05120092 (2) CITY OF CUPERTINO yzg� �z-.tz�3'
BUILDING DIVISION PERMIT CONTRACTORpINFQRMATION`;
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BUILDING ADDRESS: A PERFECT CLIMATE PERMIT N0,05120092
10191 PARISH PL
OWNER'S NAME: PERMIT ISSUE DATE
dh RICHARD GELSHANT 10570 S DEANZA BLVD 12/15/2005
IFNE: SANITARY NO. CONTROL N0.
(408) 861-9545
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u OZp LICENSED CONIRACIOR'S DECLARATION O O O
np I hereby affirm that 1 am Iicc sM under provisions of Chapter 9(commencing Job Description
<W with Sccuon7arl0)af Division 3o(NC Businuu and Profcasiuns Codc.aM mylicena is
mu
License lass�= ;Mrs en Lie.a REPLACE FURNACE & A/C
- _
=p Daa Contracer
A CHrTECTS DECLARATION
arI undersand my plans shall be used as public records
it o t; Licensed Posfessioal
s. OWNER-BUILDER DECLARATION
x3 I Wrathy affirm that 1 am exempt from the Contractors License Law(or the
po following reason.(Section 703 1.5,Business and PrefeWons Code:Any city or county
which requires a permit to construct,alcor.improve,demolish.at repair any structure $6182
Z� poor m its issuanee,9m requitatheapplicant forsuch rebut to file a signedsutemcnr
< that he,is licensed pursuant o the previsions ofthe Contracter's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing withSection 7")of Division 3nf NC Buaineuand Profeuin.Code)m
that he is exempt therefrom and Ne Buis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of (QGGU anC
not more Nan fisc hundred dallus(5500} P P Y Type
❑1,u owner o(tia property,or my employees with wages u their sole compcnution.
will do the,work and the suuaure u net inaMed or offered for sale(Sec.?W.Business
and Prafeaulona Crude:The Ontexc or's LiceRY Law duet not apply to an owner of Required Inspections
property who builds or improves thereon,and who doessuch work himandforrlwugh his b�
awn employens,provided that such improvements art not inaMed oroffemd for sale.If,
however,the building or improvement is sold within one year of completion.the owner.
builder will haus the burden of proving that he did rat Wild a imprew for purpose of
sale.). /p/vim
❑1,as muner of the Sec.7property,.B exclusively convening with licensed convecmrs i-
construct the or not (Sae.7014,Business and Preproperty
who
Code:)TheContractor'sd arson, cad
whoLaw docs not e u owner of proper(.who buildsor improves thereon,and
whocontractsfor such pmjeca wiNaconuaemr(s)licen¢d purwantm Ne Canvacm2s troll (a ,
Lkeue law.
❑Ism exempt under Sec. ,ek PC for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby sRrm under penalty of perjury ore of da following dalantiou:
1 hawandwillarad ainaccniriateaCaue.I w self-issueforwmacesCompcn-
.arm,u provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
W .vs and will maintain WmkeYs Cumpewuon Insurance,u required by Section
Ne labor Cade,for the pertormanee of Ne work for which this permit is issued.
W
My Worker's'C^o,mp^eu_ation Insurance renin and Poliry numbe art'
Carrier: f>•Tl RT Poliry No.: T�
CERTIFI COMPEN ATION 0NFRA WORKERS'
COMPENSATION INSURANCE
(Thu section need not be completed if Ne permit is foram hundred dollars(SIM)
Far fi,M)
I ecnify Not in the perromnanoe of Nc work for which Nis pcnnh u issued.1 sbdl not
crnployany person in any crsou obecomewbjnrto tits Worked Compeuauon
Laws of California.Dare
Applicant -
NOTICETO APPLICANT.If,afar making this CeniOcate of Exemption,you should
become subject m Nc Worker's Compensation provisions of Ne labor Code.you mast
Q O forthwith comply with such provisions or this permit shall be deemed andent.
Z y CONSTRUCTION LENDING AGENCY
[—� I hereby aRrm Nat there is a construction lending agency for the performance of
LL Nc work fur which this permit is issued(Sec.3097,Civ.C.)
W� A Lender's Name
z Lenders Address
U Q I ouldfY that 1 have read this application and seem Net the above ufmmauon u
f-' corecL l agrte m comply with all city and county ordinances and sure laws relating to
QU building(onsiunion,and hereby mlhorirz representatives or this city to enter upon the
C shove-memiu
ioned property for peeus
on purpose
(We)agree r an.indcmni(s er keep hornless Ne City of Cupertino against
rvFi(n liabilities,judgments,costs and expenses which may in any way accrue against said City
U z A APPLICANT
of Nc Ranting SA Permit.
'--' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date / 2-—/r-61'
SOURCE REGULATIONS.
'
Stgnawrc of ApphcanUContranor Dao Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Nc appliant or future building occupant sem orhandic ha mous material
as defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
A.11isCade,SCedrun 355330)?
❑Yea grm All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant or future building Occupant este equipment or Jcvica which pe
.
out hatardour air contaminants as do cd by Nc Bay Arca Air Quality Managemem all new materials for inspection.
District'13 1 �y//
Ycs u /`-
Ih& Mail safesthehvarcaus ons 25 ialsrequiwmcnts4.under u Clapard.95 if the Wilding l,� yyl�//vF(a/`b`/� Ce
Califor-
nia HralNkSafctyCodc,Sections]SSUS,25577 uu135534.1umferswd thwifNc Wilding
does not eume it haw a tenant Nat it is my responsibility m noufy the axupenr or Ne
t,w Itm stbemar or cln ceniraaanrolea���� Signature of Applicant Date
outhorrad agent Date roof coverings to be Class "B"or better
Community Development
X . 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY 0, Fax(408)777-3333
OUPEkTINO
J
Building Department
JOB ADDRESS: D I PERMITPd'/ 2 ub Z
OWNER'S NAME: �` PHONE #
GENERAL CONTRACTOR FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
21 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
Owner/Contractor Signature Date
CITY OF CUPERTINO
FURNACE/AC v S
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
b °�� I a ots'
Building Address:
91 Parish Pit
Owner's Name: ,�L Phone #:
973 1,29 4
Contractor: License #:
-7d5 I s
Contact: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect [� Plumb C9' Mech
Job Description:
Residential M/ Commercial ❑
For Resi ntial Installations:
Attic LZ 1 floor ❑ 2"' 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 Pro
t:// pp,,�SI Type of Construction: Occupancy group:
N /dC lav-p�aCq.
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Ener y 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
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