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04050054 (2) x c++ '4cysls.4« g>rtier`s'a:>ah 3c�3 ' CITY OF CUPERTINO m I BUILDING DIVISION PERMIT 1#CONTRACTOR INFORMATION BUILDING ADDRESS: A PERFECT CLIMATE PERMIT N10 4:050054 OWNER'S NAME: PERMITMUE DATE Abs KRISTEN YAMA IF ONE: SANITARY NO. CONTROL NO. 408 861-9545 ARCHITECGENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH t� 0 08 Z, LICENSED ONIBd underSDECons of CON (y Iion7 affirmNat1emIftheBuumlrrprovisionsofChapmrY(commencing lob Description with Secuon]Of1U)mf DiWsimn3o(NC Businessand Prokalom Code p,m�liccnu is infuBmrmad 2- /�tS ADD A/C .4 -�Z Lke sec7laau ... ,\ Dau Comacu V� a' ACTS DEC RATION I un ndcund my plans,shall shall he mud a Puhlie rtsNs OaU 3u. Licensed PmRssinnel N Oat lam exempt from DECthe Com ON sto / E:00 F i hmake aRatu that 11. eusin s an Ne fessiumrs License Any c Law for Ne Q fallowing mason.(Section 7(131.4 Business and Pe.de Professions Cade:Any city or county $ which mquima a permit re construct.aloe rat frow,h permit t or repair any mwetoa prior m its issuance,also requima prevision sof for such norm's Licer s signed amumem p=� (comm islicensedwJ PSectio 7taffic000)previsions 3 the Contractor's Lianulaw(Chodur9 Sq.Ft.Floor Area Valuation (commenof 'at attemeth xisforanand the basis the theBusinessexempt Professions Code)or Ne(he k attempt therefrom and Ne buts for the allcgcd exemption.Any violation of Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of 3 14ffs IQ'QIth121er0 0 Occupancy not mem Nan five hundred dollars($500). P Y Type ❑1,as owner of the properly,or my employees with wages as their sole compensation, will do the work end theamumum Is not intended at offered for ask(Sec,7W4,Business and professions Coda:The Contractors Liana Law does not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himuef or through his Own employ=.provided Na such improwmenu art not Intended oruffered!male.If. however,the Wilding or improvement is sold within one year of completion,the owoen Wilder will have the burden of proving that he did not build or improw for purpou of ale.). ❑I.as owner of the property,em exclusively contacting with licensed conuaoors to compost tite pmjem(Sec.7004,Business and Professions Code:)The Contractor's Li- cense Taw does not apply to an owner of property who builds or improves Merton,ad who simmeu for such projects with a ciaos curs)licensed puMak nt to the Committees Licame law. ❑l am exempt under Sec. ,B&P C for this rtesmn 1301W wner Date WORKERS COMPENSATION DECLARATION I hereby a1Rrm under penally of perjury one of the following declarations I have and well maintain a Certificate of Contin(a Ulf-imum for WorketsCompen- ion,u provided for by Section 3700 of the labor Code.for the performurce of the rk for which this Permit is issued. I haw and will mainWn Winters Compensation Insurau,a required by Section of Ne labor Code,fin Ne performance of Ne woh for which Nis permit is issued.y Workch ComPenation Inwserux canto end Polity numbs j�,rtier. 1 Polity No.: O CERTIFICATE OF EXE ON noMW RKERS COUP IT NINSURANCE (Thlssectimu need not br completed if the fermi(Is formic hundred dollars(SIM) or ecu) I certify Out in the pofomarce or On work fin which this permit is issoed,I shall rot employ any penin in any manerx as to become sbjecuo the Workeri Compeneadoa Law.of Calif o..is.Dale Applicant NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should become subject to Ne Worker's Comprnaation provision of the labra Crall you mum 0 z forthwith comply with such pmvi nese or this permit.ball W doomed mmked. El: CONSTRUCTION LENDING AGENCY [+ Iherehy affirm that dome its coawctinn[coding agency for the Performance of CiNe work for which this permit Is issued(Sec.3097,Civ,C.) ALanders Name .7 z Landers Address V Q 1 comify that I haw read this application and state that the stow inforoutiun is D. comae.I agree to comply with all city and county on inam and jute law relating to O SV" building conswction,ad hereby mraminU reprtsenmiw.of this city to enter upon the [i7 almw-me judge property fond expenses Purposes _ y (We)agree(o caw,indemnify and keep hermless du City of Cupertino against fA in equence fdremsmmd expenses may in ay way acarol against said City V z A consequence of UNDERSTANDS of this permi. '—' APPLICANT UNDERSTANDS AND ILL COMPLY WITH ALL NON-POI Issued by: Date S07CE RE ULATIONS �/ J/ilir �l/� �/ _G/IiLZ( .`110 Re-roofs 'gatuam Appy(cmV�Conte Data HAZARDOUS MATERIALS DISCL WRE Type of Roof Will the applicant or future Wilding upawam or hander Six huaNaa material dcfirnid by tits Cupenum Municipa ,Chapter 9.13.and the HealO and Safety odc1z,YO, z(.)? u All roofs shall be inspected prior to any roofing material being installed. Willi the enplic or forum builJing ac an on equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove ml(hvaNnus aistb Wor It ts u dcfnc Bq Arta Air Quality Management all new materials for inspection. Iiwict?9. z Yrs I haw real the ardnusmateriebrtquim n under Chapter6.95ofNcGlifmo-an 23 34.1 undemlad thin ifthe building ocs not cumcoly how tons.pro it ix my rcspp M1I Ity to notify the amu ( I dm uirc hichm mbemeYprior use a -er�r1 o e n n re of Applicant Date / - All roof coverings to be Class"B"or better 94 err or awhmrinc egret ate g Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: PERMIT# 1 o a-1:5 �-�R �� ISQa�e Q 1-1 D6 oD6L� OWNER'S NAME: ar)ate PHONE # G-rrs S( GENERAL CONTRACTOR: e r✓ 1 ✓VIAQ FAX # g g�j I am not using any subcontractors: Qi+�e S�CU -O 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 Rock Tile y a� Date - 2C �. r/Contrac or Signature I F CITY OF CUPERTINO 44- CUPERTINO PERMIT APPLICATION FORM APN # �3 (p tj o o la Date: _ I Building Address: ,(,Do,—t S- M(.D x SQCv1 / Owner'sPhone#: Wsk") A(V)CAsca-1 qbg Coritractor: Phone: License CA i Con ct: r Phone: ) IC ` Cupertino Business License #: Building Permit Info: l Bldg ❑ Elect Plumb ❑ Mech Job Description: �� Residential Commercial ❑ For Residential Installations: Attic ❑ I"floor ❑ 2n floor❑ Adhere to min set back requirement❑ _ For mm Coercial Installations: •Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning A royal Re uired ❑ —� Cost of ProI ct: g(f Type of Cons Occupa y Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. loor Area: 7 New Location ❑ Replacement ❑ Qty. if A li e.-- Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 elm 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 Licensp, n BUILDING