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09080015 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1392 S STELLING RD ZONTRACTOR:AAA FURNACE&AIR PERMIT NO:09080015 :ONDITIONING OWNER'S NAME: FRANKOVICH ROBERT J 1712 STONE AVE DATE ISSUED:08/04/2009 (., -:R'S PHONE: iAN JOSE,CA 95125 PHONE NO:(408)293-4717 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG I— ELECT r PLUMB f— License Class C.J(JLia# 7 (0 ��7 '� MECH RESIDENTIAL COMMERCIAL Contractors Cl tz!tfI d H tl A E_ Date_S—4—O`� I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL CONDENSER&COIL,220 POWER (commencing with Section 7000)of Division 3 of the Business&Professions HOOKUP Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1 have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5253 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36617103.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned prop for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless dieCity of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which ay crue against said City in consequence of the granting of this pe diti nally,the applicant understands and will comply with all n nt urc a lations per the Cupertino Municipal Code,Section Issued by: Date: 9.18. —4r—,j Signature Date RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,1 agree to remove all new materials for 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as de ed. y the Bay Area Air Quality Management District I will maintain complia ce th the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health& 9de3ections 25505,25533,and 25534. 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 Worker'sO mer r aut orized agent: Oq Compensation laws of California. If,after making this certificate of exemption,I Date: �� / become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address up- she above mentioned property for inspection purposes.(We)agree to save it ify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION cosi,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature_ Date C CITY OF CUPERTINO FUIViACE/AC CUPEkTINO PERMIT APPJLICATION FORM APN # Date: Building Address: 139 L 5. S k I I ►hG P-0 0"i Owner's Name: izobe fz f- FrG n ILOJ i C►, Phone#: 46Y - y 79 -52-00 Contractor: RG n d O N v Pc� I/i c. Phone#: 1-16S-—�2 93 - Fax#: Z16,s _393 - 677/ Contractor License#: 7 6 s-g7/ Cupertino Business License#: Contact: =-��R�� Tu 2_,e/2- Phone#: 1,10� - ,�q 3 -Z/ 7/7 Fax #: v,� - X93 - (v77i Building Permit Info: Elect [ Plumb ❑ Mech Residential Commercial ❑ Job Description: /NSA// C'�md c'��S�2 �t Ccs t- , Z z o I�a``�z '�- 1-/06<< L' . For Residential Installations: Attic ❑ 1St floor 2°d floor ❑ Adhere to minimum setback requirement [� For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installatiorL ❑ New installation Planning Approval Required ❑ Cost of Project:. 253, try Type of Construction (Usage Class): \-/-o Strapped 17 On Platform Bonded New Location Replacement Project Size: EXDress Standard ❑ Large ❑ Major❑ _ Valuation: $/ ZS3 j Orc-) 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. - Revised 01/07/09 CITY OF CUPERTINO FURNACE/AC CITYCUPEI�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units<= l 0k CFMpmq 1 MCRAA Commercial Mech Repair/alt/add 1BCBSC Cal Bldg Standares Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1PGASCOM Commerical for epi gas piping System P 1-4 outlets 1 PGASRES Residential for ea gas piping system P of 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. C omm/Resid 1BREMAIRHAN Residential A/C units<= 10k CFM B 1 MRRAA Residential Mech Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Resident.al B I 1 EPERMITFEE Electric Permit E 1MPERMITFEE Mechanical Permit M 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documen-.ation B 1BUSLIC Business License B Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 �CIT1'OF Fax(408)777-3333 XPEkTINO Buildi:n De artment JOB ADDRESS: 135z- S e i,�, Q 1 PERMIT # d l--f OWNER'S NAME: nbcPHONE # 40�--oX�3 - 44.7 GENERAL CONTRACTOR: RLI nd C HVA<_ FAX# 40S 2 7 / I am not using any subcontractors: —3l—ts9 Signatur 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