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09050004 CITY OF CUPERTINO BUILDING DIVISION PERNIIT � � � � ' PERMIT NO. BUILDING ADDRESS: 22448 ST ANDREWS AVE AAA FU:ZNACE & AIR 09050004 OWNER'S NAME: CONDITIONING PERMIT LSSUEDATE MnnT TN DICK T 1 :73 2 2� SA CONTROL NO. ...ONE: BUILDING PERMIT INFO ARCHfrECT/ENG(NEER: BLDG O PLUMB 0 REMOVE EXISTING FURNACE, Q o o LICENSED CONTRACTOR'S DECLARATION INSTAL C, 95 EFF I C I E1 �Description v I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z o with Section 70(X0)of Division 3 of the Business and Professions Code,and my license is n H in full force and Z License lass Lic» Dale o Contract 4?x ARCHITECTS DECLARATION 4 gd< 1 understand my plans shall be Used as public records D,U u,y Licensed Prufcssional yOWNER-BUILDER DECLARATION i hereby affirm that 1 am exempt from the Contractor's License Law for the n O following reason.(Section 7031.5,Business and Professions Code:Any city or county y 19 which requires a permit to construct,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant Cor such permit to file a signed Laic Sq.Ft.Floor Area Valuation Z< that he is licerised pursuant to the provisions of the Contractor's License Law(Chapter 9 Y(_$ (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or y .. 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 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.). 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 Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I 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- sation,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 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers �TE r and Policy,number are: Carrier. Policy No.:�I V 2 G TION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icss.) I certify that in the performance of the work for which this permit is issued.I shall no 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 Codo,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z t4 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of a .7 the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lenders Name az Lenders Address 1 certify that I have read this application and state that the above information is V cortccL I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby au 're representatives of this city to enter upon the above-mentioned property for(nape purposes. >1 W (We)agree to save,i fy d keep harmless the City of Cupertino against (n liabilities,judgments,cos d e s which may in any way accrue against said City U z in consequence of the g ting is permit. Date CANT UNDER AN AND WILL COMPLY WITH ALL NON-POINT Issued by: S R REGULATIO 671071_02.. Re-roofs - S' ofApplicant/Con for Dare T of hoof HAZARDOUS MA DISCLOSURE Type 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 roof:;shall be inspected prior to any roofing material being installed. 0Yes WO 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? O Yes C A�u 1 havc read the hazardcxu m ri requirements under Chapter 6.95 of the Califor- nia Hcalth&Safety Code,Sec ,25533 and 25534.1 understand that if the building does not currently have a itis my responsibility m notify tie occupant of the I me is which must 'or to issuance of a Certificate of Occupancy. Signature of Applicant Date ' © All roof coverings to be Class'A'or better r uthorizcd agent Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # a ql 9 5 T hEf1-ekZ AtE OWNER'S NAME: L rL,0 /gam PHONE # S//V -1513 V GENERAL CONTRACTOR: ' Id 4VZ70 1x& FAX # 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 A/,36 Owner/Contractor ature Date CITY OF CUPERTINO -I S-� FURNACE/AC �;UPEI�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-Repair Iteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absoiption unit,or ea heating,cooling,ab sorption or evaporative cooli:lg system,incl installation of controls regulated by this code. 1MCREPALT Commercial for tale repair of alt/add to M ea heating applimice,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 Instill/Relocate ea M suspended heater,recessed wall htr, or floor mounted ur it heater. 1PGASCOM Commerical for(;a gas piping System P 1-4 outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for 0:he install/relocate/ or M replacement of ea appliance vent installed &not incl in an appliance permit. 1BCBSC Cal Bldg Standa-ds Commission Fee B ALL PERMIT TYPES 1BSEISMICO Commercial Sei;;mic B 1MRRAA Residential Rep,tir/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or — evaporative coo:ing system,incl installation of controls regulated by this code. 1MRSUSHTR Residential Install/Relocate ea M suspended heats r,recessed wall htr, or floor mounted unit heater. CITY OF CUPERTINO FURNACE/AC CUPEf�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type - Gro-up-AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units<= l Ok CFM B 1MCRAA Commercial Mec:i Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICO Seismic Commer;ial B 1 PGASCOM Commerical for e a gas piping System P 1-4 outlets 1PGASRES Residential for ee gas piping system P of 1-4 Outlets l BPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid 1 BREMAIRHAN Residential A/C units <= l Ok CFM B 1MRRAA Residential Mect.Repair/alt/add M 1BCBSC Cal Bldg Standaids Commission Fee B ALL PERMIT r TYPES 1BSEISMICR Seismic Residea.ial B 1 EPERMITFEE Electric Permit E 1MPERMITFEE Mechanical Permit M 1 PPERMITFEE Plumbing Perini: P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B