05090171 (2) CITY OF CUPERTINO va I ""`i aFwf
BUILDING DIVISION PERMIT i,CoN C1R[1CMAT".I
BUILDING ADDRESS: SUPREME AIR SYSTEMS v"an"DQ5090171
20366 VIOS
OWNER'S NAME: I PBRMITLSUB DATE
ANH NGUYEN 80 GILMAN AVE 09/26/2005
ONE: SANITARY NO. 'CONTROL NO.
(408) 376-0406
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u0o LICENSED CONTRACTOR'S DECLARATION /)
I hereby affirm that I am licensed under provisions of Chepu+9(commencing Job Descriptl0llyly.j ji
with Section 701111)of Division 3 of NU Business and Pmfessimu Code.and my licenseel
m inn rase an`en �N U b(0 7 REPLACE FURNACE & ADD A/C a® ,
yr, License CIALc.•
n
Data Comncror x,sa / I S
q ARCHITECTS DEC ALIec les �—
�2 I wWersunJ my plana shall be used u public record,
6 V
L u Liccmctl Professional D O
xgh OWNER-exempt frDECLARATION
4<f I hMaso ,(firm that 1 1. exempt from Nc Canins Ca License law for 1M
p yO whicfollowing r moan. Panda I ID3 L;eusinas and ve.de Professions Code:Any city or county r, ( •�
[ 4. widish its
.Also reCOMlmel,,linc, lfor su,demaRib.ms a sig Anyedrmaelant ��17 {/ 13(](](]
Y_Z 9 tprior hat be is ecroad c,elate requires me,tie,pions of for Comoch Permit m file a signed(ummem l
< (c-Amm nxnwth So em 7")of
Division
3 dm Connnessauecne iaw(chepmr9 Sq. F[. Floor Area 4 IURt '
,Sp$ that Mnc oncepth5mtioun and f but,r,3 oft alleged
exemton.AnProfessor.CMc)or
3� tiro he u exempt iMm(rom and the baso for Ne alleged esempuon.Any violation of
Section 7031.5 by any applicant for,permit ubjects the applicant w,civil penalty of Occupancy Type
not mom than 0w hundred dollar,(5500). P y pr•J P
Laxowneraldta property,ur moralmu de wiNwNeeso Nab sere 044.8 sins,
will dothewent,Cds;The umuser's Lndcdm Law
apply 70 M,owner of Required Inspections
and Profession Code:The Canuecmf,and
who law dam or apply lf an owner of q P
propenywyces,pdaorimprow,dereommdwha arnsuchworkhimtelfar Waugh Ms
awnver.th building
uiprogdr iNal suchimprowmemsamne caurMedmalfemd ran owner.
Wilder.Nebue ftmimProwmantis sold within Sear ofImpolve far theeawmf
Wilder will Nw de burden of proving then he did int build m Improve for puryose of
momJ.
❑1,AN owner of the property,am exclusively contnering with licensed contractor,to
construct the pmject(See.7044,Business and Professioln Code:)The Contractor',LI-
cchne law does not apply to an owner of property who builds or impmvm lhemon,and,
who contracts for such projects with s co inecror(s)licensed pursuant to the Contractor',
License Law.
❑1areexemplaunder5m, .B kPCfar Nu moon
Owner Dam
WORKERS COMPENSATION DECLARATION
1hemby,fli, under Mostly of perjury ane of Ne following dodanuolu
1 Mveand will maintain a Certificate ufComsen to selRluum fm Wm1mexCampen-
modon,As provided fm by Section 3700 of W Labor Code.for me serformence of the
work for which this permit is issued.
❑I haw and will maintain Wmkeri Compensation Inaurece,As required by Section
37M of the Loom Cada,for the performance of the work for which this permit is Issued. '
My Worker,Compensation insure carica LsuojFap!�y number am:
Carrier.A4
A J i2 fS erPoliry No.:
CERTIFlCATE Op EXEMPTION FROM WORKERS
COMPENSATIONINSURANCE 7_Ct1-3f-7,0?-c 0
Cnbse wreedmtbecmnpleetl Iftiepermit4fmanchundreddollen(LIWI
or less.)
1 certify that in the performance of the work for which this Permit is Wood,I,hall not
employ any person in any customer an As in become subject to the WorkersCompensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT.If,,fur making this Certificate of Exemption,you should
become subject to the Workar's Cam pensulan provision,of the Labor Code,you mum
.,Q foMwit comply with such provisions or this permit Mall be rumored marked.
y " CONSTRUCTION LENDING AGENCY
t-n iN+ I barely alBrm Nal Nem tea mmuucdo.lendinj agency far use performance of
IY Ne.,it her which this permit Is issced(See.3007.Civ.C.)
0.25
Zanders Name
.7 Z LeM el Address
J Q I really that 1 have read this application And,site that the above Information I,
D.1-! corms.I agree 0 comply wit all airy and county on imine;and,um laws mladng to
8 building construction,and hereby Autumns representatives of Nis city to enter upon the
Liz Nhove-mentioned property for Inspection purposes
. (We)Name to move,indemnify and keep harmless the City of Cupertino against
.y ,n Ilatnithii,judgmenu,toss and expenses which may in my wry seems against said City
U
FFFF7777 In cam armee f Ne granting of to Permit.
APPLICANT NDER NDS AND LL COMPLY WITH ALL NON-POINT Issued by: Date <2.(y-G(-
SOURCE R LAT70
sigwumaf App VCon r`�semr 2-76-0 Re-roofs 1 '
Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum building oceupa ,more or handle hao dous material -
o defirad by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
lniadmu;
nNm
tla.Scotian xss3z(a)7
❑Yea €t Na All roofs shall be inspected prior to any roofing material being installed.
1 Will the applicant or future building occupant use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove
It haordaus air commandmentscommandmentso defined by the Bay AMA Air Quality Management all new materials for inspection.
❑Yes Fuw mI haad the boaidnus materials requirement,underChapter 6.95 of the Cilimr-
thSafety Cam,SaUms25505.25533mu12S534.lundenuMtsifde building
not c ally be a rai huampoo bility m mWnodfy the oupanh ofuimme which Ins 'octal smart, ruficamofoceupmicy. Signature of Applicant Date
Owref.riut rivotla end Dom
All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
$ Cupertino CA 95014
Telephone(408) 777-3228
� CITY OF Fax(408)777-3333
UPE(�TINO
Building Department
JOB ADDRESS: PERMIT#
�C�IC�WIos a r7 f
OWNER'S NAME: e w PHONE # 3q 3—
GENERAL CONTRACTO] L, rS�-s4e FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating A G
Insulatio
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO c�
`rt FURNACE/AC
CUPEVINO PERMIT APPLICATION FORM
APN # � 16 0
//9v Date: 2 ,Z , �.
Building Address:
�v3gb U , nt
Owner's Name: Phone#:
Yl u 3y3 - c�g��.
Contractor: SU 2 YNQ r S S i�vn� License#: -7116 6,b-7
Contact: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect 0 Plumb C;I- Mech
Job Description:
iv ( Nn a-ce
Residential Commercial ❑
For Residential Installations:
Attic EP I" 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 El
Cost of Project: Type of Construction: Occupancy group:
1 � oo0 -- 4vA-G
Strapped LJ On Platform El Bonded 0 Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. if
Applicable Fee ID Fee Description Fee Group
/ BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVFR 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
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
x/ 77. ° '�