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06100004t00 Lit 2zU a )WU U., [ :0 y �p0 -ZY CFO Li 2 C v C F L A v CITY OF CUPERTINO TQ:€�i�#Y��' BUILDING DIVISION PERMIT �+ BUILDING ADDRESS: AAA FURNACE & AIR GOND IT I I ftb'D` 0 610 0 0 0 4 10802 WILKINSON AV OWNER'S NAME: PERMIT ISSUE DATE LEVY ROBERT J AND LOUISE W TRU1712 STONE AVE 10102/2006 JNE: SANITARY NO. CONTROL NO. (408) 293-4717 ARCHITECf/ENGiNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and g1lect. REPLACE FURNACE 100,000 ADD A/C 4 TON License Class Lic. # Date ' ' Contractor AR ITEC "; DECLARAT I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county $950 which requires a permit to construct, alter, improve, demolish, or repair any structure Sq. Ft. Floor Area prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 that (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 —70 JAFNMifiFer Occupancy Type not more than five hundred dollars (5500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, Required Inspections 9 P will do the work, and the structure is not intended or offend for sale (Sec. 7044, Business 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.). ❑ 1, 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. ❑ I am exempt under See B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compcn- 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 3 00 of the Labor Code, for the performance of the work for which this permit is issued. My Workers ompensation Insurance carrier and Policy number are: 1-42 Cartier.5- �fAtlt LZAd Policy No.: CERTIFICATE F EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for anc hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I 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 forthwith comply with such provisions or this permit shall be deemed revoked. I CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address j 1 certify that I have read this application and state that the above information is correct- I agree to comply with all city and county ordinances and state laws rclating to building construction, and hereby authorize representatives of this city to enter upon the ? above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against j liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date S URCE RCATIONS. Re -roofs Sig of cant/Con ctor 11 t Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store 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 shall be inspected prior to any roofing material being installed. ❑ Yes No If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant o uturc building occupant use cyuipmcnt or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? C] Yes �fu 1 have read the hazardous materials requirements under Chapter 6.95 of the Cali for. 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 rcgn; cements which must be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date 40 0 All roof coverings to be Class "B" or better Ownr a orhred agent ate CITY OF 'yUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # 0(01 000 OWNER'S NAME: L e c PHONE # 4Idr -�� QaZ 25 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signat&e bate Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date 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 Cin CUPEkTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM 0(, N000001- APN # \ C) Date: Building Address: BREMFURN fog �,+r MECHANICAL Owner's Name: Phone #: L - 7d •17.f' Contractor: Phone: License #: uc�C �r4N� 7� Rec tl, Switch & Outlets Contact. Phone: Cupertino Business License #: Seismic Fee Res BUILDING Building Perm' Info: Seismic Commercial Bldg ❑ Elect Plumb Mech Job Description: ELECTRICAL zjv Mech Permit Issuance Residential ❑ Commercial ❑ PPERMITFEE For Residential Installations: ❑ P' ❑ PLUMBING 2nd floor 1St floor Attic Bldg Permit Fees Adhere to min set back requiremen BPLANCHK For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ BUILDING Structural Calculations required for new installation Gas Piping System Fee New installation Planning Approval Required ❑ BUSLIC Cosl of Project: Type of Construction: Occupancy group: Strapped El On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: ❑ 46� New Location Replacement 6 Qty. if Arnnlirnhle Fee TT) Fee Descrivtion Fee Group BENERGY Energy BUILDING BREMFURN 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 BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING