Loading...
03080063 (2) CITY OR CUPEI2'1'INO - ` BUILDING DIVISION PERMIT 4'CONTRACTON0RiINFORMATI �. _ON.� t OUILDINGADORES: PERMITN PERFECT CLIMATE 00308OO63 464 RQLLTNGnE,1.1, DR OWNER'S NAME: 10570 S DEANZA BLVD PERMITMUEDATE YU BEN AND LINDA B oN1:. (408) 861-9545 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ioo LICENSED CONTRACTOR'S DECLARATION mF 1 hereby affirm.bat 1 am lift and under provisions of Chapter 9 tommcneing - Job Description ?Zr3 with Section 7NM)uI Division 3 of NC Busiwas.ad Professions Code,and my license is +« Lilullmhf.meontl IgBb REPLACE FURNACE & ADD A/C License Ca Vl../ Lic.N �Fp Date TSDECr �1�Q�B E® e wwwn M HITELTS DECLARATION IION 111 b t E< I understand my plans shall M used as public records at `;tat Lia°nmdprofaai°ata AUG 2 12003 OWNER-BUILDER DECLARATION < I hereby affirm that 1 am exempt from thc Contractor's License Low for the 00 falbovin,moron.(Section 7131.5,Business and Professions Code:Any city or county `{2 which requires a permit to construct,since,improve,demolish,or repair any structure poor to its issuance.also M,Rnmi the applicant for such permit to file a signed statement ¢ < Ihal he is licensed pursuant to the,previsions of the Comms:lur's License Law(Chapter 9 Sq. t. DOr res ra Valuation d�th (commencing with Section 7000)of Diviaimn 3 of the Business and Professions Code)or Nat he is erompt therefrom and the buts for If.alleged exemption.Any violation of 35931062 . 00 Swilon 7031.5 by any applicant for 5 permit subjects the applicant or a civil penalty of APN Number Occupancy Type not mom than five hundred unite..(5500). U I,as owner of the progeny,or my employees with wags a their role compensation. will do she work,and the smenum is not intended of offered fanal.(See.7044,Business — as [J and Professions Code:The Commoner Littrva Law docs not apply to an swan.of 3 03 — ROUGH Llo property who builds or improves thereon,and whodoes such work himself.,through his own empmyea provided that such impmvemenu are not intended or offered formic,If, 304 — ROUGH ELECTRICAL however,he building or improvement is sold within am yead orcompielion,the owner- builder will have dra burden of proving Nat he did not build at improve for purpose of 501 -- FINAL ELECTRICAL ENERGY sale')' 502 - FINAL PLUMBING ENERGY 01,as owner of the pmpeny.am exclusively contacting wish licensed convenors to 503 - FINAL MECHANICAL ENERGY construct the project(Sec.7044,Bualfw.and Professions Code:)The Contractor.Li mase law does not apply to an owner of property who buildit or lmprovs daemon,and, 505 — FINAL ELECTRICAL who contracts for such projects with a contractor(s)licensed pursuant to the Cofactor's L1canm L.w. 507 - FINAL PLUMBING ❑ 1.ammplunderSee. .B&PC forOurfoods 508 - FINAL MECHANICAL Owner Dale WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of Nrjuty one of the following declarations: I hew end will maintain a Certificateof Consenuo coif-usum(m Worker.Compen- sation,m provided for by Section 37M of the Labor Code,for Ne performance of the work for which this permit is issued. ban and will maintain Worker's Compensation Insurance,az required by Section 37 of the Labor Code.for the performance of Ne work for which this permit is issued. ' My Worker'' C�mtcosation lnsu nee artier end Policy If0. Croom Policy No.: CERTIFICATEOFEK ON FROM COMPENSATONINSURANCE (Thismnim wed not be eomuctcd if the permit is formic hundred dollen(SIa) or less.) 1 certify that in the performance of the work for which this permit is issued,I shall not employ any pcount in any manner an as to become Subject o the WONMM Campeasadan - Law.of California.Date Applicant NOTICE TO APPLICANT:If,after making ON Ccniftcam of Escmption,you thoulu become subject to the Worker's Compensation provisions Of the labor Code,you must wJZ forth with comply with such provisions or this permit shall as deemed revoked. ZO CONSTRUCD ON LEN DING AGENCY E" I hereby affirm that there Is a comtructionlending agency for the performnmec of a > the work for which this permit is issued(Sec.709.Civ.C.) LLl Q Lenders Name D z Lender's Addam U C I certify tha1l have rood this applienion and tote that Nc above information is Ly F cones.l mctl pro ms )ogre m veharmless agree ply with all city and county ordinances and sate laws slating m O U building con cion, ed hereby authoriserepremmatives OfNie city tocnter upon the ho r [S7 avemcn ty for inspection purpoVY ( r indemnity and keep she City of Cupertino against ti raj, liabilities Judgment oskaandexpenses which may in any way accrue agaimisaid City U Z APPLIC nccU(1 ERS ung Lhis Permit. AND WILL COMPLY WITH ALL NON P INT Issued by: Date 3 i SO E ' ATIONS. L Re-roofs gnat., fApp can tractor Da HA2A OUS M OX ISCLOSURE l Type of Roof Will shca plicamne t Occu ammo.and to HeaNummamtlal az acfinctl by tine nine ipel,� apmr 9.13,and the Health amu Safety sue.seeien Ys zs5 07 u All roofs shall be inspected prior to any roofing material being installed. Will the applicant ter vecc r ing occupant use use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove it hamolous air cora ml not cf cd by the Bay Area Air Quality Management all new materials for inspection. District ❑Ys I have sad Me a steamismenu under Chapter&95.f the Calif.,. iia Health&Safclyc mat ,255 an 2534.1 onderaand Nat if the building does not cumemly have e n is my s ility 1e,fully t u and of LIF requirements which mu 1 'o wise of Cenlfmamo m ce. Signature of Applicant Date owner or sum atl en on, All roof coverings to be Class "B" or better G CITY OF CUPERTINO PERMIT APPLICATION FORM APN# ' Cl ' 7 Date: Buildin dress:/ J 190) 1 �l Owner' ame: Phone #: 10-�31s Contrac or: racf I Licensa airl Contact: Cupertino Business License #: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech Job Description: ecgtc 9 - e v-\ \A Residential Commercial ❑ For Residentild Installations: Attic ❑ 1" floor ❑ 2"d 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: Type of C nstruction: Occu aicy group: 1 Strapped U On Platform LJ Bonded Sq.Ft. Floor Area: New Location ❑ Re laceme Qty. if Applicable 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 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 aa7��