03090050 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �CQNTRACTQR INII'QRMATION
BUI LONG ADDRESS: MAGIC MECHANICAL SERVICE PERMITNG.03090050
OWNER'S NAME: 1681 MILROY PL PERMIT ISSUEOATE
KNIGHT GFORGE, T ANT) JOAN T. 'RU 09/0R /200-;
NE' (408) 978-6181 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� l� t� Q
!00
LICENSED I a.CONTRACTOR'S DECLARATION
f 1 hereby firm Net 1 em licensed under provivions of Chapter 9(commencing Job Description
s� with Section of Division 3 of the Bus. and Pmfcu.nns Cole.end mylicenule
mmnro er`m �w-24 z 2 REPLACE FURNACE & A/C SIJ
y q Z Liuenu Cl Lmm 9/— 'yam
Date Con
3 —A ITECI'S LARAT J/ a
I se pian y plans,hall w used es public rants 91a
\7
.'oy. Liccnul Pmfessionel
q y OWNER-BUILDER DECLARATIONute
2<E 1 hereby affirm on 1 em exempt from dm Cnnuactoo License Law for my
0o followingreason.Permit
103 onstr t,Business and w.do inlf Code:Any tiny or county
5$ which its requires a Pcmit re construct,alter,nt for such
h Perm tt or repair ed structustatement•Z i prior m its issuance.p ensu on to Me the
ovisio cam for such pcm.uo file e,Law sotemcan
@ < (ffiat he commencing wpuramuothepmviviomnfMe oftheBracmfsnimucssions taper's Sq. Ft. Floor Area Valuation
N! Met he is examwiththerefromon and M basis
r Me alleged
exemption,
Any
ladenCoxi or
Nn he is exempt tang applicant
p li and the aper for the objects
th exemption,Any viordon of 36936019 . 00
not...Section 7031.5 by anymars( permit abjeco the applicant to,civil penalty of - APN Number Occupancy Type
not mart Nm five hundred dollen(5500). "' -- - ——
I,pe owner arms property,many employcn with wages as Meir mit compensation.
will do Ne wolk,ead Ne structure is not intended oroffertd formic(Sec. Business — L
and Prafessions Code:The Conlnclor's License Law does not apply m an owner of 3 0 3 - ROUGH CI-IAIQI ALOns ,
property who build,or improves Hereon.and who does such work himmiror Mmugh his
ownemployces,provided Hu such haporwrou nu arc non intended.,.deiced farssle.If, 304 — ROUGH ELECTRICAL
however.He building or improvement is sold within am year of complcdon,He owner.
builder will haw dm burden of proving that he did not wild or improve for purpose of 505 - FINAL ELECTRICAL
pele.)' 507 - FINAL PLUMBING
❑L u owner of the properly am exclusively contracting with licensed contractors to --
cauuuatthepmnott(Sec.oaa,wnerof and rtywhoomcodabThewshu tan. reU.d 508 — FINAL MECHANICAL
eco contracts law dose non apply loan Nth a of property wre wilds or improves thenen,and,
whoom,Lawfor such projects;veld acmtrumr(q liunsetl pursuant to Un Conuators
Litems Law.
❑lson exempt under See. .BkPCfor this reason
Owner Data
73011WORKERS COMPP•NSATIONDECLARATION
I hereby alRm under pemlly of perJury oro of the following dcdarmiom:
I ban and will maintain•Certificate of Consent to self-lasum for Worker's Compom
M
on,u provided for by Section 3700 of He laver Cade.for Me performance of the
k for which this permit is issued.I have and will maintain Workers Compensation Wurance,u required by Section
of He Labor Code,for the performance ar He work for which His permt is issued.
rker'sC llo In,up noteartierandyNo.: G�:y6,23
IC ` �ybg¢noliry FROM
CE'ITIFICATEOFE ON FROM WORKERS'
COMPENSATION INSURANCE
(Thr.,if.need not hecompleled If nhe permit is for one hundred dollars(SIM)
or less.)
1 arufy Met In the performance of He work for which His Permit is Noted.I shall not
employ any person in any manner sou m wcomc subject to the Workcri Compematlon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Cenificate of Exemption,you should
become subject m He Worker',Compensation provisions of Me Laver Code,you must
�O forthwith comply with such provisions ar thisPcrait hall IN actuated revoked.
M CONSTRUCTION LENDING AGENCY
I handy M.last Here ra construction foolingagemy for the perfomm.of
]$ do work fur which this permit is issued(Sce.3091.ON.C.)
QLenders Name
z Lender'sAdd.
O 1 certify that I have mad this application and state Het He above information 1,
Pcorrect.I agree to comply with all city and county ordinances and some laws relating to
U wilding canawctim.and hereby authonn repfemmadvas of this city as enter upon He ._
W aware-mentioned progeny for iupecGon purposes.
4 G (Wc)agree to save.indemnify and keep harmless the City of Cupertino against
rag liabilities,judgments,costs and expenses which may in any way acerae against mid City
:.)Z in coon uenec of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
RCE REGULATIONS.
—v, Re-roofs
ignature of Applin norData
HAZARDOGS MATERIALS SCLOSURE Type of Roof .
Will Nc applicant or future wilding oaupant store or handle huudom materiel
as defined by the Cushman Municipal,Code.Chapter 9,12.and the Health and Safety
ode.Section 25532(x)1 �{' All roofs shall be inspected prior to any roofing material being installed.
A ""
C Yes
Will the applicant or future wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I havardous air conuminans,as defend by do Bay Area Air.Quality Management all new materials for inspection.
atricO
❑Yes
I have nW the hvamnusmateriar requirements under Chapier 6.95 ortho Califon
nix Hcal"SalclYCWk.gccdms 505.25533ud2553e.lundcmand HmifOnwikling _
Joys not camaml,have a uman .t is my rtspeadihow,to or,the occupant of He
nequimmenow 'chmusn prior to intanca or a C,mreate arParty Signature of Applicant 'Date
at or authameJ gem Da� All roof coverings to be Class "B" or better
CITY OF CUPERTINO 0 3 cl v oO
FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN# i� . 017. Date:_
9 9-13
Building Address:20 3$6 G L
Owner's Name: Phone#:
oa
Contractor: o Phone: License#:
Contact. Phone: Cupertino Business License#:
Building Permit'Info:
Bldg ❑ Elect ❑ Plumb mecb ❑
Job Description:
/fie >f�•r�w . Xv/��'=
Residential PLI Commercial ❑
For Roidential In&lladons: ❑
Attic LJ 161 floor LJ 2nd floor
Adhere to min set back requirement❑
For Commercial Installations:
Replacement s e.weight ❑ Additional weight(structural calcs)❑
Structur' alculati required for new installation ❑
New i allation Planni g Approval Required
Cost f Project: Type of Constru ti c / Occupancy out
-5-13z' (�
Stra ped ❑ n Platform Elg�Bonded Sq.Ft. Floor Area:
New Location ❑ Re lacemearl!! `
Qty. if
Appfigable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
EPERMTTFEE Elec Permit Issuance ELECTRICAL
MPERMTTFEE Mech Permit Issuance MECHANICAL
PPERMTTFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License, BUILDING