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04120013C CITY OF CUPERTINO''rte��7ay{"�*��'"'""` sirkn;'' WIN ORMATION - - - BUILDING DIVISION PERNUT �OL{TA'CT, x BUILDING ADDRESS: A PERFECT CLIMATE PERMIT Nfb 4120013 1351 POPPY WY OWNER'S NAME: PERMITISSUBDATE FHAILESH JOSHI 10570 S DE 4 ONE: SANITARY NO. CONTROL NO. (408) 861-9545 ARCHITEC ADIGINEER: « - BUILDING PERMITINFO - - BLDG ELECT PLUMB. MECH l� t� C= l� LICENSED CONTRACTOR'S DECLARATION liaaneed CWpter 9 "t Job Description - - 1 Macby .(fico ma,1 am a rev.. as of (common ctio d10)uf Oivlslon 3 armeB Profaufam Codcand myliceuo is PWN full ands 2Lk 'Z3 REPLACE FURNACE LI n ser De 2 I C nuaomr - ryr, �l•11 ' 1 ARCHTIECI-g R TION ` l u d my plass shsil be uaW bile seLmrdt Licensed Professionaln OWNER - ON BUILDERDECLARAT RATION I hereby 1 from ma UcmW Law for - AM. that mnempt the following won. (Section AD 1.5, Business and Pmfesalum Code: Any city or county S which requires a permit to construct. eller, Improve, demolish, or repair any $=turn j!1) ,-$2000 , -Sq. Ft. Floor Area Valuation ' fourb lB iUUA=.AIW RQu1R11IM applicant for such permit m file a signed Niemen dmheieRcenredpunuanttotheProvisions o( the Convacmrs Usama Uw(Chapter9 )of Division Se Business Prorerrfou Code) or (commencing with Section 70WMile aM Wt W m exempt therefrom and the bads (n the allegW assumption. My Attl idun of r , /.' 8 ,�, n,.';l -Occupancy Type Section 7031.5 by any applicant for a permit subjects me applicant er a civil penally ofL not mom than five handled dollan(M). ❑ L As owner of the property, army employees with wages As thecirsolecompensation, —'' - l - Required Ins ec. at WII MNewicas and.: he Tan ower Commons Law aoea not apply lf rt owner of ns License Law and Pmhsuou Code: The Convaemrl. Ld apply. ectioni q p - oveu th who much weak himnl(o duoagh his pmpeny who who imm,and yees. pro ided t Ar NMmoQeW fmnle.IL amemployee,provided Wthinane)w ofcamoetico, me hawar provemimpwwmwtartve You th{aims ofpmAthaold builder will Nw W WNW o! proWng W, he did not build er improve for puryoe of will have ❑ 1, As owner of me property, am exclusively connecting with licensed contncton to construct the pmjeer (Sec. 7016, Business and Pmrrasiom Code:) The Contractor's Li- cense Law does not apply an an owner of property who Wilds or Improve thereon, and, who contracts for such Projects with a contrecmr(s) licensed puraent he the Commerce, License law. ❑ 1 Am emap, undo Sec. . B R P C far this moon eriAsw DamWORKER'S COMPENSATION DECLARATION 1 Itcra ly affirm under penalty of perjury one of the following declarations:I law end will mainW n a Cenmifcam ofComat to self -issuer (or WorkelsCapen- ti... u provided for by Section 3700 of the labor Cade. for dm performance of. me work for which this Permit Isisssmd. ❑ 1 have and will maintain Workers Compensation Insurance, u required by Section , 3700 of the Lobar Code, for the performance of the work for which this point, is Issued. -- - - MyWorkersCorepensadonluumnttcarrierandPolicynumber=:' �5 2q Ca .Z1 wvcrS Poz;n.4J1R L3 CERIgFlC O YORKERS' OMPE SATION3 NS COMPENSATION INSURANCE ('Ihhsec6on nod notbecampleted lfrW penult is form hundred Oil= ($100) or less.) I certify that In the performance of the work for which this permit Is Issued. I shell not employ any porton In any manner an as in became subject to the Worker' Compemation Laws of California. Data,- Appficanr NOTICE TO APPLICANT, If. mutln{ cola Certificate of Exemption, you Nous become Subjectinit Wohero Commutation provisions or pose Labor Code. you roue Com forthwith comply with such provision at this permit Nall W deemed matrd. / CONSTRUCTION LENDING AGENCY I Wmby affirm Nat them is a construction lending agency for the Performance of the work fm which min permit is issued (sec. 5097, Civ. C.) Lenders Nemo . Lender's Address I certify that 1 have red this application and Nm that the chow tnmmr.due ta correct. I agree in comply with all city and county ardirr noes and stain Ism misting to Wilding construction, and hereby audio ize representatives of this city to cow upon the ahowCmandoncd property for inspection purposes. ' (We) As— In, can, Indemnify and hep harmless the City of Cupertino againstliabilities, judgments, coats and expense which may in my way acerve against said City / I. consequence of me granting of this permit APPLICANT UNDERSTANDS AND COMP Y WITH All. N% - INT /� / Issued by: Date 44 SOURC REGU ONS.' Re -roofs �- — o 3 A of .plica.---A-Wmr � Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tier applicant or future Wilding aceupanl nom or handle ha mloe material AsOcMed by the Cupertino Municipal Code, Chapter 9.12, W the Health and Safety sa , sedan 25532(01❑rat roofs shall be inspected to any roofing material being installed. R4All prior If a roof is installed without first obtaining an inspection, I agree to remove Will ft applicant or future building occupant use equipment or devices which emit hammoe air contaminam a de0ncd by the Bay Arca Air Quality Management all new materials for inspection. District? QYas 1u I hew road me hvallou ma hrnm' menuunder Mpu:r6.95arme Caffor. r. nh Hcaltb@safctycad0.S 505,25533 d25536.lunhmnsthnifOe Wilding Jan no, currently Iran A tenant that It u my retijansibility At Amity sic occupant of the A'an mquimm now' ,Were priorsi roan era erdnaa afocenpanry- Signature of Applicant Date All roof coverings to be Class "B" or better Ow r aurhod>c0 agent Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: 3 o a Co , C''��tso PERMIT # b 4 Zo613 OWNER'S NAME: ie- sL ' BUSINESS NAME PHONE # LkbW sylok—q 5 GENERAL CONTRACTOR: -'�oe-2-aLt FAX # I am not using any subcontractors: 41 f'ln d -o, / i f 6 Sia a Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass./ Glazing Heating G-} Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date 1 CM of 1UPEkTINO CITY OF CUPERTINO v� 2 6 ? F L1RN ACF/AC / PERMIT APPLICATION FORM APN # r Energy Date: Building Addre Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfin MECHANICAL Owner's Name: A/C Units <= 10, 000 cfm Phone #: -7aS-osi-W 0 i140 Rec tl, Switch & Outlets ELECTRICAL contractor:^ ^ Pho U Ru I R License al I y C n ct: Phone:Cupertino � 2,-c0 a ls�q V� Business License #: f�om Uri 1- Elec Permit Issuance ELECTRICAL Building Permit Info: Mech Permit Issuance MECHANICAL Bldg ❑ Elect Plumb ❑ Mech Job Des iptjon: Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee Residential Commercial ❑ BUSLIC Business License # For Residential InS_ta llations: ❑ Zk ❑ Attic 1" floor 2"d floor Adhere to min set back requirement ❑ or Commercial Installations: eplacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction: 2-G a-3 ddu Occupancy group: Is P-14- .UU —p-+ Strapped On Platform 19 BondedA C Sq.Ft. Floor Area: ❑ =�C)C)C7 New Location Replacement Qty. if AAn1i'cable� Fee ID Fee Description Fee Group 'BENERGY Energy BUILDING /BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfin MECHANICAL BREMAIRHAN 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 Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License # BUILDING -0?�/ ``. 0/