The URL can be used to link to this page

09030019 CITY OF CUPERTINO BUILDING DIv-1sION PERMIT BUILDING ADDRESS: PERMIT NO. 7515 MOLTZEN DR VALLEY MECHANICAL IER'S NAME: PERMIT ISSUE DATE PHONE: APAO 9 9 9 CONTROL NO. (408) 288-5675 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u0p LICENSED CONTRACTOR'S DECLARATION Job Descriptionerr C I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z m with Section 7000)of Division 3 of the Business and Professions Code.and my license is =y RPLCML\T OF FURNC IN GARAGE W/NEW FURNC j d in full force an efftZ Licene Class °�.``� Lle•N �E.c Date Contractor W/EVAPORATOR COIL & A/C gg ARCHITECTS DECLARATION d t l understand my plans sh 1 be used as public re�onia D,m,L) 1�1 rr Lam. %AAgC4�n ( e ` L ClA Llctmsed Professh al 0 CA OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from Ute Contractor's License Law for the a o following reason.(Section 7031.5.Business and Professions Code:Any city or county e m g which requires a permit to construct,alter,improve,demolish,or repair any structure Zy prior to its issuance,also requires the applicant for such permit to file a signed statement _C that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation Y t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 8 O O 0 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 five hundred dollars(6500). 36230C34 . 00 0 I,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 Conractoes License Law does not apply to an owner of q p 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 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. r-1 I am exempt under Sec. B&P C for this reason nerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 L 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. 0 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 Worker's Compensation Insurance carrier and Policy number are: Cartier.�/�f/ TJIIS�.I�JPA Polity No.: ger"yz 7l CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section meed 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.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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z RCONSTRUCTION LENDING AGENCY 1 I hereby affirm that there is a construction lending agency for the performance of a r7 the work for which this permit is issued(Sec.3097,Civ.C.) W Q L.endces Name az L.endees Address U C) I certify that I have read this application and state that the above information is LL correct.I agree to comply with all city and county ordinances and state laws relating to 8 V building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes a (We)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 V Z in consequence of the granting of this permit. Date IJ- rJ "-o T APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON- 1)y; SOURCE REGU T70NS. POINT Issued Re-rw's _ Sig at App rcant/Co tort Date �r HAZARDOUS M ALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety de,Section 25532(a)? All roo Fs shall be inspected prior to any roofing material being installed. 0 Yes VNo 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes �Nu 1 have read the hazardous materials mquirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building dors not currently have a tenant,that it is my responsibility to notify the occupant of the requirements h muss be met prior to iss mf a Certificate of Occupancy Signature of Applicant Date All roof coverings to be Class'J `'or better O ner or authorized agent Date CITY OF CUPERTINO FURNACE/AC CUPERTINO PERMIT APPLICATION FORM APN# � Date: ,-a Building Address: Owner's Name: Phone#: Contractor: Phone#: (qO�)--L&8r—SG 7 S J Fax#: O ts—S-76 72 Contractor License - Cupertino Business License#: ,.30-� 9 Contact: ��L Phone#:CyOb J�cd��3� Fax#: _ Building Permit Info: Elect❑ Plumb Mech Residential Commercial Job Description: G eticJ �ZJ.''rC� (1J Yv( C:✓ C '� E G For Residential Installations: Attic ❑ 1 s'floor r] 2nd floor ❑ 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 Re uired ❑ Cost of Project: Type of C instruction(Usage Class): S-,-Coo, J� ;__�/C? Strapped ❑ On Platform ❑ Bond,;d❑ New Location❑ Replacement❑ Project Size: Ex ress❑ 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. _7!5-- Revised 01/07/09 CITY OF CUPERTINO FURNACE/AC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Descripti,)n Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-REpair/Alteration/Add to M ea heating appli ance,refrigeration unit, cooling unit,ab,,orption unit,or ea heating,cooling,absorption or evaporative coc ling system,incl installation of cc)ntrols regulated by this code. 1 MCREPALT Commercial for the repair of alt/add to M ea heating appli ance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or e-aporative cooling sys, incl install of controls regulated by this code. 1 MCSUSHTR Commercial Install/Relocate ea M suspended heat,;r,recessed wall htr, or floor mounted unit heater. 1 PGASCOM Commerical for ea gas piping System P 1-4 outlets 1BPGAS For each gas pi,)ing system of 5 or P more per outlet 1 MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed & not incl in an appliance permit. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Commercial Seismic B 1MRRAA Residential Reliair/Alteration/Add to M ea heating appI ance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative coaling system,incl installation of controls regulated by this code. 1 MRSUSHTR Residential Install/Relocate ea M suspended heat-,r,recessed wall htr, or floor mounted i snit heater. CITY OF CUPERTINO FURNACE/AC "TM°F CUPEkTINO FEE SCIH;EDULE Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1BCAIRHAN Commercial A/C IJnits <= IOk CFM B 1 MCRAA Commercial Mecr Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1PGASCOM Commerical for e gas piping System P 1-4 outlets 1PGASRES Residential for ea gas piping system P of 1-4 Outlets 1 BPGAS For each gas pif ing system of 5 or P more er outlet. C'omm/Resid 1 BREMAIRHAN Residential A/C L nits<= 10k CFM B 1 MRRAA Residential Mech Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residenlial B i IEPERMITFEE Electric Permit E I 1MPERMITFEE Mechanical Permit M 1 PPERMITFEE Plumbing Permi: P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Buildin De artment �7,/ l'1 JOB ADDRESS: <— pl ��,ei yr PERMIT # -,� O q 03 00 1 q OWNER'S NAME: PHONE # GENERAL CONTRACTOR: FAX # Z22 I am not using any subcontractors: ��' � Signature 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 Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date