
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1" floor ❑ 2nd floor❑
Adhere to min set back requirement❑
For Commercial Installa 'o
Replacement same weightTAdditional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Plannin A--
Cost
royal Re uired ❑
Cost of project: Type of Construction: Occupancy group:
Strapped ❑ On Platform ❑ Bonded ❑ Sq-Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. if
A licable Fee ID Fee Description Fee Grou
BENERGY Ener BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit > 10,000 c in MECHANICAL
BREMAIIZHAN A/C Units <= 10, 000 cfrn MECHANICAL
BREMRECEPT Rec tl, Switch& Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITTEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
D
Jb
o"--717r