03100087 CITY OFCUPEW11NO M '-mo- - ` y r '" `� ` F• '
nu1LO1NG GIVE PERMIT =,CONTRACTOWINFORMATION +�
BUILDING ADDRESS: A PERFECT CLIMATE PERMIT N0.03100087
04 5S C;j,RNNTTT�W AIT
OWNER'S NAME: 10570 S DEANZA BLVD(408) 861-9545 PERMIT 650EDAlE
ALEX MALON70
NE: SANITARY NO. CONTROL NO.
ARCHITEC/ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�Oo LICENSED CONTRACTOR'S DECLARATION
W 1 heresy arum that I am limesd under provisions of Cha ter Y(commencing Job Description
ii� withscetiun7 0' aian]of the Bu9nnv Prg6 iyex o ,na mylicense is
;Win full fo¢ead f rt U\ ACE REPLACEMENT '
ea
v�z Licenu C Lic.x
p Datc
R CTS DECLi-W
i m�
lumber and. plans shall W used as public mmNs /
�p'F^ Licensed Professional /
) 5 OWNER-BUILDER DECLARATION
<7 I hereby affirm that 1 am exempt roma N
oe Contractor's License Law for the
:p o following reform.(Section 7031 S.Business and Professions Code:Any city lir county
iv(( which requires a permit to conswct,aper,improve,demolish,or repair any strvmum
_Zj, Her m its isamu.malsurcquimsthe applicant roe such permit m file.signeJnaNment
:R< that he isliccnsedpursuanttotheprovisionsoftheComnctor'sLimnschw(Chapter9 Sq. Ft. Floor Area Valuation
di-C) (commencing with Section 7")of Division 3of the Business and Professions Code)or
that he is exempt therefrom slid the,basis for the alleged exemption.Any violation of 3691 1012 00
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of APN Number Occupancy Type
not more Nan rive hundred dollars(S500).
❑I,as owner or the propcny,or my cmployceC with wages a their sole compensation,
will do the work,and the swctum is not intended or offered for safe(Sec.7044,Business 301 - ROUGH 1� $ 'actions
slid Professions Code:The Co minewr's LicenseLaw does not apply to an owner of
property who builds or improves thereon,and who Goes such work himselfor through his 303 - ROUGH M CHANICAL
Own employees,provided that such improvements sre not intended oroffcrW for sale.If. 304 - ROUGH ELECTRICAL
however.the building or improvement is sold within one year of completion,Ne owner.
Wiener will hart the burden of proving that h<did not nava or borrow for purpose of 505 - FINAL ELECTRICAL
sure.).
❑I,as owner of the property.am exclusively contracting with licensed contractors to 507 - FINAL PLUMBING
construct the project(See.7044.Business and Professions Code:)The Contractor's Li- 508 - FINAL MECHANICAL
music Law dors not apply to an owner of propeny who Wilds or improves thereon,and
who contracts for such projects with a conuactor(s)licensed pursuant to Ne Contractors
Lieenxt taw.
❑I am exempt under Sec. ,B&P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION ,
1 herchy affirm under penalty of perjury one of the following declarations:
I haw and will maintain a Certificate of Consent m selbinsum for Worker's Compere
cation,a provided for by Section 37W of Ne Labor Code.for Ne performance of the
ork or which this permit is issued.
have and will maintain Workers Campnnation insurance.a required by Section
of NC labor Code,for the pertarmance of Ne work for which this permit is issued.
Works�p's/C��m� neuron caro"end Policy
Carrier. 1- \1 G]��/�Poliey
CERTI ATE OF EXF.k ION MOM WORKERS'
COMPENSATION INSURANCE
Clhis section occur nor no contpl.ad if the permit is for one hundred dollars 151 W)
lir
less.)
I certify that in Nc performance of the work for which this permit is issued,1 shall not
employ any person in any manner an a ser become wbjecuo the Workcri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should
become Subject to the Worker's Compcmation provisions of the Lahor Close,you must
D.Z foMwtth comply with such Provision or this Milani shall W decreed revoked.
�O CONSTRUCTION LENDING AGENCY
I W rehy affirm that there is•construction lending agency for the performance of
.G 7 the work for which this permit Is issued(Sec.3197.Civ.C.)
37 Q Lenders Name -
� Lender's Address
7 Z
;J p 1 ccnify 0.11 nava read this
ty add Court and sate that the above information is
y E•' correct.I agree to comply with alt city and county oNinaraor and Cute laws relating m
DU show mentioned
eonswctiogand hemhyauthorize reesentatives of this city to cntcruprn the If
Lk1 ehovc(We)fi re to..roperty for inspectionkeepproposes.
,y pv
(We)ague to emoU itinerant and keep a the City of against
against
Z incoidesjuaca costs antl ea whi may ray way accmc against said City / 0 v�
7'Z incprtuqueneca grant this per '. 1/
'-' APPLICANT N ERST DS AN ILL MPLY WE HAL NON DINT Issued by: Date
SOURCE R (U AT10 .
Sit.. eafA Im/C.noracm Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will a plicant orCupkmAan. fimod
future WildingIIe.ChapOccupans 9.12.ore annals Health ns and Safety
al
a defined im the 32(.)' ' l Code.Chapur 9.12.dna the Health and safety
Cale.Section 35532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
suiellWill the a licant for building occupant a If a roof is installed without first obtaining an inspection,I agree to remove
PP6 p .Ail Qu lir MaillC which g
it h.raranus air conmmby Ne Bay Area Air Quality Management all new materials for inspection.
❑Yes
I have real Nc hareNnus mamro"T litsuns4rChapmr6.95orthcCalifor-
I
Hcalth&Safely Codo!fccdon25%5 33re dM534.rOnJ undthuirthe Wilding
s not currently have a¢rant,N. rs my r sponihilityJuwtil'y the cup t rf the
uircmcouwhichmustbc me or ur issu ccora nific ofOc rgrtcyC�/T' Signature of Applicant Date
rar,allorn g=lit .m All roof coverings to be Class "B"or better
a
CITY OF CUPERTINO
SHIMFURNACE/AC 3 C5v U`
7
CUPERTINO PERMIT APPLICATION FORM
APN # (0 I A?-� Date:
BJ/
uilding Address: / lJ
len v I et,-) t9v e
Owner's e: " 10 0 P o e
ContWr.. Phone: icense a ) c
I c> J
Contact: / Phone: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect Plumb ❑ M
Job Description Clop LALP QVJ�GP
Residential 1 Commercial ❑
For Residential Installations:
Attic ❑ 1" floor ❑ 2nd floor❑
Adhere to min set back requirement❑
For Commercial Installations:
Replaceme t-same weight ❑ Additional weight (structural calcs) ❑
Structural Calcula ns iequired for new installation ❑
New 'nstallation Pl nin A royal Re uired ❑
C t of Prot: Type f Construction: j 9� upancy group: L
trapped On Platform E3 Bonded / SSq.Ft. Flbor Area:
Ne on ❑ Replacement ❑
Qty. i
A li e Fee ID Fee Description Fee Group
BENERGY Ener BUILDING
BREMFURN Relocation of Furnace MECHANIC
AL
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
EPERMFI'FEE Elec Permit Issuance ELECTRICAL
MPERWFFEE Mech Permit Issuance MECHANICAL
• PPERMFFFEE lumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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