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09050056 CITY OF CUPERTINO BUILDING DIVISION PERMIT � R4 � � } MT � : BUILDING ADDRESS: PERMIT NO. 18832 ARRATA WAY ELITE HEATIN(1� F, ATR nqn9no96 OWNER'S NAME: CONDITIONING PERMIT ISSUE DATE PHO A CONTROL NO. (408) 726-1618 :HIIECT/ENGiNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u p pLICENSED CONTRACTOR'S DECLARATION JOb Description U 1 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 effect 20 AC INSZ L/ HOME ALREADY PREP FOR A/C Z License CIN l _Lic•S Contractor n M W Dam Q ARCHITECTS DECLARATION I understand my plans shall be used as public records �yU U.y Licensed Professional n OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the E 20 following reason.(Section 7031.5,Business and Professions Code:Any city or county 4^Pi which requires a permit to construct.alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement —z< tut he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation Y. H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $5000 000 y .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 70313 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than eve hundred dollars($500)• 3 7 5 13 O C 9 . 00 ❑1,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 ns Required Inspections and Professions Code:The Contractors License Law dors 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.). ❑1,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. PW am exempt under Secaa B&P C for this mason Owner l hn�^ V �GW"Z— Date s ,2 "1 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ve and will maintain a Certificate of Consent to self-insure for Workers Compen- •tion,as provided for by Section 3700 of the Labor Code.for the performance of the k for which this permit is issued. _ I have and will maintain Workers 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: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ('Ibis 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.1 shall not employ any person in any mannCC ZZ .y tobccopCsltYiect to the Workers'Compensation Laws of California.Date (f 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z 2 CONSTRUCTION LENDING AGENCY [~-h I hereby affirm that there is a construction lending agency for the performance of �+.7 the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name ]z Lenders Address U O I certify that I have read this application and stale that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating to 0 Vbuilding construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes W (We)agree to save,indemnify and keep harmless the City of Cupertino against F,h Co) liabilities,judgments,costs and exp nses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date P-4 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b�: SOURCE REGULATIONS. --r— Re-roofs Signature of Applicant/Conuactor Date T Of Roof MATERIALS DISCLOSURE ype 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(x)? All roofs 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r.Iaterials for inspection. District? ❑Yes 1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505,25533 and 25534.1 undcrstmhd that if the building does not currently have a tenant.tut it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of oeenp cr,,/ Signature:of Applicant Date All roof coverings to be Class'�W'or better Owner or authorized agent Date' CITY OF CUPERTINO x FUIViACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # v> .., Date: s//-? loq Building Address:/Oa w- APhone Owner's Name: /� #: 7 Oq 7S_ Contractor: Ec 1--c i- �+( i - �Y�(fi(�j Phone#: (t�/ � 7 Z�, 16 I , Fax#: Contractor License#: 00 2) q1S 7o Cupertino Business License#: Contact: . Phone#: t�� Gc:�;eZ�,� `J�`. �" Fax #: Building Permit Info: Elect ❑ Plumb ❑ Mech Residential Commercial LJ Job Description: �G { tL - ��.�� q ` � iz� For Residential Installations: Attic ❑ 1St floor 2°d floor El Adhere to minimum setback requirement LJ For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ (:onstruction (Usage Class): Cost of Project: Type of 00, Strapped On Platform Bon(led New Location Replacement Project Size: Express ❑ Standard ❑ Large ❑ Major❑ Valuation:;W,,.f- W �5)WC) , vu 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. (C-1 — Revised 01/07/09 CITY OF C'UPERTINO S11,20 FURNACE/AC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units <= I Ok CFM B 1 MCRAA Commercial Mec:h Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICO Seismic Commercial B IPGASCOM Commerical for(;a gas piping System P 1-4 outlets 1 PGASRES Residential for ea gas piping system P of 1-4 Outlets 1 BPGAS For each gas pi Jing system of 5 or P more per outlet. Comm/Resid 1 BREMAIRHAN Residential A/C units<= I Ok CFM B 1 MRRAA Residential Mech Repair/alt/add M 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1 1 EPERMITFEE Electric Permit E ( 1MPERMITFEE Mechanical Permit M I 1PPERMITFEE Plumbing Permir. P 1TRAVDOC Travel Documentation B 1BUSLIC Business Licens(; B Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF CUPEkTINO Buildhn De artment JOB ADDRESS: j1 V'va1 zzt i,_.jP4,/ PERMIT # �4sko(,-_ OWNER'S NAME: N14NO GENERAL CONTRACTOR: EL4-e i+k FAX# �' 3R - 3Y(o I I am not using any subcontractors: ' Signature Date Please check applicable subcontractors and complete the followin 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 � f Owner/Contractor Signature Date