04030143 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,CONTRACTOR,INFORMA.TION
BUILDING ADDRESS: UNITED AIR COMFORT PEBMLT"°04030143
11044 HOLLY TRF.F. T.TJ
OWNER'S NAME: PERMIT ISSUE DATE
Alba JAMES CHU 5819 N ANDREWS WAY cz19no4
40
ONE: SANITARY NO. CONTROL NO.
(408) 771-8967
ARCHITE=I]NGINEER: BUILDING PERMIT INFO
1 BLDGELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION Job Description
C I bunchy affirm that I am licensed under Provisions of Chapter 9(mmndg
men
b wiNScction7M))ofDivision3ofdmBusinm"PmfcuimCode.andm licensees
in mnecf FIN4
LEDjqi . S & /
Z. o Dao: ntnator
ARCH 'S DE O ,1
�i IuneersmnJ my Plans rc MAR 2 6 2004
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30 LicensedProfcssianal
OWNER-BUILDER DECLARATION BUILDING
I Wrthy.(firm(Section n,11. exempt from dte Cosions C s License Law far tW
np0 followingmnson. archei7(*1.5,Business and Pe,iletons CWC:Any city Of County
$�i which requires o permit re air construct.alar,imforsu demolish, fi repair any atmewa
PA.m its issuance.alw requires the applicant for such permit m files signed mmmcm
NatW is licensed purauanuotbe previsions of the Contractor's License law(Chapter9 Sq.Ft.Floor Area Valuation
�$ (commencing with Section 7")of Division 3 Of the Business and Professions Cadu)or
— Wt W u exempt therefrom and de buss for the alleged eaemptfoo.Any violation of
Section 7031.5 by any appliml for s permit subitm the aPPlhcam m a Civil Nasty of 3 2PDAiall hber0 0 Occupancy Type
not more don five hundred dollen(5500).
❑L u ownar of the pmpeny,or my employees with wages u their sele ca fTeroa ton,
will do the work and the structure isnot intended asof(cad forage(Sac.7W.Business
and Professions Code:The Conuaemes Licensa law dote trot apply w an owner of Required Inspections
peTany who Wilds orimprovea thereon,and whodoessuch work himselforthmugh his
own employes,provided that such improvements art not intended oroRe cul total&If.
however,the W ilding or improvement is sold within one year of completion.to owner.
Wilder will have the Womm,of proving that W did not Wild or improve for purpose,of
sale.).
I,as owner of the prapeny,am exclusively contracting with licensed comm,me,m
construct the project(Sec.7614.Business and Professions Code:)The Contractor's Li-
comm law does not apply W an awna or peopeny who Wilds or improves demon.and.
who contracts for such projects with a eontraton(s)licensed Permian w the Contracwls
License Law.
1 am exempt under Sec. .B A P C for this(won
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hemby off rte under penalty of perjury am of the following declarations:
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have and will mainWn a Canificam of Consentto self-insureforWorkcYsCompen-
n.u provided for by Section 3700 of the labor Code,nor t e performance of the
k for which this permit is issued.
bave and will maintain Worker's Compensation Insurance,u required by Section
Cir the labor Code,for the Kdo m ince of the work for which this permit Is luued.
Warkcfs pryytion Iruurymac artiv and Polity numticier. lyrf^•" Paliry No.: J'7 G fo 3 O O
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
(rl,is action need not W completed lithe Permit is foram hundred dollar($IIX)
or Ices,)
1 certify that in the pe fnrmance of the work for which this Permit is issued.I shall net
employ any person in any manner se as w become abject to the Workx Comsmosatfon
lawn of California.Dew
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
Weome subject in the Week.',Compcnudon provisions of on,labor Cade,you must
O roMwith comply with such p rwisums w this permit shall W deemed evoked.
z N CONSTRUCTION LENDING AGENCY
,
E1 bcmhy aRnm that thea iso emearuetinthe n lending agency for anforman.of
> Ne,weak for which thu pem,it is Wood(Sec.3097.CO.C.)
W A lender's Name
d Lender's Addmu
V p1 Certify that 1 have read this application and slaw that the&hove infonmadun is
f•' caracL 1 agree 10 Comply with all city and county onlimmax,and nam laws relating he
O V Wilding consuucnion,and hereby author&repreanudvin of this city to enter upon tW
W abovetu.judncepmTeny fond expenses
purposes.
f~6v (We)agree w eve,indemnify and keep harmless tW City of Cupertino against
h liabilidu.judgmcn¢,cosla and eapcnscs which may in any way&cmc against aid City
V z in cansequcnce of the ung of th' pc
^+ APPLICANT UN ST L COM WIT ALL NO Issued by: Date
SOURCE Ri
IS/u� Re-roofs
Sq...ofA,li.VCan.. Dae
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant stere or handle hazardous ma ctial
as defined by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
Code.Schon 255320)?
Yu I &W— All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment in devices which If a roof is installed without first obtaining an inspection,I agree to remove
I,bawrdnaa air Co..,..nm as deflated b to B Arta Air Quality Management all new materials for inspection.
1d..n.lcu
Yca
1 hart mail the hazareous materials aquimm rds undrChapter 6.95 ofthe Califon Hcahbh SafctyCade.ScctioUxD505.25533 an12553a.I wWemmnd that ifthe Wilding
rcn,ly a wnanL ,it' responsetymnotily do accupem of dteairemannwh aR I ancear IftiFIO.Mceeap r. Signature of Applicant Date
3IS�e t F All roof coverings to be Class"B"or better
Owner or authato,cd agent D
Community Development
10300 Torre Avenue
au
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEf�TINO
Build' De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: PHONE # 30 — 05
X GENERAL CONTRA R: #
)C I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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
O;vn
er/Contractor SigKature Date
10/28/03
CITY OF CUPERTINO
FURNACE/AC d 3
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:Ila y l
�—
Owner's Nan n n Phone#:
Contractor: hone: License#:
a�� - 9B $-/o ss '7s 7.5 9b'
Contact: Phone: Ste— Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech
Job Description: ��
z.t = v7/
Residential Commercial F1 'J
For Re idential In tallations:
Attic LJ I" floor Ll 2nd floor❑
. Adhere to min set back requirement❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structuralEl calcs)
Structural Calculations required for new installation
New installation Planning Approval Required ❑
Cost of Project: Type of Construction: Occupancy group:
�l LIDO - 6-b
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
/ BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
1 BSEISMICRE Seismic Fee Res BUILDING
EPERMITFEE Elec Permit Issuance ELECTRICAL
1 MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
z/ /.