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05090102 • CITY OF CUPERTINO � s `-a �� '��'�"` BUILDING DIVISION PERMIT CO,NRACTORINFORMATIQN BUILDING ADDRESS: A PERFECT CLIMATE PERMITNO.05090102 18385 CHELMSFORD DR OWNER'S NAME: PERMIT JESUP DATE KATE WHITTLEY 10570 S DEANZA BLVD 09/15/2005 NE: SANITARY NO. CONTROL NO. (408) 861-9545 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB - MECH uoo LICENSED CONTRACTOR'S DECLARATION JobDescri [ion i u� I hereby affirm Nat 1 am Iiansed under provisions of Chapter 9(commencing P 0 with Sceion7")of Division 3 ofthe Business and Professions Code ndeylicenseis infmlf.rocandef g1_ '73 — FURNACE REPLACEMENT y Ljz License clam Lic.N r, Dale Cuntraaor ARCHITECTS DECLA ATION ¢ 1 command my plans shall he used az public rceords JyU scab Licensed Professional OWNER-BUILDER DECLARATION 1 hereby ff".shat 1 am exempt from to Contractor's License Law for the 00 following mason.(Section 7 W 1.5,Business and Professions Code:Any city or county 2 m which requires a Permit a construct,alcor,improve,demolish,or minor any someone 8291 e2} poor W its June e.also Mqums the applicant for such Permit to file a signed statement < Nat he is licensed pursuant a Ne provisions of the Camranur's Moons law(Chapter 9 Sq. Ft. Floor Area Valbatie6 xFG (commencing with Section 7000)of Division 3 of Ne Business and Professions Code)or i r3 Nn he is exempt Ihesefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects thio applicant to a civil penalty of 3 Mfler U Occupancy Type not more Nan five hundred Jolla.(SSW). I,wo ncrofmepropeny,ormyemploycawithwagesuNeirmiccompensuuon, will do the work.and the swaum is not intended or offered for sale(Sec.7064,Business Required Inspections and Professions Code:The Contractor's Licenw Law does rot apply m e ns an owner of q P property who builds m improves lherem,and who does such.,it himself.,lough his own employees,provided Nat such improvements are not intended mroffered f frale.If. however,the building or improvement is sold within one year of completion,the owner. builder will have Ne burden of proving But he did not build or improve for purpose of sale.). ❑I.as Owner of Ne property,am exclusively contracting with licensed contravors to construct the project(Sec.7044.Business and Professional Code:)The Conuactoi s Li. _ cone Law dors not apply to an owner of property who Wilds or improve hmeon,and. who contracts for such puri with a c.fimactor(s)licensed perform m dm Contracmtsc Lkeeve La . ❑1 am exempt under Sec. .B&P C far this mamn IC3 ner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following dcclas iumu: I ham and will maintain a Cerufieam of Co..,Io self-mmre for Workers Compcn- ion,as provided for by Section 3700 of the labor Code,for site performance of the rk for which Nis permit is issued. 1 have and will maintain Workers Compcoumion Insurance,u required by Section 00 of Mc Labor Code,for Ne performance of Ne work for which this permit is issued. Wor Cmmpcua. Inaunna nrticr end Policy nurrier. Policy Nm.:�a CE TIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed if the Permit is for one hundred dollars(SIM) fir less.) I ccnify Nat in the performance of the work for which Nis Permit is issued.I shall not employ any person in any mannerso to of become subject o Ne Workers'Compewuon Laws of California.Date Applicans NOTICE TO APPLICANT:B,after making this Cenificatc of Exemption,you should become subject W the Worker's Compensation provisions of Ne Labor Code,you must ,J z forthwith comply with such Pon umns or this Permit hall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY I hereby affirm that Vert is a cmnsuation lending agency l'nr lM performance of LLa Ne,work for which this permit is issued(Sec.3097,Civ.C.) D-1 Q Lender's Name z Lenders Address U Q 1 ccnify Net 1 have read Nis application and sum Nat Ne&Wye information is LL P correct.I agree,to comply with all city and county ordinances and state laws miming to C)V building consuumion,and hereby amhorim epesenutims of this city to enter union the r above-mentioMd property for inapeeti.n purposes. G (We,)agree to scout,indemnify and kap homeless the City of Cupcnino against H N liabilities.prigmces.eosts and expenses which may in anyway acres against said City U Aconsequence NDERTANPgranting fNis count. ^ in tom CAgN ce of Me RSnAN SAND ILL COMPLY WITHAL ON-POINT Issued by: Dale Y �CtSL X�oNl�o i � 'l!/5/0J Re-roofs Si aturc ofCTc .lot Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or fore building occupant nom or handle h tum ous material az def red by IW Cupertino Municipal Coca.Chapter 9.13.and the Health and Safety one ScNmn 2ss3z(a)? All roofs shall be inspected prior to any roofing material being installed. ❑secs 9au Will the applicant or mer:building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it havallous ail contaminants defined by the Bay Ama Air Quality Management all new materials for inspection. District? ❑Yes Nu 1 have read!the WvaNnusmamrials equimmen.under Chapter 6.95 of the Califon fila HcalN&Safety Codc,Seton.2550515533 and 35534.1 undersmnd Nnifthe building doer not[unto y have a mvn4 Not it is my responsibility m nosily acupant of Nc me cher maplimniuvuanec.faCcruficam0 an Signature of Applicant Date Ownermoubmdndlige I Dam All roof coverings to be Class "B" or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building De artment JOB.ADDRESS: I a 3OJ T &A yyl S , a PERM v o"r o 1 02 OWNER'S NAME: R&TZ WV�q PHONE # ' S GENERAL CONTRACTOR: FAX # U 8 /- c15 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 mr Glass/ Glazing Heating r 3 15 Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO vsz> aloes SUPEkTINO PERMIT APPLICATION FORM Date: AP1V # Building Address: 1 X385 b Owner's Name: Phone #: cl� . N60 7d5 /l L�5q Contrac one:� � _ License #: a3lS Pa' � Contact Phon : vvll Cupertino Business License #: Building Permit Info: l Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description YVl C� Residential ❑ ommercial ❑ For Residential InLta jlations: Attic ❑ 1" floor 2nd floor❑ Adhere to min set back requirement❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ ost of Project: Type of Construction: Occupancy group: Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BRENIAIRFIAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL / BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bid Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License / UILDING