05050032 (2) CITY OF CUPERTINO %4 '�'2%
BUILDING DIVISION PERMIT CONT•RACT,OIi TNFORIVIATIQN
.AUILDING ADDRESS: PERMIT N0.
AAA FURNACE & AIR CONDITIONING 05050032
021 :7 RORNTO BLVD
OW NEWS NAME: PERMIT ISSUE DATE
7kTATAjAxj 17i2 STONE AVE
NE; SANITARY OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O l�
uo0 LICENSEDCONTRAC'IDR'SDECLARATION Job Description
F I MrtbY affirm dol 1 am licamed under pmvldou of Chapter 9(Commencing
n= with Sectian]gl(17a(Oivinon 3af Nc Budnesa and Profeulou Cade.aM mYlteensts
n full(ora an I y,,,,,,,,,,,,,�T�_
,qz LI me les Lie.g REMOVE WALL HEATERS'/afr`yWly']�tvay►OJ/r~y`9 L SYSTMES
t;, Dau Comramor
ARCHf1EC1'S DEC ON
I undewnJ my phis Nall be used u pamblk records
!:Q ic Licensed Pmfeulonal _ 2005
3 OWNER-BUILDER DECLARATION /a[
gm 1 hereby Wines that 1 am exempt from the Contractm's License Law for the
r.O o following reason.(Section WA 1.5,Business and Professions Code:Any city at county
$ which requires a permit to eomwa,alter,Improve,demolish,lir repair any nructum
_Zj, prior w its issuance.also acquires the applicant for such permit to file asigned statement
< that he,la licamed pursuant to Ne provisions of tce
he Contractor's LJnsa Law(Chapter 9 Sq.Ft.Floor Area lues On
X
S (commencing with Section 70W)of Division 3 of the Business and Pmfeasiam Code)or
'!L dot he is exempt therefrom and Ne thesis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit objects Ne.ppliant to a civil penalty of
not moa dans five hundred dollen(M 3 0 Occupancy Type
I,uawner oftim prmpeny,ormy wploycn with wgesu theh dile cornpeesWon,
will do the work and themmsium ts not Intended oroRered for We(Sec.7044,Business
and Professions Code:The Contreco's Liceue law dote not apply to an owner of Required Inspections
propmy who builds or res pmtes thereon,and who does suc h work himself or through his
own employee,provided that such improvements art not Intended aro@rml frosts.It,
however,the building or Improvement is sold within oro year of eompletion,me awner-
builder .will have the burden of proving that M did not Wild or improve for puriom of
sale,).
O 1. a owner of the property,w excluively contracting with licensed contractors to
construct the project(Sec.7044.Burineas and Pmfesdam Cade:)The Commuter Li.
casae Law does not apply m an owner of property who Wilda or impmw memon.and
who contracts for such projects with aconmctor(U Restated punu.nt to the Coneravors
License Law.
❑lameamptunderSee. ,BkPCfortiJswmm, _
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby eam under penalty of perjury one of the following declantiou:
1 have and will maintain•Ceniflam of Continuo self-inure for Worker Comfort.
1�710'0
lon,u provided for by Section 3700 of the labor Code.for the performance of the
k for which this Permit is issued.
have and will maintain Worker's Compensation Insurance,u requintl by Section
of me Labor Cade,fu the Performance of the work for which this permit is Issued.
Workces Compensation n once carrier and Policy n�urmber nmrtier. Compensation
J4a✓S ,4�
C RTIFl TE R CEMPTION FROM WORKERS'
COMPENSATION INSURANCE
finds inion need rotbeeampkuJ title Permit is foranehundmE dollars(SIM)
Or less)
1 artily mat In me performance of seas work for which this Permit is issued.I shall not
employ any person In try manner an as on become Sub)at to tite Workers'Compert ation
Laws of Calimr Data
Applicut � <
NOTICE TO APPLICANT:If.d making thts Cenificau of Exemption.you should
become subject to the Workeri Compensation prevision.of the labor Coda you must
,J O forthwith comply with such provisions or this pound shall be deemed rewhed.
z► CONSTRUCTION LENDING AGENCY
[ti IbembyaRirm met there u a comtruelion lendingagenoY for than perfermanauf
cite work for which this permit is issued(Sac.3097.Civ,C.)
GQ Lender's Name
z Lendoes Addmm
U Q 1 artily that I have rad this application and mate that the salve information ts
D. F correcL 1 agree m comply with JI city and County ordinances and sum Is"missing m
OU building construction,ted herebyaWmrim upresaMsatima afmis City On error upon the
W aWve-menti...d Property for Inspection purposes.
(Wes)agree to tea,indemnify and keep hatmless Lk City of Cupertino agaiat
l;n Ilabllitiu,judgmcros,costs and expenses which may in any my.cmegtlmt saidCity
U 7 in conreguence of the swung of this permit.
A APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO CERE ULAT/nIONS. �s, ]�r
Sig sun of Appli 1/I/ill .. Q/-1/seldt • •¢� Re-roofs
Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding=owl nom orhandle hazardous maurial
Ibigrict?
defined by tin:Cupertino Municipal Code.Chapter 9,13,and the Health and Safety
ane.Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
QYes o
Will the applicant ver tum Wilding acemmpam tax equipment u devices which If a roof is installed without first obtaining an inspection,I agree to remove
mh haesmous air ronun rutnts as defined by the Bay Ama Air Guilty Management all new materials for inspection.
❑Ye.Ihave mad the haesNn matenab mquimmcnu unJcrChaPter6.93 ofJte GlifonaHealth@SafetyCade,Secdom2551)5,75533w M534.1unJnwdthatiftite Wilding
a.not currently have a want,mu It 4 my uaponsibility u modify tits oxupent lir tiesqu�l ^ciuswhichmunbematprioroisauanaar,Ccrtllkauor0acupency. Signature of Applicant Date
/. ��`" zPaf aff- All roof coverings to be Class"B"or better
Owner or mahariredagcm Dau
Community Development
10300 Torre Avenue
j i Cupertino CA 95014
Telephone(408)777-3228
C OF Fax(408)777-3333
`UPEI�TINO
wwJJ
Building Department
JOB ADDRESS: PERMIT # a--o Sr0d3
jo
OWNER'S NAME: So o iv q4.) PHONE # 7W 1-1 6
GENERAL CONTRACTOR FAX #
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
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
*UPEI,TINO PERMIT APPLICATION FORM
APN# 3,5Date:
� 0 2 � ��
Building Address:
Owner's Name: Phone #:
Contractor: Phone: License#:
4,4
Contact: Phone: Cupertino Business License#:
,r yo - a s -
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech Ar
Job Description:
/ a 1'l
Residential M Commercial ❑
For Residential Installations:
Attic ❑ I" floor ❑ 2"d floor❑
dhere to min set back requirement❑
or Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation Fl
New installation Planning Approval Required ❑
Cost of Project: Type of Construction: Occupancy group:
moo
Strapped On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 clin MECHANICAL
BREMARMAN A/C Units<= 10, 000 cfin MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMTTFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMTTFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING