05100023 (2) r
CITY OF CUPERTINO W74 70 � '
BUILDING DIVISION PERMITON fRACTQR INFURMATIOi
BUILDING ADDRESS: A PERFECT CLIMATE PERMR110.05100023
10141 PAPLETT PL
OWNER'S NAME: PERMIT ISSUE DAIS
GAYLEN WALTERS 10570 S DEANZA BLVD 10/06/2005
JNE: SANITARY NO. CONTROL NO.
(408) 861-9545
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300
LICENSED CONnRdmulcrSDECLARATION JobDescription '
� I hereby )of Net 1 am licensed in. p I pmf.s of Chapter 9(rommcning
with1110 n olDivisian 3o(Ne Buvneas vb ProfesaionsC .armmylkenseh w B�g ��
^� mmnmme.n rc REPLACE FURNACE & ADD ASC '\Yif ®�tli
j�? LkcnseC s -' Lk.g
Dem CunIncmr
ARCHITECTS DECLARATIO
I understand my plans shell he used u public record OC
�/
=Q Licensed T � 1005
7 GWNBR.BUILDER DECLARATION
i i 2 I hereby arciren that I am exempt from the Contractors License Law for the pppp
O O fallowing mason.(Section 7031.5,Business and Profecium Cade:Any city or county A fl.42014,
$ which requires a permit to eonmuct,alter,improve,demolish,or repair any atruelum .9 9 6 6,
prior In its issuance,Min requires the applicant fors"h permit un Me a signed wtement �.
< Nat he is licensed pursuant to the provisions of the Contractors licenseLaw(Chapter 9 Sq.Ft.Floor Area aluation' �.-
>�$ ritint with section 70510 of Division S ofthc Butlrcssand Pruftessiom Cedc)or
Q that k o cumpt therefrom and the basis for the alleged esemptian.Any vlolcfon of
Sotion 7031.5 by MY applicant for a permit subjects the app0eant to a civil penally or r Occupancy Type
not more Nen five hundred dollars(3500),
(_1 I.as owner of Ne property.or my employcu with wages at their sele compensation,
willelothework.and thenrontucb noloondstd"oRered forsalasec.7014,1lummus Required Inspections
Nd PIaCommutesflon/Cade:TIM Commutes License Law alae!act apply awnof q P
Property who build or improves theme,and who doessuchworkhimselforNmush his
own employment,provided that such Improvements arc notimended oro@red f"sale.if.
however,the building or,Improvement is veld within one you of completion.the owner.
builder will have the burden of proving that un did ret build or improve for purpose of
sok.).
❑1,as owner of Ma property.am exclwlvely contracting with licensed conuacmrs to
construct the project(Sec.7044,Business and Professions Cade:)The Contractor's I.J.
came Law docs not apply to an owner of property who build or improves thereon,and
who contracts for such pmjecu with a eonuacmr(s)licensed pursuant to the Contractors
License Law.
❑I ore eempl under Sec. .B&P C fer Nis recon
owner Data
WORKER'S COMPENSATION DECLARATION
7D I hereby ARIM under penalty of pejln)'one of the fallowing declandom
Lr ha wand will maintain a CWBcamof Connor to self.inum fear Workers Compen.
canon,a provided for by Section 3700 of da lab"code,for the peformwze or that
w__oLhL for which this NMI,is issued.
cit have and will maintain Workers Compeacdion Imuran¢,as required by Section
1700 of the labor Code,for the performance of the work for which this permit is issued.
My Workers TCom^pensation mmranm carrier and policy num ram:
Cannier. lei ' Policy No.:� � 5
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Ibis merlon recd not uncompleted if tun permit Is ferane hundmddollan($14)
or len.
I certify that in the performance of the work for which this Permit is issued,I Mall not
employ any person In any restaurant as to become mbjecuo the Workers Compensation
Lawn of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Carl of Exemption.you should
become subject to Ne Workers Compensation provisions of Ne labor Code,you man
.J 0 forthwith comply with such provision or this Permit thou Is,domed revoked.
z CONSTRUCTION LENDING AGENCY
L~ IherebyaRimdo,ft.Is a mnmmeinn lending agency for than performance of
!Y 7 de wcos for which Nu permit ts issued(Sec.3097.Civ.C.)
ELattices Nunn ,
r7 Z Landers Addreo
U0 1 oudry No I have read this application W sum No the above Informadun is
Ig,Fcorreut.I agree m comply MN Lsome I city and county eminences and se law reading to
O W uxtding construction,and hereve-mentlmmd property("Ibiupeedon purpoca.nmthorin udws of Nu city reenter upon the
Lys, (We)agree in cave,indemnify and keep harmlcu the City of Cupertino against
y Ilebili0o,judgments,cams and expenses which may in any my amue again)Wd City
O 7 in consequence of Ne standing of this permit.
fi APPLICANT N ERSTANDS ND WILL C PLY WITH ALL NON-POINT Issued by:3 Date
ERE L ONS.
61 m t1< Re-roofs "�.
Si awtaof Ap c antratld Data
HAZARDO MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occulant store"handle himedous national
u deRned by the Cupemno Muni 0 Code,Chapter 9.17.and the Health and Safety
ode,Secdion 25532(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑yes u
Will the applicant or future building=upset um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mli br erduts air contsminut defined by the Bay Area Air Quality Management all new materials for inspection.
DimicO
❑Yes u
t hm mad the om hnammaterials requbemem un k,Ch pmt B.95of doC lifor-
nimHcalN&SafelyCodo.Sotiom25505.2S533md25334.Iundcmualthatifthe building
does rot eurm 0y haw a tenant that II h my res ponihillly m notify the mumot of tit
� cno kh nun tpriormi anceo Ccrtiecate'fOttypaangyo✓ Signature of Applicant Date
Owner or amhorimdegent IPM
�/ All roof coverings to be Class"B" or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
'PUPEkTINO
Building De artment
JOB ADDRESS: PERMrr# Ooa Z3
1 [ -<\� L4 1-1
OWNER'SNAME: e � PHONE # S.a S-- 335-0
GENERAL CONTRACTOR FAX # -86 - 9S ,6
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 ,25 5 S
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
lb los-
Owner/Contractor Signature Date
CITY OF CUPERTINO
FURNACE/AC
41UPEf�TINO PERMIT APPLICATION FORM
APN #�� b 26
�S— Date: n O.S�
Building Address: U
Owner's Name Phone #:
le 0- S 68-0155`3350
Contractor Phone: License #:
pr { sok- �61_6)WS a315 �
Contact: ���1 Phone: Cupertino Business License#:
Building Permit Info: /
Bldg11 Elect Plumb Q• Mech 9
Job Description:
Residential ,7 C mmercial ❑
2: �Qce tirnczce Q
/c-
For Residential Inst lations:
Attic ❑ 1" floor 2nd floor❑ /
Adhere to min set back requirement p
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
st of roject: Type of Construction: Occupancy group:
q 46-a3
Strapped 0 On Platform El Bonded El Sq.Ft. Floor Area:
New Location Replacement ED
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
/ BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfrn 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
7gBPLANCHK
PERMITFEE PlumbingPermit Issue PLUMBING
PERMFEE BldgPermit Fees BUILDING
Plan Check Fee BUILDING
BUSLIC Business License BUILDING .