03060076 (2) CITY OFCUPERTINO � s7�y Kzzbc�axE*' _
BUILDING DIVISION PERMIT CUNTRX`CTOR_INFURMA (,
-
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BUILDING ADDRESS: ALTON AIR CONDITIONING & H MITNo.03060076
i
• OWNER'S NAME: 45300 INDUSTRIAL DR *4 PAWN 19,7`10/2003
RN XTIVI
NE' (510) 490-5655 SANITARY NO. CONTROL NO,
ARCHITELTIENGINEER: BUILDING PERMIT INFO
BLDGOO PLUMB MOECH
Sop LICENSED CONTRACTOR'S DECLARATION IobDescri tion
1 wmby affirm Net 1 am limmd under pmWwons of chapter 9(rommencing p
with section 7QpV09)01Division 3ofthe Busin PrelculonsCor my license is
n in full fume anYcff e
Liar clulq_ yEue. S INSTALL A/C
Dams'--ay`y—>-- extractor
�� ARCHI'IECTSD RATIO
I undenund7n7(plensslmll w used u public me
k Licensed Professional
R5� OWNER—BUILDER m Ce Conte ON
Si 1 wmhy Ammo. 1 m exempt from the Conmactoh e:my c Law for the
p O
which
moon.(Section 7(Dser Business and ac,duona Code:Any m or count'
9� which,autres a permit o consumt.alms wprow,demallm.or rtpWr any.uuctum -
print in its issuance.elm requires the applicant for uch permit to 11"signed statement
�< mat he is licensed pursuant to the proviamnsnf me Conummr'i Uccom I..(Chapter 9 Sq.Ft.Floor Area �` I��100
p (commencing with Suellen 7000)of Division 3 of me Business and Profession.Code)or
$ met Its is exempt therefrom and the beat.for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit objects tied applicant be A civil penalty of 3 AM N)bffi&r 0 0 Occupancy Type
not mon than Rw bond"dmHe.(M).
❑I.na ofthepmpmy.wmyemployeuwimwgesuthevmlemmpawdm,
willdo the work and me muctme is ml Intended"offered fonale(Sec.7041•Business
And Potassium Code:The Convector's Lienee Law dors not apply m an owner of 304 - ROUGH ns
property who builds or im prow discover,and who doessuch an himself or through his
menet employes•provided mat much imprownenu are not intended certificated mraale.If. 505 — FINAL ELECTRICAL
wwew,the Wilding or Improvement is sold within ones year of ampleuon,me L wwr-
wtlder will Aare tw when of proving that 1e did not build or impm"for purpose of 508 — F I NAL MECHANICAL
❑L As owner of ct property,am mess and
Prof contracting with )Tim C mm etmn i.
CenamselLa me es not (Sec.70n ancrof end Prowho Wiasionsld,
code:)Tim Comments'.LI- 1t
cense law rime net apply man owner of property who wilds or iAm he Oman,and ' f+
who antracls for such pmjeM with aeonumor(e)licensed pursuam to me Contractors IIITrrrr(((License Law,
❑ismemmpt under Sue. ..k P C fn m4 won
Oma Dam
WORKER'S COMPENSATION DECLARATION ..•.--� ••--
1 hereby Niro under penalty of perjury,ow of the following Limitations:
1 Nee end will maintain•CWfiate of Consent to self-Wore far Wouter,Comper-
s uan,As provided for by Section 37W of the Labor Code.for de pore mance of the
we
for which this permit u issued.
❑1 have and will maintain Workers Compensation Inmance,an required by Section
1700 of me labor Code.for the perfemmame of the mark forwhich this permit Is lamed.
My Wo es Compecation a v Policy numberam:
Carrier: cy blo.�• o7(i o 3
CERfIFlGTE OF E%Fjyl of FROM WORKERS'
COMPENSATION INSURANCE
(This section wed notwampletedifthe permit Isforomwndmddollare(SIM)
or leaq
1 certify met In the performance of one work for which this permit B issued.I"I nue
employ anyperson in my mom,an As in becomesubject to the Worimrs'Compenntion
Laws of California Dam
Applicant
NOTICE TO APPLICANT.If,Aller making Nis CcniOcam of Exemption.you should
become subject to me Worker's Compensation provisions of the Labor Code,you must
0z forthwith comply with such pmvisiam or mu permit Aull he domed ermined,
Z CONSTRUCTION LENDING AGENCY
I hereby affirm mat vert is a cmwrocdon lending Agency forme performance of
me work for which this permit h issued(Sue.3041,Cit,C.)
Y Q Lenders None
=z Lueders Address
:>O 1 modify mat 1 low read this pplication and.tsm this the above information is
Ll. correct.l agree be comply with all city and county ordinances and see laws reading to
•` wilding contraction,and thereby mthodm representatives of this city to enter upon the
gf7 .bow-mentioned progeny lw Inspection purposes.
(We)agree to saw,indemnity and keep harmless the City of Cupmino against
liabilities,judgmam,ensu and expenses which may in my way same AgaWt aid City
in s lanruil.
APPLICeRI
ANTUNDESTAND$AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCXR• UL
VP 2= XL ` Re-roofs
Sign of'A rose en-'er Dam
/l HAZARDOUSMATERIALSDISCLOSURE Type of Roof
Will aapplicant or future building occupant sone or handle hea mus material
As de0md by the Cupenins Municipal Code.Chapter 9.12.and the Health and Sarety
ode.Sc mon 25532(.)7 / All roofs shall be inspected prior to any roofing material being installed.
❑Yes [s]NO
Will the applicant or tomo wilding occupant me equlpmal or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hwardous air commitments s Imcd by me Bay Area Ab Quality Management - all new materials for inspection.
imiat7 mrd/
❑Yna u
Ihavemai tie Ww wsmmdalsmquimmenuunderChaperR95oftheCAlifor-
HwlthhSaficy Code.Suetimts25505,25533mv17S534.landeamlmulflhe wilding
not oto currently how a m ant.that,it le my mepowlMlimy At notify de occupant of the
mumu 'c t 'ormissmwcer.0 ere Occupumy Signature of Applicant Date
Owner,' Authorized agent oath All roof coverings to be Class"B"or better
CITY OF CUPERTINO
FURNACE /AC T�,l
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
Owner's N ( yv\� .l l Phone#:
b yA0?- 3 43-- c) LA
Contracto . License#: S
l tea
Contact: Phone#:
�J— StoSS
Applicant/Contractor:
Building Permit Info:
Bldg Elect Plumb Mech
Job Descriptio ZZUUZkCA -G
Residential: L Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
Type of Construction: Occupancy Gr p:
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILIDNG
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAfRHAN 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
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
• BUSLIC Business License BUILIDNG