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04060062 (2) CITY OF CUPERTINO - s BUILDING DIVISION PERMIT CU1 T12A.C', gTi'IN' G1' AT10 s_ �a LONG ADDRESS: VALLEY HEATING & COOLING PERMITNOO4O6OO62 927 NnRTT-TRTT)r7 PQ WNEWS NAME: PERMIT ISSUE DATE RICHARD NE: SANITARY N0. CONTROL NO. (408) 294-6290 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMBMECH tom- 0 0 0 o o LICENSED CONTRACTOR'S DECLARATION zoa 1 here y strum that I em limned under provisions of Chapmr 9(commencing Job Description n< wi@Seedd1�ty91y0(101 Of Division Sof Ne Businessm (cssiom Code,end mylicenm is < m011fn- aodaffec _ c REPLACE FURANCE & LicenseGl Te• DIALED E G Dam sounder r d£C£ ARCHITECTS DECLAR N Y C< �Inticrsund my plans shell M iced as public records g n. C Licensed Ptofessienal g OWNER-BUILOERDECLARATION AUG g 2004 4<I I hereby affirm that 1 am exempt from the Contractors License Law for the O O following mason.(Section 703 1.5,Business and Professions Cade:Any city or county 1§2 which requite a permit to construct,alcor,improve.demoRvh.or mpwr any structure -Z' prior to its issue=,also requires the applicant for such Permit to fix a signed mlement ££ that hcislicensed pursuant in the previsions oftoContractors License Law Chapter 9 Sq. Ft.Floor Areaaluation Y $ (commencing with Section 7")of Division 3 Of to Business and Professions Code)or .- that he is exempt therefrom and the bass for Ne alleged exemption.Any violation of Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of 31�&6Qbi?eierO 0 Occupancy not mom than Eve hundred delta.(SSW). P y •7Pe ❑I,as owner of the property,or my employee with wage as their sets compensation, -will do the work.and Ne structure isnot intended or offered for sale(Sec.7044,Business and Professions Code:The Contextures License law does not apply to an owner of Required Inspections property who buildsor improves there n,endwho dmssuchworkhimmlfer through his own employers,provided that such Improvements arc notin ended oroffemd formic.If, however,the building or improvement is mid within one year Of completion.the owner Wilder will have the burden of proving that be did not Wild or improve for purpose of cote.). ❑I,as owner of the property,am exclusively contracting with licenud convectors in construct the project(Sec.7044.Business and Professions Cade:)The Contractors Li. csme Taw does not apply to an owner of property who Wilda or improves themes,and who contracts for such projects with a contrator(s)licensed pursuant to dm Contractors License Law. ❑IamesemptunderSa. ,B&PCforthsrmmn wner Dae WORKER'S COMPENSATION DECLARATION 1 hcrchy affirm under penalty of perjury one of the following declarations: - I haw and will maintain a Certificate ofConum to se1f4mme for Worker's Compere amum,as provided for by Scotian 37W of Ne Labor Code,for the p.dmource of the work for which this permit is issued. ❑I haw and will maintain Worker's Compemadon Insurance,as required by Section 37W of the labor Code,fm tui performance of the work for which this permit is issued My Workers Cnmpenmtion Irmo m earn icrand Policy numberam: Cey4er. Pa�VFRO: s� CERTIFlCATE O^EXF1.1PfIQFlFltM ORK� COMPENSATION INSURANCE (This section need nut W completed lime Paul,isforcre hundred dollars(SIM) nr less.) 1 certify Nat in me performance of the work for which this Permit is issued,I shall not employ any permm in any manner an as to become$Object to the Werkeri Compemadon Laws of California.Data Applicant NOTICE To APPLICANT:If.after making this Certificate of Exemption,you should become subject to the Worker's Compensation previsions of me Labor Code,you must .JO fmthwith comply with such provitinm or this Permit shall be deemed ranked. 04 ti CONSTRUCTION LENDING [-i mat there is a Consction lending agency for the performmce of GC ? the work for which this permit s issued(See.3097,Cit. IberebyafConstruction ¢C.)CJ aQ Lender's Nune z Lenders Address U Q 1 certify that 1 have read this application and trate that the show information is IT.U comecL I agree to comply with all city and county Ordinances and state laws miming to C) building construction,and Wmby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. LL (WC)agree to saw,indemnify and kap hurtle.the City of Cupertino against VI liabilities,judgmens,costs and Cap.which may in any way acme against acid City U Z in consequence of the granting of this Permit ` a.1 APPLICANT U ERS ND WILL COMPLY WITH ALL NON-POINT Issued by: Date O SOURCER L Re-roofs Sij;-Ajuiwo lice. omractor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle haardous material as dc0ncd by the Cupertino Munici 1 Code,Chapter 9.11,and the Health and Safety Section 255320)? Yes u All roofs shall be inspected prior to any roofing material being installed. Will the applicant or tutu uilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air con.mina as dcEned by the Bay Ana Air Quality Management all new materials for inspection. District? ❑Yes ❑Ne 1 haw read the haardnus materials requirements under Chapter 6.95 of the Uhler. ria Health&SafotyCOd.,Sections 25505,25533 and!25534.1 undereund that if 0th Wilding daim' 'I atenant Nat it is my mspor.ocrytotearyde Occuptof me f.ClitytonoufytececugnatureofApplicant Date All roof coverin s to be Class "B"or better rag m Dam g r Community Development "410300 Torre Avenue 1 s Cupertino CA 95014 Telephone(408)777-3228 UPEt�TINO CITY OF Fax(408)777-3333 � Building Department JOB ADDRESS:ZffJZti PERMIT#� D v OWNER'S NAME: a% G PHONE # GENERAL CONTRACTOR: �, y FAX # � I am not using any subcontractors: jSignature Date Please check applicable subcontractors and complete the followin 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 Rock Tile mer/Contractor Signature Date CITY OF CUPERTINO FURNACE/AC I@CUPERTINO PERMIT APPLICATION FORM APN# ��/ 3 / D Z Date: Buildin Address:b (p Z1 /V• I26d%c S 6t 6-c'1°- Own 's Nam /�,e: Phone#: lG�� d� l i� �d�•��'Co3G�v CcWctor: rJ Phone: Contact: s 11I Ph e- � � Cupertj �usiness License#: cv Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech Job Description: L �o �� Residential [� Commercial E) 4 G� For RMidential InL Ilations: \ Attic u 151 floor 2"d 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:,5Z l� Type of Construction: Occupancy group: Strapped ❑ OnPlatform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Ener BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tt, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMTTFEE Mech Permit Issuance MECHANICAL PPERMTTFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING