No preview available
03100185 CITY OF CUPERTINO '' _ ' � amLnwc mvlsloN PERMIT <CONTRACTQRINFORMATIION ,BUILDING ADDRESS: AAA FURNACE & AIR CONDITIO "i( VIC103100185 10441 MILLER AVE OWNER'S NAME: 1712 STONE AVE PERMRLSSUEDATE BARBARA SANDBERG 10/27/2003 NE (408) 293-4717 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 30o LICENSED CONTRACTORS DECLARATION l u F I hereby affirm that I am rift,Business i under and Professional of chapter 9(commenting lob Description s� With Section 9UIM))nf Divixion3 of Ne Business end Prufcuinns CsWc,and my liccnu is jo infulifome and c(e T!s Llc g CHANGE FURANCE Z Liande Claw GV Cmatritair 47" EE A W DEC ATLON 1 W 3 I undcmanJ my plans,hall shall W used as public records FINALEO is o LiccnseJPmfcasicnel MAR 1 5 2004 OWNER-BUILDER DECLARATION 11 a F 1 hereby affirm that I oro exempt from fee f Contractor's Co :Any c Law for fey .00 followhich re rayon.sect(anti t 1 coon.; Business andmpr ve.Professions h.or Any city it county 5$ which requires a Permit m crammer,alcor,improve.for such demolish,orerepair anygned structure $1700 -iy prihe or in its issuance.aalso uantto ns tMvision of for Contractors onractor s icense W(Chmmem o BUILDING (commecingwJpuction7 cpmvivismcfmcCausinesiLiandelaw(Code)or Sq.Ft. Floor Area Valuation 3�s (commencingwihSelian1000)nfDivision3ofthe Busincuand Professions CnJc)ser 36915005 . 00 �.. met he is exempt therefrom and use buts for me alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects me applicant to a civil penalty of APN Number Occupancy e not more man Bra hundred dollars(g500). P YTYP wi L u owner .the p.armac or my cmployeu with wagu u (See. 0,14,B orlon, will Pr fieile work,ands:no Contractor's intended Law do far sole(Sec.to an Business and Professional builds or The wis menton, rad who law dots not apply lf an owner is Required Inspections "" property who buildsored lodeshereon,and who dmsalinwork oreffe althrough his own employees,provided that such improvements arc oat CU 017 tl MPlin in.On Owfolsile.if, builder,Neave Our uimprovement Ivsold withinone yeti of completion,me nose of Owner- builder will have the burden of proving Nm he did not build or improve for purpose of plc.). 0 1,as owner of me property,am exclusively contracting with licensed contractors to - coestmct the project(Sec.1064.Business and Pmfwiou Code:)'per Contractor's Li. . cense law docs not apply to an owner of property who Wilda or improves Hereon,and, who contracts for such projects with a contractor(&)licensed pursuant o the Contractor's License law. 0 l am exempt under Sec. B h P C for this rcuon Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury am of me following die aratill raw and will maintain a Certificate of Consenuo sel6iname for Worker's Cumpem sation,ns provided for by Section 3710 of me labor Coda or the performance of the wor for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,u required by Section 700 of On labor Coda for me performance of the work for which this permit is issued. My Workers Coym�erasa Insure/ntt carticr and Policy number art: carticr.k/¢wF"- /fid Polity No.:�jJ/� � CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not W completed If the permit is fnronc hundred dollars ullill nr leca) I Cenify that in the performance of the work for which this permit is issued,I shall not employ any person in any manor se as m become subject to the Workers Compcuaion Laws of Cali nla.Dase Appiieam _ NOTICE D APPLICANT.IL a cr making this Certificate of Exemption,you should Weimar subject to the Worker's ampewtion previsions of the Ichor Chile.you must z forthwith comply with such provisions or this Permit hall W deemed revoked. Z'O CONSTRUCTION LENDING AGENCY I hereby affirm mat them is a construction lending agency for the performance of x Z the duh for which this p nnit is issued IScc.3W7,Civ,C.1 V Y 0 Lender's Name �z Lender's Address ;J Q 1 eenify that 1 have mad his application and show the me a move information is i F colonel.1 Agree to comply wife all city and county ordinances and state laws relating to U building construction.and hereby aahorrae represematiscs of this city to crater upon me „ d shove-memiuned property for inspection protrudes. —, (We)agree w pw,indemnify and keep harmless the City of Cupertino against Oq liabilities.jodgmeab,costa and expenses which may in any way aeeme against said City ..I z in consequence of the granting of this permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date REGULATIONS. 50 CE X" ' Re-roofs Signature of ApplicanVCon cmrData HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store at handle hazudous material u defined by the Cueenim Municipal,Cade,Charter 9.12,cad the Health and Safety do.Section 25532(a)? ❑Yen Na All roofs shall be inspected prior to any roofing material being installed. Will the applicant or rate.building ocil use cquiPmcnt or devices which If roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants u Jerined by me Bay Area Air Quality Management titer? all new materials for inspection. /❑Ycs Nn Ihave reed Or WuNn&materials requirements under Chapter 6.95 of the Cali fon nil Health k Safety Code,Senators;25505,25133 and M5341 underaund Nat if he Wilding Jona not currently how a wnpt,Nat it u m ponsihil1 m notify d¢acupent of the . he qForents which ust be met prior w cauLne.of a certifies.of Occa y. Signature of Applicant Date All roof coverings to be Class "B"or better Owner or aemoriled a en m g W CITY OF CUPERTINO 3 Ulm FURNACE/AC CUPERTINO PERMIT APPLICATION FORM APN# J 6 - �tJr- O©� Date: Building Address: Owner's Name: Phone#: iox z S e, - .3 lea Contractor: �q�1,A License#: o � r Contact: Cupertino Business License#: Building Permit'.Info: Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: ` SIC 4�9 I, u Residential Commercial ❑ For Roidential InAa llations: Attic LJ ls` floor LJ2"d floor❑ • Adhere to min set back requirement E]'' For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural-C-aleul tions required for new installation ❑ New installation Plarming Approval Required Cost of Project: Type of Construction: Occupancy group: 7Op ¢o Stra ed ❑ O Platform ❑/f Bonded ❑ Sq.Ft. Floor Area: New ati Replacement T Qty. if ApOfible Fee ID Fee Description Fee Group 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 EPERMPI'FEE 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 J