03030083 (2) CITY OF CUPERTINO »* ',: -
t `BUILDING DIVISION PERMITGUNTRA.C'T®R INUMA' I�ON` -
BUILDING ADDRESS: A PERFECT CLIMATE PERMIT NO.
'S NAME: 10570 S DEANZA' BLVD. PERMrtISSB A ..
DICK & 'KAY
NE. , + 408) .861-9545 .. SANITARY CONTROL NO.
ARCHITEC IENOINEER: - - BUILDING PERMIT INFO
BLDOELECT PLUMB MECH
0 0 0
go Z, LICENSED CONIRACIOWSDECLARATION JobDescriptl( g- ����®
4 I batch,art,.that 1 arra licensed under paNalou of Chapter,9(commencing ,
wiNSectlon70(IU)of DiW.i.. .are Oudnat and Prore.alona Code,and myiicen¢h
In run o Z roarad fire LieY� REPLACE FURNACE-ADDA/CLieo Q -
MAR 2 4.2003
A TEC
GLA ION
l udcrun plc sed spublwand,
Lknaestlontl
BUILDING
3 Oat I am exempt f DECLARATION
gy 1 hereby.(firm Net 11. .Bumps from Ibo Canlns Ca :Anse law for the
i O O whawing remora.(Saito 7031.5.Business end Pro(cuiau t.or Any city or county
3$ whichrequires•Permit to reciresdwaltar.Wfmw,deermitt nrrepairanyttramm
prier Wslianted palorcqulthe tWvpplieant for tach permitrefileuUw(chemenl
¢ < mathe mecttnwit pSecuem rets))of Division
of Ne Comnnessan cenmseimC Code)or Sq.Ft.Floor Area $0Y2F91�tion
i 8 (commenting pttSection70 and
the
basis n3Mthe
eged Business antlon.Any
Bd onof
}� diel he It tempt therefrom and dm huh for the alleged exemption.Any vinlNon of '
Section 7031.5 by any applicant for a permluubjects Oe applicant o a civil penalty of 3 AFN AIO®I'{ET 0 0 Occupancy Type
.at moa than five hundred doll.(M).
. ❑I.uawneroflheproperty.ormyemployces with wages u their ole compensation,
will do the work.And the structure is not intended or offered for age(Sec.706/.Bualrca, _aa304
]jyT.FIS .
and Protrusions Code:The Contractor's Liana law does oat apply a an owner of 3 O 4 — ROUGH E ECTR CAL
propeanywho Wilds or improws lherton.andwho duch work himselforNmughbla '
own employees.provided that uch Improvements sae not interred aro@red forsake.It. SOS FINAL ELECTRICAL
however,Ne Wpro
building w imvement Is old within one)w of completion,we owner-
builder .will haw Ibe burden of paring thel he did not Wild or improve for purpose of 508 - FINAL MECHANI CAL
sale.),
❑1.as owner of the property am exclusively contracting with licensed c motion to -
construct the project(Sec.7064.Bwlneu and Profusions Cotler)The Contncter'A U.
ams law docs out apply to an owner of property,who Wild.or improves thereon,and -
who cortfor such project,with aconlnctoK.)Im ued pursuant in the Contractor's
License,Law. -
AmexemptunderSec. Bk P C for Nle rtuon
- r Dam -
WORKERSCOMPENSATIONDECLARATION -
I hereby aRren under faulty of perjury as of the following decluallow.
I hew and will malntsin a Certificate of Concent ro self-muter,for Worker.Compen- .
sedon.As provided for by Section 3700 of the Labor Code,for me performance of the
work for which this permit is issued. -
❑1 haw and will maintain Worker's Compensation Insurance,as required by Section
3700 of the labor Cow,for the performance of the work forwhich dds permit is Issued. ..
My Worker's Campenalion insurance center and Policy number ate:
Cant r. ��t}�/'/1No -
19
CERTIFICATE OF ER PDON PR M OR ERS'
COMPENSc TION INSURANCE
(171d,=it.rad not beamplewd if lk permlt lsfursm hundred dolliasnI lfl)
or len.)
<ly _ - _employ
maler I.the inany manneof As workfor whkh Ni.permsrkire Comatoll not ,
Lawso alifoaon in any manner ou to become subject to Worl¢n'Compemedon
Laws of California.Dem
Applicant - t
NOTICE TO APPLICANT.If.after making this Certificate of Exemption.you mould _ -
Wanw mbjauo tha Worker'.Compensation provi.w.,of the laborCoda,you mon
.JO forthwith comply with such provisions or this permit shall W accrued revoked. -
,zr CONSTRUCTION LENDING AGENCY -
f+'N'� Iherthy Wrion Be.Isere lueorutacim.mmlint.geney for be performance of '
> the work for which Nu permit it Issued(See.3097,Civ,C.) `
0 Lender,Name
z Lenders Addreas .
J 0 1 anify Nal 1 haw read this pplication and.am that the above information Is .
V. F correct.l agree to comply with all city and county ordinance,and sate laws mlating in
0 V building convection,and hereby Audience representatives of this city to enter apart the .
W Nave-memiuned propcn for inspection purpose..
LL (Wa)egrte to lndemniry and keep honleu the City al Cuperfino against
(A Iab111tIu.Judgmen .ct6ls end pansea which any myeceac ageial utaCity
U z In consequcnao gnnti Isla permit.
APPLICANy DER ANO WILL COMPLY WITH ALL NON-P IN611ZT Issued by: Date
SO LATIO S,
Re-roofs
S' bmo IieanUARDm 0 '
HAZZARDOUS MATERIALS DISCLOSURE Type of Roof '
Will the Ciarttor future WildipalCgoaupaptalum m handle Health and Safety
Encd by Um CupeNno Municipal Code.Chapter 9.11,and the Health end Safety -
ptvm 1553x.)7 All roofs shall be inspected prior to any roofing material being installed.
Willi me appose r fuwm Wiring occupant vee equipment or Jcvkoa which
If a roof is installed without first obtaining an inspection,I agree to remove
It hea dkoo.ir cmu nin Bud cd by the Bey Arca Air Quality Management all new materials for inspection.
Iurict7 -
❑YCA
Ihavereadme&.S.-U metcnalartquirtmenuunder Chepmr6.95oftMWlWif g
rias at
& iuly,fbde.Sado met 1, sale and25S36.1 Mm amend Null Ne Wiring
doessre cunearly,
arly, uvea rjtam to mYrccoulbilltym naify arc aeu ret of tic
require
w'lhmu bo ICIpnorWlssuaneeorsCcrtiri Dcgl� x 'Signature of Applicant Date
)61AC
ow .w sods rat one All roof coverings to be Class"B"or better
CITY OF CUPERTINO
C L;P E Iql IN o PERMIT APPLICATION FORM 30jZY183
APN# Date:( �D�r ^ Date:
Building Ad c�r � I If �(/
er's Name: Phone
h� � #: asp- ya3a
Contrao Lice
I S
Conta t: 21JI Y N //pyo rt ines icense( Cupes #;
lqqBuilding Permit Info: ry�(U� aY
gq�
Bldg ❑ alect lumb
�Tpb Description:
�(� I
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1' floor ❑ 2"d floor❑
Adhere to min set back requirement❑
For Commercial Installations:
Replaceme t ❑ Additional weight(structural calcs) ❑
S 1 Calculations requ for new installation ❑
,New installation Planni A val Required
Cost ofroj Type of nstruction: Occupancy gro p:
Strapped LJ On Pl rm U Bonded LJ Sq.Ft. Floor Area:
Re lacemen
Qty. if
Appli . 1 Fee ID Fee Description Fee Group
BENERGY i/ Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 c&n MECHANICAL
tj BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch& Outlets ELECTRICAL
Ll 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