04020035 (2) \ 5 CITY OF CUPERTINO a s -
BUILDING DIVISION PERMIT CONTRACTQRUNk��URMATIO
BUILDING ADDRESS: A PERFECT CLIMATE PERMIT ND.04020035
L0620 STQKF,.q AV
OWNER'S NAME: FERMfr ISSUEDATE
KOMMA
ONE:
SANITARYNO. CONTROL NO.
(408 861-9545
BUILDING
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3oio LICENSED CONTRACTOR'S DECLARATION JbDescriP hon
ly 1 hemby affirm Nal 1 am Renewed o
under Provisions of Chapter 9(commencing
n�1 with Salon 7")af DhWan Sof We Business and Norman..Coda,cd my liccnc is
W con fWcx..deffmk REPLACE FURNACE (FORCED Af;U%^,WF Y. )
z Licenc Clue Lk.0
Dem
ARCHITECTS DECLARATION FEB 2 5 zN4
1 undersand my plana shall he used as Public nemodt
DN!
3LLs.0Licensed Pmfasamnal
OWNER-BUILDER m CLARATION BUILDING
<I I hereby haso .(Sero on 11. exempt from dee Contractor's License Law for the
En 0 whfollich
roues a Perrot i 703 construct,
Business ReRssi..h.or Any city or county
a$ which requires a Permit re cores e,alter.Improve,demolish,fie A sig any structure
�y prior W its issuance.pursuant u In the thovisio s o far such permit W filcense new(Chapter
< omornelicancd Section 7000).the mviand.o.fWeBf We uaetor..d Ptarmus Chace)m Sq.Ft. Floor Area Valuation
meths swompdmhmfrom nd WasDivides 3 BathecZcd exemption.
Myo.Cnde)or
Jul he u eaempl Wertfrcm and We Eesti for dve allegnd ecmption.My violation of
Section 7031.5 by any appllesnt fora permit subjects We applicant W a civil penalty of 3 MN9Offi9er 0 0 Occupancy y e
om mom man five hundred dollar($500). P y pr`!P
❑1,u owner of ds,Property,or my employees with wages as Weir sole compensation,
will do the work and Waswaum u nos intended oroRared fonak(Sm.7064,Business
and Preload...Code:The Comediennes Licenc Law does not apply W an owner of Required Inspections
property who bunldaorierproves lhercrn,and who dossoch weak himself.,Waugh his
own employees,proshim Wel such improvements are not intended croQered for We.If,
homwe We building or impmvement is sold within arc year of completion,We ower.
builder will love We burden of Proving that he did not build or Improve for purlsos,of
;cwte
e.).
1,u owner of We property,am.elusively contracting with licensed contr tcWrs W
struct We project(Sec.7U4q Business and Prefixal..Code:)The Canlnames U.
law docs not apply W an owner of property who builds or improves thereon.ando aonuacla for such M),cu with a conlractor(s)licensed pursuant to the Conuactor's'ense law.lam exempsundersce. .B&PC Ire WO n r D
WORKER'S COMPENSATION D U ON
1 hereby alarm under penury of perjury Ina of the following declaretia.:
1 have and will maintain a Certificate of Consent to cif-insure for Weaker'.Compenm
sation,as provided fm by Sm40n 37M of We labor Code,for We performance of We
work far which this permit is issued.
❑1 have and will maintain Worker's Compensation Inwranm,as required by Section
3700 of the Labor Cade.for We pcRmmance of We work forwhich this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Caner. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ThD section need no,ba completed If the Permit is for one hundred dollars(I IM)
or less.)
I certify that in the performance of the work for which tills permit is issued.I shall out
employ any parson in any manners.as W become subject 10 We Workers'Compenudon
laws of California.Data
Applia m,
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
became aubjm W I.Worker'.Compensation provisions of We IaMr Codi you most
.J O forthwithcomply with such Provisio.or this permit Nall be deemed revosm.
'Z'-" CONSTRUCTION LENDING AGENCY
fr ate+ I hereby affom mal Were is a convection lending agency for We performance of "
�i rte•. We work for which this permit is iced(Sec.3097,Civ.C.)
W� 0 Undoes Name
a Z LenderaAddreas
U Q I ceNfy that I have read this application and state tat We above infomudun it
D. P correct I agam to comply with all city and county ordinances and suite laws relating to
OU building convection,and hereby autharine MPMCnudvcs of this City W enter upon We
W aWw-mentioned prolerty,for inspection puTaaY
(we)agree W save,indemnify and keep harries;We City of Cupertino against
N3 Ilabilides,judgmenls,costs and espensea which may in anyway seems agalnstssid City /
C) In mosegocaa of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO RCE R ULATIONS. CL
Re-roofs
.sura of Appliewo/Cmdracmr ate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will We applicant or future building occupant store or handle hazardous material
u defined by We Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
oda.5adon 155J1(a)? All roofs shall be inspected prior to any roofing material being installed.
C]Y. "A No
Wtll We applicant s Bud.
building occupant tic equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
II hazardous air conturnmanu u contact by the Bay Area Air Quality Management all new materials for inspection.
District?
Dyes 1No
1 have mad the harardo/TTus maurtalsrcquirements underCNplerb.95 of We Califon
ni.Hutlh&SafctyCoos .25505.25533.d25534.IundarsW ifdc building
Jou rat currently haw•tenant War ilia my mspo.iEility te coufy the oceupanl of the
m viremcn hien musndmet prior Wissu ofa CatiOca f u Dales Signature of Applicant Date
Owner or auWormcdagcn o All roof coverings to be Class"B"or better
e� CITY OF CUPERTINO c� o a , 3S�
FURNACE/AC I
UPERTINO PERMIT APPLICATION FORM
APN # ? Z Date:
s1 PZ—OH -oy
Building Address: P ZO 9 r�Es � 576
l O CuCuPC��,v� 1 y
Owner's Name: H A L L I KAKI/V A P, Kph ( IA Phone #:
q09 3�6 2
Contractor: Phone: - License#:
P Fcc7 cUr7A7F t40_0 &61 R5q �2 3 ► t)Contact: 1097o 5. "9FAAf2.A 9 L/4 Phone: Cupertino Business License#:
CVnC'�INO `ESDI lltt� ►
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description: /Vfl LC
u+-tc rt" FaKce� Fu _rPot-JA/ r LOL-a 9-0
Residential rKi I Commercial ❑
For Residential Io tallations:
Attic ❑ l" floor 2"d floor❑
Adhere to min set back requirement❑
or Commercial Installations:
eplacement same we Additional weight (structural calcs) ❑
Structural Calcul 'ons required ford w installation ❑
New installatio PlanningApproval jequired ❑ r—
Cost of Proje t: p 23^75 do ype of Construction Occupa y gr
Strapped ❑ atform ❑ Bonded ❑ Sq.Ft. Floor Area: gy0
New Location ❑ Replacement
Qty. i
A 1' a 14 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
BSEISMICOM Seismic Commercial BUILIDNG
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