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07050030 CITY OF CUPERTINO r� BUILDING DIVISfON PERMIT W-01 PERMIT NO. BUILDMffg...$PANISH OAK CT SUPREME AIR SYSTEMS 07050030 OWNER'S NAME: PERMIT ISSUE DATE PAT SILVEUS 80 GILM,�N AVE, #1 05/04/2007 INE: (408) 37 -)-0406 SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o p LICENSED CONTRACTOR'S DECLARATION Job Description m C I hereby affirm that I am licensed under provisions of Chapter 9(commencing U y with Section 7000)of Division 3 of the Business and Professions Code,and my license is FURNACE & AIR CONDITIONING CHANGE OUT h a in full force and nZ License Lie.N p Datc Contractor ARCHITEC'S DECLARA ON I understand my plans shall be used as public records >yU a H Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the COO following reason.(Section 7031.5,Business and Professions Code:Any city or county alter,improve,demolish,or repair any structure rZ which requires a permit to construct Z} prior to its issuance,also requires the applicant for such permit to file a signed statement 's=G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ;iq.Ft. Floor Area Valuation aF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $19000 L 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 Number Occupancy Type not more than five hundred dollars(5500). 3423207 a � ❑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 q property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements arc 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.). ❑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. ❑1 am exempt under See. B&P C for this reason OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations•. J 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Wa coot on hisurance carrier and Policy nnuum(berr are- CarrierJ 11nZl1W fliviey No.:i.a:L'(6+4W7_ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section meed not be completed if the permit is for arc 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 0 forthwith comply with such provisions or this permit shall be doomed revoked. z , CONSTRUCTION LENDING AGENCY E-+C/) I hereby affirm that there is a construction lending agency for the performance of CC the work for which this permit is issued(Sec.3097,Civ.C.) QLender's Name z Lender's Address U 0 I certify that I have read this application and state that the above information is UI ► correct.1 agree to comply with all city and county ordinances and state laws relating to 0U building construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. (Wc)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date APPLICANT UND T DS AND WILL COMPLY WITH ALL NON-POINT Issued by: S CE REGU Re-roofs Signature of ApifficariXontracLor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant stoic or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs,,hall be inspected prior to any roofing material being installed. ❑Yes Ip No Will the applicant or future building occupant use equipment or devices which If a roof h installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes 1PNo I have read the hazardous materials requirements underCh2pter6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.[understand that if the building does not currently have a an that it is my responsibility to notify the occupant of the re ' mcros wh;ch mtrsf o issuance of a certificate of Occupancy. Signature A Applicant Date .0 All roof coverings to be Class ','B"or better Ownar or authoriA agent Date , , r CITY OF CUPERTINO �ry UPvN .0 /AC a►n of FORM r ��) UPEf�TINO PERMIT APPLICATION APN# Date: IA/ Building Address: v C n;` Q Co J j Owner's NPho #: !T�A 4SAV �e'j S qe) Contractor: ,. �Phone: _ O��r License#: ' ` P� � r j b `1 Contact: '—Phone: Cupertino Business License#: S-VQVai Building Permit o: Bldg ❑ Elect P.umb © Mech Job Description: j f i\ C , Residential `[ - Commercial ❑ For Rdential Installations: Attic W Is' floor ❑ 2nd floor❑ Adhere to min setback requirement 10 'or 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 Construction: Occupanc group: a161 ,�. oc, Strapped El On Platform Bonded Sq.Ft. Floor Area: New Location ❑ Re lacernent Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Er ergy BUILDING BRENULTRN Relocation of Furnace MECHANICAL BREMACOVER Ai C Unit> 10,000 cfin MECHANICAL BREMAgtHAN A C Units<= 10, 000 cfm MECHANICAL BREMRECEPT R,;c tl, Switch& Outlets ELECTRICAL BSEISMICRE Scismic Fee Res BUILDING BSEISMICOM Scismic Commercial BUILIDNG EPERMITFEE E:ec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE B:dg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC B isiness License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ''UPEkTINO Building Department JOB ADDRESS: PERMIT# OWNER'S N `fit PHONE # '- S-7- GENERAL CONTRACTOR:`' ), ,\t, '�c n FAX# I am not using any subcontractors: i-nature Date Please check applicable subcontractors and comip lete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile ' Owner/Contractor Signature Date