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09030170 CITY OF CUPERTINO BUILDING DIVISION PERNIIT � ► ' � " - PERMIT NO. BUILDING ADDRESS: 90-10170 20728 GARDEN PLACE CT AAA FUI MACE & I PERMIT ISSUE DATE OWNER'S NAME: C OND I T-TONING �' SA CONTROL NO. '`tONE: BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH RPLCMNT EXT FURNC & DUCTS & u p p LICENSED CONTRACTOR'S DECLARATION A/C IN;STL S Job Description v C I bereby 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 n y in full force and v�z License C LIc.M n L-9 Date 4s 2f,4 Contractor ARCHITECTS DECLARATION 12.1-, 1 understand my plans shall be used as public records J0. L O H Licensed Professional OWNER-BUILDER DECLARATION 2 1 hereby affirm that I am exempt from the Contractor's License Law for the in o following reason.(Section 7031.5,Business and Professions Code:Any city or county .i s Pi which requires a permit to construct,alter,improve.demolish,or repair any structure n"rn prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation S Ft.Floor Area G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q Y.t-$ (commencing with Section 70D0)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 APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). [11,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 Contractors 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 la- 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 SeB&P C for this reason Sec. Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- -ion,as provided for by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. ❑1 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 Work %omns(auon Inurance�tsrricrand Policy number arc: Cartier. rPolicyNo.. 7 I �S AkCATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one 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 ,J Z forthwith comply with such provisions or this permit shall be deemed mvoked. Z� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of p! the work for which this permit is issued(Sec.3097,Civ.C.) W QLender's Name 0 z Lcmices Address U J 0 1 certify that I have read this application and state that the above information is LL H correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building conswction,and he authorise representatives of this city to corer upon the above-mentioned property _. _P_ ion purposes. (Wc)agree to ,i emnify and keep harmless the City of Cupertino against ,Hy liabilities,judgments as and expenses which may in anyway accrue against said City U Zin consequenc a Ung of this permit. Date ►+ U RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SO RCE ATIONS. —'Z _G Re-roof: - Si u of Applicani/Con Dare T Of �OOf HAZ S MATERIALS DISCLOSURE Type Will the applican r ure 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 roof:;shall be inspected prior to any roofing material being installed. ❑Yes [ If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which it It air contaminants as defined by the Bay Arca Air Quality Management all new 1 naterials for inspection. ,vitt? ❑Yes 1 have mad the haz s materials requirements undcrChapter 6.95 of the Califor- nia &Safct dons 25505,25533 and 25534.1 understand that if the building docs not c;authorized n -h tenant.that it is my responsibility to notify the occupant of the Date reyut mes is m he met prior to issuance of a Certificate of Deco ane D Signature Of Applicant All roof coverings to be Class"��{`'or better Own agent Date' -71 CITY OF CUPERTINO FUIViACE/AC CUPEI�TINO PERMIT APPLACATION FORM Date: Building Address: Owner's Name: Phone#: ^(Z 11 k ' 4os- - 2 it I Contractor: 'R4y1C�� �� Phone#:zie�__Z� 9 3-(-/7 ! -7 Fax#: p — d c, --(c Z--71 Contractor License#: kS' 7 q 3/C zv Cupertino Business License#: 90&') Contact: &)Ct(2 w2 7 Phone#: 6273 Fax #: Building Permit Info: Elect 1�r Plumb []' Mech 0— Residential Commercial ❑ Job Description: I)epieLe r��n � f�� �- rurNFec ay')J A-lo-- z jl l�'cCt'✓�'�t�.-�I- cj �� L'c C+ For Residential Installations: Attic [r, 1St floor [] 2°d floor El Adhere to minimum setback 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 Constructionr�.(Usage Class): Cot,33 IC-Lo 4 �000.00 k-", Strapped On Platform El Bonded New Location Replacement Project Size: Express ©'Standard ❑ Large ❑ Major❑ _ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. 0 Revised 01/07/09 CITY OF C UPERTINO AT a( FURNA.CE/AC CUPEI�TINO FEE SCHEDULE Quantity Fee ID Fee Deseriptiort Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-Rep air/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MCREPALT Commercial for the repair of alt/add to M ea heating appliaace,refrigeration unit,cooling unit.VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1MCSUSHTR Commercial Install/Relocate ea M suspended heate;-,recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for --a gas piping System P 1-4 outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of e a appliance vent installed & not incl in an appliance --permit. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Commercial Seismic B 1 MRRAA Residential Rep air/Alteration/Add to M ea heating appli ance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or — evaporative cooling system,incl installation of c:)ntrols regulated by this code. 1MRSUSHTR Residential Install/Relocate ea M suspended heator,recessed wall htr, or floor mounted unit heater. CITY OF CUPERTINO FURNA.CEAC CITYCUPEf�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units<= l Ok CFM B 1MCRAA Commercial Me&1 Repair/alt/add M 1BCBSC Cal Bldg Standards Commission FeeB ALL PERMIT TYPES 1BSEISMICO Seismic Commer,:ial PB- 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1PGASRES Residential for ea gas piping system P of 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid 1 BREMAIRHAN Residential A/C units<= l Ok CFM B 1 MRRAA Residential Mecr.Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES / 1 BSEISMICR Seismic Residential B 1EPERMITFEE Electric Permit E 1MPERMITFEE Mechanical Permit M 1 1 PPERMITFEE Plumbing Permit P I 1 TRAVDOC Travel Documer.tation B 1BUSLIC Business Licens,; B ��i � ttjs'�' Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 f7UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # a1 v-7 L�- c•►r C t e-►-) P loci D OWNER'S NAME: 97iZ►' C PHONE # 4tE 1 GENERAL CONTRACTOR: ) G) v l c FAX # ?- I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing f Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing V Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal 14 Sheet Rock Tile Owner Contractor afore Date