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09040115 CITY OF CUPERTINO �� .... BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 21920 EATON A PERFE(;T CLIMATE PERMIT ISSUE DATE OWNER'S NAME: SA CONTROL NO. )NE: BUILDING PERMIT INFO ARCHITECT/F-1'IGINEER: BLDG ELECT PLUMB ME�CH ADD A/C TO EXT SYS Z ad Z LICENSED CONTRACTOR'S DECLARATION Job Description U o I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 70(10)of Division 3 of the Business and professions Code.�and my license is e<H in full force and eft Lic.# -Z License Class p Dao _O Contractor !► a"� 19 ARCHITECTS DECLARATION —+ 1 understand my plans shall be used as public records 5 U L O`�' Licensed Pnifcssional OWNER-BUILDER DECLARATION 1 1 hereby affirm that I am exempt from the Contractor's License Law for the p O following reason.(section 7031.5,Business and professions Code: mp yin tarry r county lure .4$9 which requires a permit to construct,alter,improve, Ft.Floor Area that he is licensed pursuant to the provisions of the Contractor's Valuation n"w prior to its issuance,also requires the applicant for such permit o file a signed statement Z< License Law(Chapter 9 �'q x (commencing with Section 7000)of Division 3 of the Business and Professions Code)or Occupancy Type y that he is exempt therefrom and the basis for the alleged exemption.Any violation o[ Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number not more than five hundred dollars(5500)• p 1,as owner of the property,or my employees with wages as their sole compensation, Required Inspections will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and professions Code:The Contractor's License Law docs 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 r°tion,the owner- red for sale.If, however,the building or improvement is sold within one year comp le 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 conswct 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. B&P C for this reason ❑I am exempt under Sec Date Owner WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: tJ I have and will maintain a Certificate of Consent to self-insure for Workces Compen- ton,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued• have and will maintain Worker's Compensation insurance,as required by Section 37 of the Labor Code,for the performance of the work for which this permit is issued. My Wo r s ore nsation Insurance carrier and Policy number�d Z h/ N i •C' Policy No.: Carrie CERTIFICAOMPE EX SAS TIONINSURANCEON ORKERS' (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 Codc,you must ,J Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of 1:4> the work for which this permit is issued(Sec.3097,Civ.C.) W QL.endces Name CIO Lender's Address I certify that I have read this application and state that the above information is LUL correct.1 agree o comply with all city and county ordinances and state laws relating to building construction, enter ction,and hereby authorize representatives of this city tupon the W above-mentioned property for inspection purposes >4 a (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accnie against said City Date in consequence of th ting of this permit V Z APPLICANT UN ER ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: — 6 REGU S• — ;.�, -7 7 Re-roofs Si to of can ontract Date T of Roof HAZARDOUS MATERIALS DISCLOSURE y� 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 All roofs shall be inspected prior to any roofing material being installed. Code,Section 25532(a)? 0YC5 ;F " 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 all new materials for inspection. UC Jt hazardous air contaminants as defined by the Bay Area Air Quality Management District? p,(� OYes P(NQ, 1 have read the hazardous materials requirements under Ch�p-6.95 of the Califor- nia Health&Safety Code,Si crions 25505,Or and 25534.I unded that iC the building Date docs not currently a tenant that it is my Or o nodie occupant of the Signature of Applicant whit be me r o issuarice of a Certificateccopancy. `r�`Z'�--� All roof coverings to be Class%, or better Owner r a horizcd agent Date q�� o �� CITY OF CUPERTINO FURNACE/AC CUPS TING PERMIT APPLICATION FORM R. APN # Date: Building Address: owner's Name: ' Phone#: 6 Contractor: Phone#: yog g� / A—p Fax#: L Contractor License#: Cupertino Business License#: C� ley __ Contact: Phone#:Y O� (` ` J J r, Fax#: Building Permit Info: Elect] Plumb ❑ Mech ❑ Residential Commercial Job Description: 1/-1 d oi, A For Residential Installations: 2nd floor ❑ Attic ❑ 1st floor [] Adhere to minimum setback requirement [-' For Commercial Installations: Additional weight(structural calcs) Replacement same weight ❑ ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction(Usage Class): 3 ion lacementEl Strapped On Platform Bon3ed New Locat ❑ Re p Project Size: Express ❑ Standard ❑ Large ❑ Major❑Valuation: Green Building: Please complete relevant porti,)n of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Revised 01/07/09 CITY OF CUPERTINO FURNACEAC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-Repair/Alteration/Add to M ea heating applia-ice,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1MCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit cr ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1MCSUSHTR Commercial Inslall/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for ea 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 ca appliance vent installed &not incl in an appliance permit. 1BCBSC Cal Bldg Standzrds Commission Fee B ALL PERMIT TYPES 1BSEISMICO Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling absorption or — evaporative cocling system,incl installation of cz)ntrols regulated by this code. 1MRSUSHTR Residential Install/Relocate ea M suspended heat,;r,recessed wall htr, or floor mounted knit heater. CITY OF CUPERTINO FUIVIACE/AC OF CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Grou 1MRAPPVNT Residential for the install/relocate/or M replacement of ea appliance vent install &not incl in an appl permit. FURNACE FURN/AC 1PGASRES Residential foi ea gas piping system of P 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES / IBSEISMICR Residential Seismic B IME CK Mechanical P.an Check M 1 MFR=<100 Furnace Syst <=100k BTU install or M relocate ea fo,-ced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h 1 MFRN>100 Furnace S yst> 100k BTU install or M relocate ea forced-air/gravity type fumace/bumcr, incl ducts/vents attached to such appliance over 100,000 Btu/h I EPERMITFEE Electric Pemiit Fee E 1MPERMITFEE Mechanical Permit Fee M IPPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B CITY OF CUPERTINO `- FURNACE/AC CITY Of FEE SCHEDULE CUPEf�TINO Quantity Fee ID Fee Description Fee Permit Type Grou AIR FURN/AC CONDITIONING 1BCAIRHAN Commercial A/C :Jnits <= IOk CFM B 1MCRAA Commercial Mech Repair/alt/add M IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES IBSEISMICO Seismic Commerl%Hal B 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. (:omm/Resid 1BREMAIRHAN Residential A/C lints <= 10k CFM B 1MRRAA Residential Mech Repair/alt/add M IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B IEPERMITFEE Electric Permit E 1MPERMITFEE Mechanical Pernnit M 1PPERMITFEE Plumbing Permit P ITRAVDOC Travel Documentation B IBUSLIC Business Licen:e B