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04010073CITY OF CUPERTINO ' 'x �-•' "r BUILDING DIVISION PERMIT YrrFoxMATlo�v ,CONTRACTt�R EUILDING ADDRESS: 0-74n r)RT TNE CT A PERFECT CLIMATE PERMITNO04010073 OWNER'S NAME: PERMIT ISSUE DATE ONE: _ SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRSDECON Job Descriptiontion 1 hereby af0rm that I am licensed underProvisions of Chapter 9 (commencing _ withSection 01 Division Jofthe Busincxnd Professors Codnmy license is in full foeand offet License ClassLlc.a REPLACE FURNACE 'FINALED Date Comucmr ARCHITECTS DECLARATION IunticnunJ my shall the used as JAN N 1 6 x5004 L plans public records FI1Y O Licensed Professional OWNER -BUILDER DECLARATION 1 bonds, a(Sce that 1 oto exempt from the Cnnlrns Lew per the - BUILDING maso Co :Any. following moon. it 703L!,Business and Professions Code: Any city or county which Tits iss s erten alter, improve, demolish, or repair any structure permit re cores n prior m its issuance, also inquires the applicant for such permit m files signed summcnt the, wit purstion7 h) Contractor's Law (Chapmr9 Sq. Ft. Floor Area Valuation of Divisnsmthc (commencing with Section ]0lnd of Division 3 (co me cing Prod the Business and Professions Code) or Net li and the Amis for the alleged Any violation of is exempt any Section applicanttt pplICO to p omtan 6yaundreddollarfor apermit subjectsNeapplicanuoacivilpenalty of 3 L.9�gr00 Occupancy Type P not not more lean 0w hundred nonan (5500). y YP ❑ 1. an owner of the progeny, or my employees with wages m Nair sole compensation, will do the work, and the structs isnot intended or offend for sale (Sec. 7044, Business and Professmo; Code: The Contractors License Law dons at apply Io an owner of Required Inspections property who builds or improver themon, and who does such work himaelf or through his own employees, provided that uch improvements are nut intended or offend for sale. It. however, the building or improvement is sold within one year of completion, the own.o- builder will have the burden of proving that he did not build or improve for purpose of sale.). I.,t/1, as owner of the property, am exclusively convecting with licensed contractors to ebtDwa the pmjcel (Sec. 701 Business and Professions Code:) The Comnctor'a Li. came law does not apply to an owner of property who builds or improves Merton, and who contracts for such projects with a contractor(s) licensed pubmanuo the Convectors License law. &P C for this ma ❑IIom exempt under Sec. ,B son / WORK 'SCO NSATION DECLARATI /Y NS, , 1 hereby affiml under penalty of perjury one of the following declarations: 1 have and will maintain a CeniOcan of Consent o selFWinume for Workers Comped. cation, SO provided for by Section 3]00 of the Labor Code, for the performance of the work for which this permit is issued. 03I have and will maintain Worker's Compensation Insurance, m required by Section 3]00 of the tabor Code, for the performance of the work for which this permit is issued. . My Workers Compensation Insurance carrier and Policy number aa: Carrier, Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ('Dissection need not he completed If sn<permit is rotor. hundred dollen DIO(d ver less.) 1 certify 0.1 1. the performance of the work far which Nis permit is issued. I shell noI employ any remain in any manor an at in become subject to one Worker'L'ampersatlon Laws of California, Data Applicant NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisinns or this Permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that then is a consurie inn lending agency for dm performance of the work for which this permit is issued (Sec. 309], Civ. C.) Lenticr's Name Lenders Address I eenify that 1 have read this application and sure that the soon information is correct.) agree to comply with all city antl county ordinances and sole laws relating to building construction. and hereby authorise representatives of this city to cover upon the ahow-mentioned properly (or Inspection purposes. (We) agree to new. indemnify and keep menders the City of Cupertino against liabilities. judgments. cote and expenses which may in any way seem= against acid City /// / In consequence of the of this granting permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT (/ Issued by: Date � D SOURCE REGULATIONS. Re -roofs Type of Roof gra ofAppinzHA RDOr MATERIALS DISCLOSURE Deu Will the appsictum lir Aitme building occupant store .,handle hazardous maRnd m defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Oda, sc❑ction 2ss32(a)] secs f2fNu All roofs shall be inspected prior to any roofing material being installed. Wirt the applicant or future building occupant ua. equipment or devices which If a roof is installed without first obtaining an inspection; I agree to remove mit hazardous air contaminants m defined by the Bay Arca Air Quality Management all new materials for inspection. Disvicl] ❑secs Nu )have marl Ne h.. sus materials requirements under Chapter 6.95ofthe Califor- mts Health & SafetyCade, Satiate 25505,23533 and 25534.1 understand that ifthe building does not carnally hove a unanl, Nat it is my responsihility to Mary the occupant of the regmmm.nts which mall Acte 1pnorlo nsuence of a Cemficam of Occupancy, Signature of Applicant - Date a r5V All roof coverings to be Class "B" or better caner ar thon'rcd ageDate CC CITY OF UPEII;TINO CITY OF CUPERTINO FURNACE/AC ° PERMIT APPLICATION FORM APN #� 2 Z OPb Date: I -ice- a� Building Address: 7Lrp Or Owner's N*e:n WX- loo- n r%,.,) ��v Phone #: &-b8,41-4z Z� (/ 33 Contractor: Phone: pe,)ma-Xa License #: 7z a i �F Contact: Phone: Cupertino Business License #: Building Permit Info: A/C Units <= 10, 000 cfm Bldg ❑ glect ❑ Plumb ❑ Mech Job Description: 6114 ELECTRICAL BSEISMICRE Seismic Fee Res Residential ❑ Commer al ❑ BSEISMICOM For Residential Installations: BUILIDNG Attic ❑ ls` floor ❑ 2nd floor ❑ Elec Permit Issuance Adhere to min set back requirement ❑ MPERMITFEE or Commercial Installations: MECHANICAL Replacement same weight ❑ Additional weight (structural calcs) ❑ Plumbing Permit Issue Structural Calculations required for new installation ❑ BPERMFEE New installation Planning Approval Required ❑ BUILDING Cost of Project: 2-7 Z ` 0 w Type of Construction: 7 Occupancy grou ,�— BUSLIC Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replace nt Qty. � �nnl' ab3�e Fee ID Fee Description Fee Groun BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 Ciro 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 O O�Z37