03080008 (2) CI'PY OF CUPER'1'INO a"�' '�'�s$ '+ °+*'+ ; `�'
Duu.Ornc DIVISION PERMIT . CONTRAC'TOR INFORMATION 4
BUILDING ADDRESS: PERMIT NO.3 0 8 0 0 0 8
OWNER'S NAME: PERMIT ISSUE DATE
RAJ KALISH 3
ONE: - SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+Oo LICENSED CONTRACTOR'S DECLARATION lob Description
�uF 1 hereby affirm Not 1 am licensed under provisions of Chapter 9(commencing p
Z1 est with Section]gkq of Divixion Sof NC Busirmumul limfeasium Codc,and my license is
<a in full!Oros and cifp0
i'�_ Liccnac a=v -`+ LIc.N INSTALL CENTRAL HEAT & ASC
Dale cu raaor "N CONTRACTOR: BAY MOUNTAIN AIR, INC.
eq
ARCHITE-CT'S DECI-ARATIClibi1Ne4LE®
e @ 1 understand records
my plans shall used Public rcrds
sod Licensed Professional
c 5
OWNER-BUILDER DECLARATION AUG 1 9 2003
f 1 hereby eEirm that I em exempt from the Contracmh Liccnm Law far the
o O following mason.(Section 7031.5,Business and Pmfessions Cede:Any city or County
<$1! which requires a permit u,ennuruet,alter,improve,demolish,or repair any structure
poor In its issuance,also requites the applicant for such permit to rile a signed statement
pp < thetheI,licensed instant tothe roviltim. Ithe Contmcmr'sLicense Law(Chapter y BUILDINGFt. Floor Area Valua$ap000
u+�$ (commencing with Section 70W)of Division 3 of the Business and Professions Cnde)0
y�.. that he is exempt therefrom and Ne buia for do,alleged exemptlun.Any=of nn��rr,,
Section 7031.5
1.5 by any applicant for a Mom h subjects the applicant to a civil penalty of Yvv..14O1"arO0 Occupancy Type
not more than An hundred dollars(SSW).
I,as owner of the property,or my employees with wages as their vele compensation,
will do the work,and the sudi is not intended or offered for sale 7W,Business �pAeQL{�C ,at �$❑
and Profeviom Code:The ConlracmYv Lianxis Law does net apply man owner of 3 0I — ROUGH )3eQLjgC jnSnectlons
property who builds or impmvea thereon,and whodoetsuch work himself orthrough his 1a111�1tS l N Ci
own employees,provided that such improvements am net miendad oroffemd foraela.If. 303 - ROUGH MECHANICAL
however.the building or improvement is sold within one year of completion.Ne owner-
huilder will have the burden of proving that he did not Wild or improve for purpose of 3 04 — ROUGH ELECTRICAL
`ale')' 505 - FINAL ELECTRICAL
[:j'1.as owner of die property,am exclusively contracting with licensed contractors to 507 - FINAL PLUMBING
construct the pmject(sec.]044,Buainev and Profmacm
ions Code:)The Conuri Li -
cense law does net apply to in Owner of property who builds or Improves Barron.and, 508 — FINAL MECHANICAL
who contracts for such projects with a eontmemr(s)licensed pursuant o thin Contractor's -
License law.
O l am exempt under See .B A P C for this recon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby of Irm under penalty of perjury one of the following declarations:
I have and will maintain a Cenifcate of Consen to self-insureforWorker'aComp
re-
serion,u prnvitictl for by Section 37W of the Inbar Code.for the pertortnance of the
work for which Nis permil is issued.
I have and will maintain Worker's Compensation Insurance,u required by Section
37 Dobe labor CodC,forincpcdormmOn of Ne weak for which Nit permit is issued.
All Workck{I,�Cntntff11ppeensait Iuunna anicr and Polity
Caron: y, y. Poliry No.: / •D(�_
CERTIFlCATE OFF.%EMPfION FROM WORKERS'
COMPENSATION INSURANCE
(ffiuscction need norWcomPlcred Kdo,Permit is foronchundmddollare 151BE) ..
er less.)
1 certify that in the performunec of Inc work for which this permit is issued,I shall nut
employ any person in any manner an As ui Ivcome subject o the Wormos Compensation
Laws of Califamia.Date
Applicant
NOTICE TO APPLICANT:IF,after making this CCNf101C of Exemption,you should
become Subject to the Worker's COMNASI ten Provisions of the Labor Code.you must
�O mMwith comply with such provisions m This permit hall W deemed revoked.
z� CONSTRUCTION LENDING AGENCY
1 hereby aMrm that there is construction lending agency for the performance of
1i the work fur which this permil Is issued(Sec.3097,Civ.C.)
4 Q Lender's Name ,
3 z UndeM1 Address
J Q 1 Cmily that 1 have lead this applleation and lath that in.above iafnrmatiun is
correct.l agree to comply with all city and county ordinances and slate laws relating to
'U building construction,and hereby Authorize representative of this city to enter upon the
N OWi above mentioned property,for inspection purposes. _.
r (We)agree to sane.indemnify and kap harmless the City of Cupertino against
to liabilities,judgments,sem and expresses which may in any may accrue against said City
Uz in consequence of the granting of this parent.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: DateL/
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicantlContractor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle haem our material
u dcOned by the Cupertino Municipal Code.Chapter 9.13,and the Hcallh and Safety
ales-1 en he Cupertino
C]No
❑Yes All roofs shall be inspected prior to any roofing material being installed.
Will the applicant of future building occupant use,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Ice hvardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
iabin?
❑Yea 'All.
I have mad the havarddouss Materials requirements under Chapter 6,95 of the Colifor.
IdeCa
ia Hcallh gs Safety Code,Sce ions 35505,15533 and 25534.1 understand thin if the but lding
not currently have a mnent that it is my responsibility m nnuty the occupant of the
qu' cn re muse atptiereissuanceeIaCerfificatedOedpUp, Signature of Applicant Date
wner ur auth oro esem Dale All roof coverings to be Class "B" or better
f,
CITY OF CUPERTINO
�� vbi 6 v v
FURNACE/AC
IT
OF
UPERINO PERMIT APPLICATION FORM
APN # 3 7.3 O O p s' Date
Building Address: IN
J$Vao NuSo
Owner's Name: Phone#:
K I ;s
Co rac'-I .v yds _ 63� S - License -)OJ S'6
Contac • ` 1 Phone: _2co< Cupertino Business License #:
1 D J+ < </0 �Z�I
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech X
Job Descriptions I `
1,J5ItI Cc,rivwl I �c�-1 �l , L
Residential V Commercial ❑
For Residential Installations:
Attic ❑ 1" floor ❑ 2nd floor❑
kdhere to min set back requirement❑
qP#or Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
ost of Project: Type of Construction: Occupancy group:
O.O �
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A1C 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
I
z �0 - � 7