03040211 (2) CITY OF CUPERTINO _ .z n a• s` -'�' 1s''z,*= 2'✓� "
BUILDING DIVISION - PERMIT CONTRACTnR INFORMATiION.
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BUILDING ADDRESS: A & H HEATING PERMITN 003070211
TN003070211
OWNER'S NAME: 770 CHESTNUT ST PERMIT ISSUE DATE
BARRI
ONE: (408) 279-0722 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
±00 LICENSED CONTRACTOR'S DECLARATION
l u❑ 1 hereby eflrm that I am licensed under provisions of Chapin 9(commencing Job Description
Zj Use with See 05 )j ofDivision]of the Business and Professions Code,and my license is
mmne,r der t. REPLACE FURANCE & A/C
Dam Cuntnc lg (��
fF ARCTSDE u RATION SEP O 2 2003
aU I understand my plans shall he used public records /■q��
1 Licensed Pmfcunne
il
yocenB���WI�\M
3 .4 OWNER-GUILDER DECLARATION
Z<E 1 hereby eRrm that 1 am exempt from the Counselor's License Law for the
p O following mason.(Sccdun 711]1.5;Business and Professions Code:Any city or county
4$�i which requires a permit to construct,alter,improve,demolish,or repair any structure goon
prior to its issuance,also requlmnhe applicant for such permit.life a signed statement
gZ Ihe,heI,Iiccnsedpursuanttmr
otheprovisionsoftheCoacturiLicroseLaw(Chapter9 Sq. Ft. Floor Area Valuation
��0 (commencing with Section 7MXd of Division 3 of Lou B Ostrom And Professions Code)or
$ that he u exempt therefrom and the basis for the alleged exemption.Any violation of 36913032 . 00
'Section 7031.5 by arty applicantfar a Permit subjects the ane applicanno a civil penalty of APN Number - Occas Type
nm mom than fiw hundred delta.($500). '" Occupancy - -
❑I,as owner of the properly,or my employees with wages u their sole compcnsnion,
will do the work,and the structure IS not intended or offered for sale(see IDC.Business 3 U1. — RUUN
And P.fassm.Code:The Cmancmes License Law does not apply to an owner of. 3 O 3 — ROUGH HODS
property who builds or improves thereon,and who doessuch work hia l(ar through his Int
own employees,provided that such improvements are not intended at offered mrnle.lf, 304 — ROUGH ELECTRICAL
however,fee building or improvement is sold within one year of completion.the Owner.
builder will have the burden of proving that he did not Wild or Improve for purpose of 505 - FINAL ELECTRICAL
"le'' 507 - FINAL PLUMBING
0 1,as owner of the properly,am exclusively contracting with licensed contractors m 508 - FINAL MECHANICAL
construct the project(See.7040,Business and Professions Cods:)The Contractor'sLi-
cane,Taw docs not apply to an owner of progeny who Wilda or harrow themon,and '
who contracts for such projects with C contractor(s)licensed pursuant.the Conlnctors
License Law.
0 l am exempt under Sec. B S:P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hcmby af0rm under penalty of do,one of the following declantimu:
1 hoe and will maintain a Cennicue of Consent to sel r-insum fm WurkaraCompcn-
inion.As provided for by Section 3700 of the labor Code,far the performance of the
.,it for which mil permit is issued.
0 1 have and will maintain Worker's Comp nation Insurance,u mquimd by Section
3]00 of the labor Code,for Ne pcAormanec of dfnr which this pemrit iaissued.
My nrk,e�r-iACnmperrs�atfian lnsunnrocanierand tcy num her am:
f OF icy No.:N�Q'! )
CERT F1 ATE OF EMPDON FROM WORKERS'
COMPENSATION INSURANCE
(Thu action reed not W completed IOhe permit is form.hundred dollar(51110)
or less)
1 ccnify that in the performance,of the work(of which Nis permit is issued.I shall not _
employ any person in any manner an as to become subject a the Workeri CompewGon
Laws Df California.Dam
Arid team
NOTICE TO APPLICANT:If,at making this CeniEcate of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Cask,you must
0 ,z forthwith comply with such provisions or this permit hall W deemed revoked.
zCONSTRUCTION LENDING AGENCY
1 Wmhy offirm that Nero its construction lending age.,fm ft performance of
x dm work for which this permit issued(Sec.3097,Civ,C.)
QLendcra Name
33. Lenders Add.
L)OF I cenify that I have read this application and sate that the above information is
Ecorrect.I agree to comply wit all city and county ordinances and slam laws relating to
building construction,and hereby authorize reprasenmtiwl of this city to enter upon the
C above-mentioned property for inspection purposes
(We)agree to saw,indemnify and keep harmless the City of Cupertino against
liabilities judgments,costs and expenses which may in any way accrue against said City
or the Standing of
J z in conshis Permit.
equence
UNDERSTANDSIAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
U E REGULATIONS.
-zp
Re
-roofs
ignaum of ntm
Applicaoncor Date -
HAZARDOUSMATERIALSDISCLOSURE Type of Roof
Will the applicant or future building Occupant sure or handle haxa dour material
as defined by the Cupeni no Municipal Code,Chapter 9.12,and the Health and Safety
.Lkodc, 4W.
sen as zssu(.r. ...✓ All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building Occupant use,equipment ordcvi=which If a roof is installed without first obtaining an inspection,I agree to remove
II hvaunus air contaminants u ticfncd by the Bay Area Air Quality Management all new materials for inspection. _
inrin7
O Yes QNu
1 have mad the hanadous materials requirements under Chapter 6.95 of the Califor.
nits Health k Safety Code,Seniors 25505,25533 and 25530.1 understand Not if the Wilding '
does net cunantly hew a mnam, nl it is my responsibility la notify Ne occupant of the
a antswWchmnslMm p r Issuance,oft e 'ma.akw�aan Signature of Applicant Date
Owner ofa.horiacd egeal / ,-0 All roof coverings to be Class "B" or better
-
= r ';y CITY OF CUPERTINO
o 3 L5 �
FURNACE /AC
j
CUPEkTiNo PERMIT APPLICATION FORM
;*0 APN # 2j
Building Address: '
2500 NC v'149 AVE,
Owner's Name: r Phone#:
- ( $73 -0609
it` Contractor: 4 License #: '
30VV9,
t'r Contact: Phone #:
T �?7? o7xL
IN
". +i 'Applicant/Contractor:
Building Permit Info:
Bldg El Plumb ech
Job Description:
tf, Residential: Commercial:
S I t. Floor Area:
q• $/Scy.Ft.:
.KY
Architect/Engineer: Valuation: / C�
zS Type of Construction P, !Z l a_) C-e=_ _ Occupancy Groul .
ZZD V6 r d(rZort t 7-
r\
Qty. if
A li Fee ID Fee Descri tion Fee Grou
BENERGY Energy BUQ.IDNG
' 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 BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
.r�
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permiffees BUILIDNG
- BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUL IDNG
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