The URL can be used to link to this page

07010130 CITY OF CUPERTINO BUILDING DIVISION PERMIT G� 7C�AG �1R It}RITI€IlY• PERMIT NO. BUILDING ADDRESS: FUR7PERMIT L95UE DATE OWNER'S NAME: r11\TT)T rP T r TAT T TTTf, JULIE PLANK 1712 Sq ONE AVE SANITARY NO. CONTROL NO. SNE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: REPLACE FURNACE BLDG ELECT PLUMB MECH a 0 a 0 p o LICENSED CONTRACTOR'S DECLARATION Job Description t 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing =Z UJ with Section 7000)of Division 3 of the Business and Professions Code,and my license is =a. in full force and feet. J , �^�/ v�Z License Cl s d � Lic.ii L- /17 w Datc -f L 62 2 Contractor r ARCHITECTS DECLAITA71ON C< I understand my plans shall be used as public records �aU n.� Licensed Professional C a OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county K mwhich requires a permit to construct.alter,improve,demolish,or repair any structure zi Z y prior tri its issuance,also requires the applicant for such permit to rile a signed statement Valuation F S that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq•Ft.Floor Area yt- (commencing with Scction 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than rive hundred dollars($500). 0 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. 0 1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: J I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 3have and will maintain Worker's Compensation Insurance,as required by Section 0 of the Labor Code,for the performance of the work for which this permit is issued. Workers Compesauon Insurance carrier and Policy number arc: Carrier. Policy No.: C RTI C ATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. 0 Z ""' CONSTRUCTION LENDING AGENCY (�Cn I hereby affirm that there is a construction lending agency for the performance of (Y> the work for which this permit is issued(Sec.3097,Civ.C.) QLender's Name Z Lender's Address U O 1 certify that I have read this application and state that the above information is ► correct.1 agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorise representatives of this city to enter upon the a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities,judgments,costs and expenses which may in any way accrue against said City :ad� V Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. 5 J�Z L Re-roots ig urs of Appli tIConuwtor Dare Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupant store or handle hayardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roo's shall be inspected prior to any roofing material being installed. 0 Yes ° If a roo�is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? Yes [ilia I have read the hazard(is materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the reirements which must be met prior to issuance of a certificate of Occupancy. Signature of Applicant Date _ l>_, - �� All roof coverings to be Class"B"or better Oicrier deautharizcd a nt Datc Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT # C/.;,, �� dr10 1 D/3 0 OWNER'S NAME: �,Te, /•z iQ,� /� PHONE # �,- GENERAL CONTRACTOR: FAX # xI am not using any subcontractors: .) u- - 0 L Z"�7 >i ature 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 ?cInsulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 0wner/C tractor Signature Date CITY OF CUPERTINO ()r7b 0 FURNACE/AC CUPEI�TINO PERMIT APPLICATION FORM APN# Date: Building Address: �_ C/ z:A rA _ Owner's Name: Phone#: Contractor: Phone: License#: Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: Residential Commercial ❑ For Residential Int Rations: Attic El1 s' floor F 2nd floor❑ Adhere to min set back requirement❑ For Commercial Installations: Replacement same weight ❑ Additional weight (.structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Constniction: Occupancy group: Strapped ❑ On Platform ❑ Bonded 11 Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Grou BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL BREMRECEPT Recptl, 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 BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING