Loading...
03080122 crry or cotaaaTlr o z CONTRACTOR INTORMATION.,.a BUILDING DIVISION PERMIT BUI LONG ADDRESS: N P CONSTRUCTION PERMIT NO 03080122 1 53 T<T7NTwnnm A77 OWNER'S NAME: 416 MARTIL WY PERMIT ISSUE DATE R A '"E' (408) 942-0520 SANITARYNO. CONTROLNO. BUILDING PERMIT INFO ARCI{IITCT/ENGINEER: BLDG ELECT PLUMB MECH C� 0 ipp LICENSED CONTRACTOR'S DECLARATION Job Description 'Lep I hereby affirm IM1at 1 am licensed under provisions of Chapmr Y(commencing p r�}� ?Zw with Second 7000)of DivisionJn(the Business and Professions Code,and mY license is >>„ tnLumrceannerpact' REPLACE FURNACE & ADD A/C s raZ Liceasc Class Lica 1-w Dare Commetar ARCHITECTS DECLARATION JAN 0 2 2004 aa,:a I understand my plans shall be used as public records )au onLicensed Professional 'reg OWNER-BUILDER DECLARATION OI�n�II full n(,�n/�'! a Y 1 hereby affirm that 1 am exempt fru.the Contractor's License Law for Inc v IC.I U/(f��'f WJ a O following bottom.(Section 7031.5,Business d Professions Coda:Any city ad county e m which requires a permit it,construct.alter,improve,demolish,ter repair any structure o"^ prior us its issuance.also requires the applicant forsuch permit o lilt a signedsatemcnt c?a that he is licensed pursuanun the powisinssaf the Cnntracmr's Licer.Daw(Chapter 9 Sy. Ft. Floor Area Valuation eFG (commencing with Section 7WE of Division 3 of the Business and Profcssinns Code)(it that he is exempt therefrom and the basis for the alleged exemption.Any violation of 359310 Section7031.5 by anympuicantfor apermitsubjects the applicant to acivil penally of APN Number Occupancy Type not more than rive hundred dollars($500). ❑ I.as owner of the property,or my employees with wages as their.sole compensation, pTT77����T��p-r Is�f� will do the work,and the socclum is not intended or offered for sale(Sec.7044,Business — UGH I[L�li'YI'e61ARections and Professions Cuda:The Contractor's License Law due,nut apply to an owner of F61 �+ property who builds or improves thereon,and who aces such work himself onhlough his 303 - ROUGH M CHANI AL own cm ploysives.provided that such improvements are not intended or offered for Pic.if, 304 - ROUGH ELECTRICAL however.dm building or improvement is sold within one year of completion,Ne owncr- builder will have the burden of proving that he did not build or improve for purpose of 501 - FINAL ELECTRICAL ENERGY Il,as 502 - FINAL PLUMBING ENERGY lJ 1,as owner of the propersy,am exclusively contacting with licensed contractors to constmct the project(Sec.7o44,Business and Professions Code:)The Coovactors Li. 503 — FINAL MECHANICAL ENERGY cede Law does not apply to a a owner of property who builds or improves themoo,and 505 - FINAL ELECTRICAL who contracts far such pr cs with a enntractor(s)licensed pursuant to the Contractor's License Law. 507 - FINAL PLUMBING 01 tundcr Sec, a ,B&P C for this rcasnn — mte811:71(a.- an �� a3 508 FINAL MECHANICAL WORI i'S COMPENSATION DEC ATION Ihemby alldm under penalty of perjury one of mlNlowing declarations: 1 have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided far by Section 3700 of the labor Code,for the performance of the work for which this panni is issued. 1 have and will maintain Workers Compensation Insurance,as required by Section 37W of the tabor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insumnee carrier and Policy numMr,arc: Cameo Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (iris section need nm be completedif the permit is baone hundred dollars fi Rs)) or aid.) 1 ucnify that in the performance of the work for which this permit is issued,I shall oat employ any ocramn in any manner so ax,it)become subject to the Workeri Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making This Cenilleate of Exemption,you should become aunject to the Workers Coupcoestion provisions of the Labor Code,you muss Z forthwith comply with such provisions or this pandit small be deemed revoked. z O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency ler the performance of lYi > he work fur which this permit is issued(Sec.3097.Civ.C.) W Q Lender's Name, Z Le der's Address CJ 0 1 ecnify that 1 have read this application and swte that the above Information is W H correct,i agree to comply with all city and county ordinances and state laws relating to pU huildiogconswction,and hereby authoore representatives of this city menorupon the ahovcmcmioned progeny for inspection W purposes. (—' W (We)agree to save,indemnify and keep harmless the City of Cupettion against p] liabilities judgments.costs and expenses which may in any way scene againsl.wid City U Z Ia eonscqucnce of the gaming of this permit. ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date rMULATIONS.e � Sf2 yJo Re-roofs ApFlic JCnntractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Ne applicant or future building uaeopmosande ar handle himarduus material y the Cupertino Municipal Cade,Chapter 9.12,and the licalth and Safely n 25532(x)? All roofs shall be inspected prior to any roofing material being installed. es [�Nuthe applicant or future building occupant use equipment ter devic,,;whimIf a roof IS installed without firs[obtaining an inspection,I agree IO remove ars aid canmmimmus as deflacd by the Bay-Area Air Quality Mare,bacat all new materials for inspection. ❑Ycs RNu I have mad the hamNous materials requirements under Chapter fi 95 of the Califon nim hr, d &Safety Code,Seeded 25505,25533 and 25534.I understood i1ma Ne,building does not currently have a mmanl,that 11 Is my responsibility to n my the occupant of the regw enrewbienmaatbe.elpnadmissaaneenracertircamarOcempanay. Signature of Applicant Date wood ad arltnari.d agent Dam All roof coverings to be Class "B" or better 2- J CITY OF CUPERTINO !7� C' FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN# J 2, b Date: — / S)2.2 fz©c3 Building Address: 1 I S 'j I<EN I W 06D Owner's Name: M Phone#: /108 - ti H 6-9135 Lf Contractor: p0 Phone: License #: (�j "PAto&—Ss$g-1'27g Contact: Phone: Cupertino Business License#: I Building Permit Info: Bldg ❑ Elect Plupib Mech /LJ ' Job Description: Wiz,) Residential Commercial El For Residential Installations: Attic ❑ 1s` floor ❑ 2"d 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 ❑ Cost of Pn jec Type of Construction. Occupancy gro r 2, Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: / New Location ❑ Re lacement AIBPLANCHK . Fee ID Fee Description Fee Group BENERGY Ener 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 EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL Alh PPERMITFEE PlumbingPermit Issue PLUMBING BPERMFEE BldgPermit Fees BUILDING Plan Check Fee BUILDING BUSLIC Business License BUILDING