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05050065 (2) CITY OF CUPERTINO ' t �-'aal . •�'� ' ''" "�" BUILDING DIVISION PERMIT CO�t��ACTOR INFURMATIOI ; tial tie,: 5:,�'a',.. .,..� _s?^'�4+'ved'p•%- g;_. ,c.'�.;in t BUILDING ADDRESS: PERMIT N0. 05050065 OnRn PRIVINS111A D1 111) W NER'S NAME: PERMIT ISSUE DATE ONE: SANITARY q9kOL NO. AR CHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH l� 0 BO a LICENSED CONTRACTOR'S DECLARATION lY 1 Mreby affirm Nat I am licensed under previa me,of Chapter 9(ammcmieg Job Description z1 with Section 7000)of DiWaker Jaffe Bminwand Professor.Cade.and my liccnm4 in rail ranee and erceeL REPLACE FURNACE & ADD A/ T�'J,�Njpl�#® LIC Section Clans Contractor "�V�`IIgT��LLCC ' tit W< ARCHfIECI'S DECLARATION V U 1 ummu and my plana shall he teed as public ra ah, / ori� Licensed Pm2005 fcssional �i OWNER-BUILDER DECLARATION L F I herebyo.afflam(Scc Net 1 1. aempt from the Citions rs License Law for the i O o following mason.(Scotian 7(171.5,Buimu and Pwfdaluu Cade:Any oily or county $f<i which requires a permit to ceowucL alar.Impmw,demolish,lir repair any structure rif III Miss. _�S^ pdarmits ivuence,Blau requima me applicantfonech permilw 011 aligned atammcnt Nethcullanscdpurseentmtiaprovisionsn(1MConhrtswr'sLIecnselaw(Chapmr9 Sq,Ft. Floor Area (commencing with Section 7000)of Division 3 of the Business and Reactions Cosmic, that he is exempt therefrom and the basis for Ne alleged exemption.My violation of Section 70]3 by arty applicant for a permit subjects the applicant In a civil penalty of 3 2WV jft*gr0 0 Occupancy Type not more than five hundred Mariana($500). ❑1,as owner of the properly,ar my cmpla mos with wages u debaak compewtion. will do the work ad thesuucture tsnotineen4d neoffmad for We(Sec.7044.Buumes Required Inspections and Professions Code:The Conucm's Licensere law dahet apply w an owner of 9 P property who builds lir Improves Mariann,and who dareauchwork himselforthrough his awn employees,provided that such improvements are not amended moRcmd forsale.If. however,the building or Improvement Is mid within one you of Completion,the Owner. builder will haw the burden of proving that he did ret build or improve for purpose of sats.). ❑1,as Owner of to property am acluaively contracting with licensed cantraseem m - construct the project(See.7044,Business and Profession Code:)The Cm uwtoes U- ants Law does not apply to an owner of property who builds at improves themon,and who contracts for such projects with a comruter(O licensed puuuant in me Coruscate' License Lou'. ❑I am exempt under See. .B&P C for this reason _ Civmr Dau Ah WORKERS COMPENSATION DECLARATION I hereby affew under penalty or perjury am of me following declarations: 1 have and will maintain a Certificate of Consent rotslbinsum far WarkersCompen- ptian,as provided for by Section 37M of the labor Gude,fm Me Performance of Me such for which this permit is issued. ❑1 have and will mainmin W Wke's Compensation Insurance,as required by Section 5700 of Ne Labor Cade,for Me performance of the work for which this permit u Issued. My Warkera Cam ennuon l auras aerie" P_oliry number am: Carder. CERTIFICA •OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need notbeeampaimi If tic permit Is foram hundred:1.11.(5100) or leu.) I Certify that in the performance of Me work for which this permit is issued,I shall not employ any Forms in any manner m as to became subject to the Workms'COmpensaGOO Laws of Ci Applicant NOTICE iO APPLICANT:If,after making this Cmifhcate of Exemption,you should became subject to the Worker's Compensation provision,of the labor Code,you mut .,O forthwithcom with ply with such provisions or this permit shall be domed lowland. 'Z� CONSTRUCTION LENDING AGENCY I--h 1 hereby affirm that tam is a anmuction lending agency for me perform race of CG> me work far which this permit I.issued(Sec.2097.Cih,C.) WM Lenders Name D z Landers Address U G 1 amity that 1 have mad this mplicadon turd sum mat the show information H Iy" cones.I agree to comply with all city and county ordinances and sum laws relating to 0 building construction,and hembyaumadm apreanuuves ofthis city w a nus upon the Lf7 show-mendoned property for IMPectian puryatsa py (We)agree to save,indemnify and tap homeless the City or Cupertino against `V)) Ilebilifies,judgmmnts,coast and expenses which may in my way acne against said City in APPLICANT A OUN Uof Me NDERSTANDS thisof permit. WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURC EC TIONS. 12 Re-roofs Signature,ffl-ApplicasoXantiggetcar Dau HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant at future building occupantuom or handle huardous nu u ill as dented by the Cupertino Munieip 1 Cade,Chapter 9.13,and the Health and Safety Code.Section 25522(07 All roofs shall be inspected prior to any roofing material being installed. ❑Yea u Will the applicant or future building occupant use equipment or M aica which If a roof is installed without first obtaining an inspection,I agree to remove It Incestuous air eontsminmts as sed by the Bay Ansa Air Quality Management all new materials for inspection. DiurictT ❑Yes u I have mad the huaNeus materials requirements tank,Chapter 6.95 or the Celifom rats liealm@ Safety Card,Sccuom 25505,25522 and 25524.1 underauos than Irma building does Out currently hove a meant,and It is my responsibility Or not is,dm occupant of the reyucihmunMmmprior wiasuanccoflCeruncamafOcupancy Signature of Applicant Dale 1 I� EjS't2DY All roof coverings to be Class"B"or better Owner or malmr and ftlifn Dam Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 coo Fax(408)777-3333 �UPE(�TINO Building Department JOBADDRESS: (06804--WNSk - VE PERMIT# c u 9 rra7i N z A goo dS6S Qa6f OWNER'S NAME: L P S4, PHONE # g- GENERAL CONTRACTOR FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followinginformation 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 - p Owner/ ontractor Signature Date CITY OF CUPERTINO 5� ISE FURNACE/AC oS CUPElkTINO PERMIT APPLICATION FORM APN # 3 2 6 bZ Building Address: /oo8D PErvWSUCA -AVE , CUPEPI1Nib , CA ) 9 ,'p/4 Owner's Name: Phone #: T IRUt4P AT La LI H-NAN Q9, L5'S 1 03 06 Contractor: CTI U y P E`{ I�U L. D S License #: 9 ?> b 33 Contact: 408 , O8 /11 -1 -1 Zf 3 8 Cupertino Business License #: Building Permit Info: d Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: k,46&— Mnac-Q , inS Q q Ac j CAUCV vkwv, Residential [g-�' Commercial ❑ For Residential Insta ations: Attic ❑ 1" 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: �� Zs� Type of Construction: Occupancy group: Strapped LJ On Platform Bonded LJ Sq.Ft. Floor Area: q OD New Location ❑ Replacement 1 Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energ BUILDING BREMFURN Relocation of 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