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04010043CITY OF CUPERTINO `� ` 1n11 I e `_ , " *"�''' BUILDING DIVISION PERMIT CONTRACTOR INFORMAT-ION � s s.., ,rev, _ nULLDINC ADDRESS: WEIGEL MECHANICAL & REFRIG PERMIT NO OWNER'S NAME: PERMIT t59UEDATE 7 NE: SANITARY NO. CONTROL NO, ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH (� (� LICENSED CONTRACTOR'S DECLARATION' Job Description 1 Wreby affirm Net 1 am licensednsedunderunder provisions of Chapter r 9 (commencing escrlP with Section ]gk))or Division 3orthc Bu' dPrufcssions Cndc. and myliccnsc is mmum qdf_' b,f' J`h�/�%Oi ) License I,.. INSTALL HEATER (HERIZONTAL UNIT) DdIC Contractor eE ARCHITECTS DECLARATION I undcrsWnd my plans shall be used as jmb c ommods - Licensed Professional OWNER -BUILDER DECLARATION - 1 hereby affirm that I am exempt from the Commmms License Law fur the Following reason. (Section 7031.5, Business and Professions Code: Any city ur county which mquirca a permit to consuucl, eller, improve, demolish, or repair any structure prior m its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contrwtur's License Law(Chapmr 9 Sq. Ft. Floor Area Valuation (commencing with Section 7") of Division S of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation or section 7031.5 by any applicant for a permit suncect the applicant to a civil penalty of 3Y1E�IY W31beI00 Occupancy P Type not more than five hundred della. (2500). Y ❑ I, as owner or the pmpmty, or my employees with wages m their sole compensation, will do the work, and the sc umme is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of Required Inspections property who builds or improves thereon, and who does such work himself or through his Own employees, provided that such improvements are not intended or offered for sale. If. wner- however, the building or improvement is sold within one year of completion, the owner-builder �'� �� builder will have do, burden of proving Nal did not Wild or improve fur purpose of W sale.). ❑ I. as owner of she property. am exclusively contracting with licensed cunvactora to \I La 2004 JAN o OO,g JA construct the project (Sec. ]044. Business and Professions Chile:):) The Contractors Li- IY O Y cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projecb with a contractor(s) licensed pursuant to the Contractors License Lew. BUILDING Lie exempt under sec. , B B P C for this reason Owner Das WORKER'S COMPENSATION DECLARATION I hereby affimr under penally of perjury One of the following ccelsoations: I have and will maintain a Cenificale or Common to self -insure for Workers Compcn- "alio. On provided for by Scetion 3700 of the IaWr Code, for Ole performance of the walk for which this permit is issued. 0 I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of She Labor Code, for the performance of tire work for which this permit is issued. My Workers Compe tion ins renin caricnntl Policy nu Wram: 2l7 me Pvlic No.: U / CERTIFICATEO XEMPrION WO� COMPE SATION ICE (This section need nmbecu ndculd if the permit is for onehundred dollen (51011) . or less.) 1 certify that in the hurt rrnamm, of the work for which his permit in issued. 1 shut] net employ any Person in any manner w as W become subject o the Workers'Compensation - - Laws of California, Date Applicant _ - NOTICE TO APPLICANT: If, after making Ibis Cenificam of Exemption, you should become subject to Ne Worker's Compensation provisions of the Labor Code, you most forthwith comply with such provisions or this permiuhall W deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constmeinn lending agency for Ne performance of the work for which this permit is issued (See. 3097, Civ. CJ Lenders Name Lenders Address 1 certify that 1 have read this application and "Wm that the above information is - - chimed. I agloe to comply with all city and county on inareas and slam law" relating to building construction, and hereby authorim representatives of this city to color upon the above-mentionedpropeny for i s. - which ox,onseh (We) agree Io save, indemnify and keep hadmla. the City of Cupertino against cama may in any way accrue against mid City ts,the qunce PPP inof Aconsequence of the granting of this permit. granting or this mit. i L APPLICANT UNDERSTANDS AND WILL COMPLYt0`TH ALL NON -POINT SOURCE REGUL S. 1/ issued by: Date " i kt`0 Re-roofs Type of Roof lithium or Applicam/Conlracmr Dam HAZARDOUS MATERIAZrMSeeOSURE Will the applicant or future building Occupant some or handle havar0om material a defined by the Cupenino Municipal Code, Chapter 9.12, and the Health and Safety Cedac❑Ycs ctien zss32(a)1 - - All roofs shall be inspected prior to any roofing material being installed. Will use - If a roof is installed without first obtaining an inspection, I agree to remove the applicant or mro,.ldfng aiupam equipment or devices which It hazardous air conmminanB as def od� the Bay Arca Air Quality Management all new materials for inspection. istrim1 ❑Yes Nu 1 have mail the hwardtms materials requiroments under Chapter 6.95 of the Odifor. ria Health le SidedYCode, Schmos 25505,25533 and 25534. I undcrsmnd that i(de Wilding does not curendy how a Wheat, that It is my res si ad ty to notify the rccup., of the out merits.' albmel ucpnortoiaa cent. 'fieamoroccmancy. ` 4 Signature of Applicant Date roof coverings to be Class "B" or better own rauthorizcJegenl DateAll kCITY OF UPEkTINO A CITY OF CUPERTINO , [ �� 7"-3 FURNACE/AC `T PERMIT APPLICATION FORM APN # 2, � 6 � � � r� Date: ^ ' /v Building Address: BREMFURN A p MECHANICAL Owner's Name: Phone #: MECHANICAL BREMAIRHAN Contractor: E ` Phone: D L Licensse : a Contact: Phone: Cupertino Business/ License #: Building Permit Info: BSEISMICRE Bldg ❑ Elect Plumb Mech 0 Job Description: � � �� Residential V1 Commercial ❑ EPERMITFEE ForR idential Installations: ❑ ❑ ELECTRICAL Attic—ls floor 2°a floor Mech Permit Issuance Adhere to min set back requirement ❑ PPERMITFEE or Commercial Installations: PLUMBING eplacement same weight ❑ Additional weight (structural calcs) ❑ Bldg Permit Fees Structural Calculations required for new installation ❑ l BPLANCHK New installation Planning Approval Required ❑ BUILDING Cost Pro' It Type of Constructi Occupanc gr / �I S, ppe On Platform ❑ Bonded ❑ Sq.Ft. Floor ea: New Location Re lacem Qty. if/� Fee ID Fee Descrintion Fee Groun 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 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 ,�3,6( 1