03110006 (2) CITY OF CUPER'1'INO
BUILDING DIVISION PERMIT v CONTRAC COR`INFORMATION
n mLDING ADDRESS: WEIGEL MECHANICAL & REFRIG PERMIT"°'03110006
OWNER'S NAME: 823 SAN ALESO AVE PERMrrlssue oATE
ONE: (408) 252-2338 SANITARY NO. CONTROL NO.
7AR1,C,HIT12�/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
LICENSED CONTRACTOR'S DECLARATION
1 hereby aff m Thal1 am licenud under provisions of Chapter 9(commencing Job Description
SeciionlrDivision3ofth.BusinessandRofeuionsCode.andmylicenseispl�yypum can Ce. 50 REPLACE FURNACE �'11,V�. LE®
nu Clu Lic.N--.Conlracmr
iBnd nandmyplanshallk.vcda,r.rnJ DEC 19 2003
jadJ
'G
Licensed Professional
u OWNER-BUILDER DECLARATION
Conn ON BUILDING
:0
<Y 1 hereby.('Seco that 1 1. exempt from the ContraeCo Licenu Law for the
LIO followingrcuon.Permit
7031.3,Business and vefdcoul Code:Any city mructum
5$ county
which requires m pemit re cores t e,alcor,improve,h ptreanh,or repair any tatement
that he its tensed pursuant
requires thovisio ant softhe for Contrarmiuofile icense Law
nammcm
,xx< IhethcencinnwJpuntion7 )ofDivierm3oftheBusinesandPro law(Chod r9 Sq. Ft. Floor Area Valuation
ZF$ (cot hehexemptthecaiomeandtabanxsiomrnrthceedeuandon.AnynxCade)or 1400
Nu io u exempt therefrom and or bun for ubj alleged exemption.to Any violation of
Section thLSby veeundredicanafonpctmitsubjectstheeppiicannaacivilpenaltyof ApNNumber Occupancy Type
netmom wnefire epropetyllanyempl 31633127 . 00
wi L u owner kor..md properly,re is employees with wages u heir sale compensation.
will Pr fe work,and e: swami is noa intendede Law do for Ile(Sec.304,1,Business
and Professions Code,:The CnnuacanYe Liccue Law Joea not apply an an owner of Required Inspections
property who builds or improves hemon,and who does inch work himself or through his
own employees,provided that such improsemenu art noa iou,ded oroRered for sale.If,
however,he building or improvement is sold within one year of completion,he owner.
Wilde,will have he burden of proving than he did not Wild of improve for purpose of
ule.). - -
❑h u owner of the progen,am exclusively conaruting with licensed cornmeal to
construct the project(Sec.30,14,Businessend Pons,,.,,Code:)The Contractor's Li.
ceue Law does not apply to an owner or property who Wilda or improves hereon,and
who contacts for such pmjccu with a contractor(A)licensed pursuant to the Contra tor's
Limes"
Law.
❑1 am exempt under Sec. .B 6 P C for this..me
Owner Data
Al WORKER'S COMPENSATION DECLARATION
I hereby afatm under penalty of perjury one of the following dulmdens:
1 have end will maintain m Cenihrnm o(Comnt a ulfdnsum far Wortefs COMNn-
udue,as provided for by Section 3380 of the labor Cade,for the Performance of fee
work for which this Permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
33W of the Labor Code.for he performance of the work for which his Permit is Issued.
am orteri n pEn dpynun rticrPeonl�Ncy ray: _ _� O _
CERTIFlCATE OF EX PTION WORKER/-/L�1N\/f/�
COMPENS ION INSURANCE
(This uctlnn need rat W complcmJ If the permh n for one hundred rattan(Slap
or$a.,.) 17
1 certify that in he performance of he work for which his Permit is issued.I shall out
employ any person in any manner so u In become ubjecpo the workeri Compcuation
Uses of celifomia.Dau
Applicant
NOTICE TO APPLICANT:IL after making this Cenifcae or Exemption,you should
Wcome&Object to the Worker's Compensation provisions of the Lahm Code,you must
Z forthwith comply with such provisions or this pcmah&hall be deemed revoked,
zO CONSTRUCTION LENDING AGENCY
I herebymffirre had here itsmuwctinn lendinggent,for the redeem sof
Ya moi+ the work for which this permit Is issued(Sec.3W3.Civ.C.7
1) Q Lcndcr'x Nam.
z Lcndcr'3Address
Q 1 eerie,hat 1 have reel thirty and county
and sou that the shove iw.re,aaiun is
y U Wildia I once m comply with all city and county.Ninancea and sou laws rupong ro
�U 'have-gcononcel mKrty fercbymmlAoriuupuess, irca of his city to tour upon the
pw (We,)agree m cove,indemnify endhich may
anhey. of Cupenst said
ti Ny incoisequenc of the
gracing expenuswhich may in any way accrue against mid City
APPLICANTcUNDERSTANDSof ahis ANDrmit. I
WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
JQLLECE REGU N5.
Re-roofs
Sure a(AppllcaHAZARDOUS MATERIALS DISCLOSURE DateType of Roof
Will he applicant or future building occupant store,or handle humorous material
as defined by the Cupertino Municipal Code,Chaper 9.12,and the Health and Safety
CWe,Sectior,25532 a)3 All roofs shall be inspected prior to any roofing material being installed.
'3 ����y^�N�\
Will he am ntant a.future building oT upant use equipment or rcvm.x which If a roof is installed without first obtaining an inspection,I agree to remove
B haumnax air comaminanu m defined by fee Bay Area Air Quality Management 'all new materials for inspection.
iso,
❑mea y�.0 f
1haveread the .Swddm 255r5,25quimdc Sunder Chapur ,orhe Caldin,
ria Hc,lhlk Safety Code.Satitw 253115.255JJ and 2553,1.1 unJcmand thulnc�Wilding
docs not currently have a mnanL Not it is my responsibility m notify Ibe occupant of he
re, uirmtnuw a rior to issuance of 'bean of Oce ey. Signature of Applicant Date
mer or authoriuJ egcm oat All roof coverings to be Class "B"or better
CITY OF CUPERTINO b
FURNACE/AC b ( dao 0
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
a o 3 - 0
Building Address:-'-
Owner's
ddress:',Owner's Name Phone#:
.�Pc d � UtC
Contractor: Phone: ZS Z a� License #:
L FYI E P� G Z 0
Contact: IGFI Phone: Cupertino Business License #:
a .z Zo
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech
Job Description•
u
Residenti Commercial ❑
For Residential I st lations:
Attic ❑ 151 floorPC—gLfLQor❑
Adhere to min setback requirement 0
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Pr je t: n--D ' e of Construction: i Occu cy gr
�
Strapped ❑ I O Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacemenv
Qty. i
Appli ab e Fee 1D 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 cfrn 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