03070197CITY OF CUPEWrINO
7777, € ++says
BUILDING DIVISION PERMIT
,+. j, %,_
gON'TRACTOR INF,URMA.T.IQN�'4
-
BUILDING ADDRESS:
14 -AC; WUNT)RRTTCjj MR
ATLAS HEATING
PERMIT ND03070197
OWNER'S NAME:
155 SAN LAZARO AVE
PERMIT ISSUE DATE
E:
(408)739-0516
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
C� (�
DECLARATION
LICENSED CONnsed
Job Description
1 hereby affirm That 1 am ad ,
under provisions of Chapter ra (CommencingMy11is
P
fth Bd
with Scctiun ]B011)nf Division Sof NC Busincsa tlPmfcssinns Cnde ntl My 11 is
in full foceandor '-1-.0
2 A/C & 2 CI.RCIUTS
a _
•REPLACE
Da a
ARCHITE SOECLARATION
I understand my plans shall Mused as public records
��p —
�E�!
Licensed Pmfesainne)
OWNER -BUILDER DECLARATION
I hereby aexempt
affirm that I am cacmpt from the Contractor's License Law for thefoll
maso II13Lmed.5. ana Pm@anions Code: Any tiny
guiresa
/'1 O 20
JAN -�
whichtic , or repair any swmurc
which requires a Permit alter, softens,
cnnswn, aloe nt
�7
04
Permit
prim sea its issuance, also requires the applicant for Con pmmi' w Glc License signed nalcmem
e. also re for such
is
Sq. F[. Floor Area
p��' Valuation
ec«nWithSection")ofDiamon3mecnmmetnranProf�w&Codeer9
(that Comm@c Business and A Code) or
(Commencing Section7")and
that
III,iu
DI
he is the on. Any
is Bumpy thcmlmm and the basis rte the alleged exemption. Any violation of
that bad. far the eaxe
37516033.00
Section anyapplicant for Permit subjccu to applicant to acivil penalty of
�
- - ' - APN Number
Occupancy Type
P Y
not more
nm mere than five hundred antlers tssoo).
($50)
YP
I, as owner of the props ny, or my employees with wages as their sets compensation,
will do the work, and the slNCIYR Is a., Intended ofoBered for sale (S., 7044, Business
—
and Professions Code: The Comfacmri License Law does not apply to an owner oftt''OBs
properly who builds or improves thereon, and who desessuch work himselfor thfeugb his
303 - ROUGH I�L
own employees. provided than such improvements are not intended oroRercd for sale. If,
304 — ROUGH ELECTRICAL
however, the building or improvement is sold within one year of completion, the owner -
builder will haus the burden of proving Nat he did not build or improve for purpose of
505 - FINAL ELECTRICAL
Cale';'
507 - FINAL PLUMBING
❑ 1, as owner of properly, am exclusively confessions with licensed contramors i-
ct the Ponce, u-
ces,
and Professions Code:)Omproves
SOS - FINAL MECHANICAL
Lawdes tapply to
cense law docs not apply to en owner or properly who builds or improves Nemon, and
an Remus.
who Comment for such projects with a contractor(s) licensed pursuant to the Convaclofs
Lacu
License Law.
❑lam exempt under sec. ,BAPC for this rcuan
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penally of perjury one of the following declarations:
ave and will maintain a Cenificao of Consent to ulGinsurc for Worker's Compmr
n, as provided for by Section 37M of Ne labor Code, for Ne performance or the
'
work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as required by Section
00 of the labor Code. for the performance of the Work for which this Permit is issued.
CnmPetSpSstion Insunnp earlier and Policy n12
Ca iC1: 1J s �
Cartier. /K✓C_.L L/I/JI. KW. •Lff sLav� Policy N
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not bm CumP)eud Hire Permit is fir one hundred dollars (SI00)
to less.)
1 taffy than in the performance of to work for which this permit is issued. I shall not
employ any Person in any manner so as sea become Subject o the Workers' Compensation
Laws of California. Date
APPlicanf
NOTICE TO APPLICANT: IL after making this CcnlfiCam of Exemption, you Should
become subject no the Worker's Compensation provisions of the Labor Codc, you must
forthwith comply with such provisions or this Permit shall he deemed awaked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm Nat there is a construction lending agency I'm the performancc of
the work fur which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
1 certify that 1 have read this application and sum than the above information is
Cmrecn. l agree to Comply With all City and County ordinances and shot laws relating to
building conswction, and hereby allthOriM representatives of this City no enter upon the
above-mentioned property for inaremion purposes.
(We-) m save, Indemnify and keep harmless the City of Cupcnino against
gme
in..iliesmseno thicoatsend osteoses which may in any way eceme against ssid Ci(y
in cnnuqucncc eRh smiling of this pc 't.
APPLICANT U RSTAND A LL CO Y WI�'H ALL NON -POINT
SOURC E TIO
Issued by: Date
Re -roofs
Type of Roof
9
Signature of ApplicaMComfacmr Dane
HAZARDOUS MATERIALS DISCLOSURE
Will dim applicant or future building s<cupenl smrc or handle havarduus tamorial
as defined by the Cinnamon Municipal, Code, Chapter 9.12, and the Health end Safety
udc. Section 25532(a)?
❑Yea gni
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
haeardnus air conurnots;az define y the Bay Area Air Quality Management
all new materials for inspection.
let?
❑Yes u
I have mad the havaNuus materials requirements under Chapur6.95 of the Califon
iia Health A Safcny Codc, Sections 25505, 25533 and 25534.1 undersand their Ja huilding
docs non Carmody hove a unam, that in is my respoasihiliny o audit the accepann of the
reyvircmcntsw'ch most Mmet prior tissuancc arta CcrdGoateof Oe- pan=t.
Signature Of Applicant Date
All roof coverings to be Class "B" or better
Ow m tab
07/25/2003 12:45 5105303262 LEGALITIES INK
CITY OF CUPERTINO dS
FURNACE/AC
�UPE�uvo �'�� ]PERMIT APPLICATION FORM
i
1
PAGE 02
Q�• 3c�-s'
lZe.w. S'
APN # 3 7r16o3.
Date: 2 .Si a3
Building Address:
l0 q3 55 1,t�..t�;M �
BUILDING
Owner's Name:Phon
#:
o �a 7 -3 q 7 7
Contractor, Phone,
�✓D-a�; �,
License #:
u.GC�
BREMACO ' ER
Contact: t, Phone:<L�
CupertirSo,Bipess License*
C� 6
Building Permit Info:
i
BREMAI IN
Bldg O Elee1. Plumb
M�epch
�—
Job Description: C2�
BREMREC81JT
Residential Commercial ❑
ELECTRICAL
For ResidentialIn llations:;
BSEISMIC ` :,
AttiCI" floor Intl f100'
BUILDING
dhere to min set back regvire' eut
I EPE_ FBE
or Commercial Installationo:
Replacement same weight. ❑ ,i Additional weight (structural talcs) ❑
ELECTRICAL
Structural Calculations require for new installation O
MPERM E
New installation Planning A oval Required ❑
MECHANICAL
Cost of Project: SZ Type of Construction:
. t �' • d"D .
Occupancy group:
Strapped ❑ On Platfortfi Bonded ❑
Sq.Ft. Floor Area:
I,
2
New Location Re la�ement�
Z
Qty. if�
Annlicnhlr. FP', m Fee Descrintion Fee Groun
BENERGY
Energy
BUILDING
BREMELIMRelocation
of Furnace
MECHANICAL
BREMACO ' ER
A/C Unit > 10,000 cfm
MECHANICAL
x
BREMAI IN
A/C Units <= 10, 000 cfm
MECHANICAL
BREMREC81JT
Rec tl, Switch & Outlets
ELECTRICAL
1
BSEISMIC ` :,
Seismic Fee Res
BUILDING
411�• W
I EPE_ FBE
Elec Permit Issuance
ELECTRICAL
�
MPERM E
Mech Permit Issuance
MECHANICAL
PPERMUFEE
Plumbing Permit Issue
PLUMBING
BPER? F&T5
Bldg Permit Fees
BUILDING
BPLANCH -
Plan Check Fee
BUILDING
BUSLIG
Business License
BUILDING