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05120061 (2) CITY OF CUPERTINO °�€^: >g '^ `" '£ " 1 BUILDING DIVISION PERMIT CC1�l�fi, =R�.C�T�UR�XI�4RM�'�Y6�.k BUILDING ADDRESS: HUSSEY BROS INC PERMIT 140.0 5120061 20233 NORTHCOVE SO OWNER'S NAME: PERMIT ISSUE DATE ig 1h MARIA IPSARO 640 TAYLOR AVE 12/13/2005 NE: SANITARY NO. CONTROL NO. (408) 733-6360 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BO EO PLUMB MECH O �oo LICENSED CONTRACTOR'S DECLARATION Job Description booby afumn Net 1 am licensed under provisions of Chapmr 9(commencing wllh SmUon7OW)0(Divtsion3orawnusin mdprofessium Cod andmylicemch n infullfenceandeffea. REPLACE FURNACE j02 Llcenmcless LIe.4 Dam 1 understand my plana shall hene d As public records 5 3 Licensed Professional OWNER-BUILDER DECLARATION .� 1 hereby affirm that I am exempt from be Comrscmrs License Law for the 0 o following mason.(Section 7131.5,Business and professions Cade:Any city or county i$ which requires a permit to construct,elm,.Improve,demolish.or repair any structure $2600 prior W its iauance,also requires the applicant for such pereliva role a signed smtenclu q C that he I,licensed pursuant in Mepmvisiomnfthe Connector's UcemeLaw(Chapter 9 Sq.Ft. Floor Area Valuation . y (commencing with Section 70110)of Division 3 of the Business and Predications Code)or $ that he is exempt therefrom and the basis fm the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit Objects Oe applicant in a civil penalty of J AP14 NVAYer U u Occupancy Type not more than Eve hundred dollars(5500). ❑1,As owner of the property.or my employees with wages As Weir Ole campewlinn, will do the work.and teswaum canal intended or offered farsh(Sec.7044,Bushel Required Inspections and Professions Code:The Convector's License Law doe,not apply m an owner of q P property who builds cr improve,Mercer.and wine does such work himself e,through his own employees,provided tat such improvements Are not intended aroffered f Bale.If. however.the building or Improvement is Old within one year of comped..We owocr- builder will have to burden of proving that he did sal Wild or Improve for purpose of ale.). ❑1.as owner of the property.am exclusively canuacling with licensed contractor m construct the project(Sec.7014,Business and professions Cade:)The Commumar'a U. came Law does not apply 0 an owner of propeny.who build,or Improves theman,and, who conu ons for such projects with a contractor(s)Eurued pursuant W to Convectors License law. ❑Iamexemptundef Sec ,68,PCforthi,maon Owner Dam WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of pedone of tc fallowing declantiom: 1 haveand will maintains C,,dI ofcomenuo xelf-insum ferweakees Coot saran,As provided for by Section 3700 of the Labor Code,for the performmm of the wads for which this permit is fared. ❑1 have and will maintain Workers Compensation Insurance.as required by Section 3700 of the labor Cade,for to performance of the work forwhich this permit is Issued. My Worker,Compensation Insurance cart.cr and Policy numocr am: Cerner. 0 . O .MPolicy No,: I*RTA � IIONFROMWOR RS COMPENSATION INSURANCE missection nerd notbecompleted iftle permit is foram hundred dollars($100) or less.) I anify that In the performance of the work for which this permit is laved,l shall not employ any person in any manner an As in become subject to the Workers'Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT.IL after making this Certificsm of Exemption,you should become subject to the Worker's Come sensation provisions of the Labor Code.you must .,Z forthwith comply with such provisions or this permll Well be doomed evoked. r O CONSTRUCTION LENDING AGENCY [—t (hereby aff,m that then is aconstruethn lending agency for the pelf urmancauf W> the work for which this permit I,issued(Sec.3097,Civ.C3 WM Q Lenders Name z Lender's Address U Q I certify that 1 have read this application and sum that the above information Is V,H correct.l agree to comply with all city and county ordinances and state laws relating W O U Wildingcow ction.mdhembyauthoro<mpmse Wives oftiscity to enter upon led X121 abovc-menlioned property for inspection purpose (We)Agee O sere,indemnify and keep h less the City of Cu no against y Iiabilivesjudgments. dexpenOs ichm In any azfislacialy to U APPconsequence CAannceUNDER ANDS Aof N MPLY WITH ALL NON-POI T Issued by: Date L ?r -� SOURCE TIONS. Re-roofs Signance of AfflMoMobald HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle harardaa material As defined by to Cupertino Municipal Code.Chapter 9.12,and be Health and Safety ode,Section 255320)? All roofs shall be inspected prior to any roofing material being installed. C]Yes ,ef Na Will the applicant or future Wilding occupant ac cgvipmenl Of devices which If a roof is installed without firs[obtaining an inspection,I agree to remove It heardosl air contrNnants a defined by the Bay Area Air Quality Management all new materials for inspection. istric17 ❑Yea faMG I m ehaakaus materials rcyuircmcnu under Chapter 6.95 oft,Califon nia He &S IyCode,Scctiam 25 .25533anti5534.1understaedthenifto Wilding Java al cu ntly haw A come, is my=possibility m notify the occupan f the sort them wissuanceoraCertifmateofOccas�`' Signature of Applicant Date q '�"3 All roof coverings to be Class"B"or better Owner or eWhomn0 agent D e Community Development 10300 Torre Avenue aCIF Cupertino CA 95014 Telephone(408) 777-3228 Fax(408)777-3333 OUPEkTINO Building Department JOB ADDRESS: PERMIT# 233 v 6611 OWNER'S NAME: H612AP PHONE # -2—q-- GENERAL GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical 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 T /Co act alure 15ate f CITY OF CUPERTINO / u CITY **CUPEI,TINO PERMIT APPLICATION FORM APN # 3 /6 i// 0J l Date: Building Address: —/ 33 Owner's Name: Phone#: fkU P S rt�a sem- g 477 2 Contractor: 1 ` Phon License#: Kvssc �6�05 Ka8 73�6�C� (�7566 Contact: Phon . Cupertino Business License#: t Sse yob 733- 360 Building Permit Info: Bldg a Elect V9— Plumb -9 Mech E5 Job Description: L 4,s1 2 Residential Commercial ❑ For Residential Int lations: Attic ❑ 151 floor 2nd floor❑ Adhere to min set back requirement❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction: Occupancy group: e>C,-) Ir Strapped ❑ On PlatformBonded ElSq.Ft. Floor Area: New Location ElReplacement* Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN 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 BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING