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040401050 z 0 O F� W Com. SL C] Uo OU U W U� CITY OF CUPERTINO z� BUILDING DIVISION PERM* BUILDING ADDRESS: HUS'S'EY BROS INC PERMIT N0. o4040105 OWNER'S NAME: PERM1TI55UEDATE /1E: SANITARY OL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION lob Description I am licensed under provisions of Chapter 9 (commencing 1 hcrcby affirm Nn ns p with gcclion7 )o(D sion3ofd¢'BuslnEu entl Pm(cuiuos Cadc endmyliccnu is 10"inlm(a a ermaC..w LX1e R '� �G fI' Dale dREPLACE FURNACE/ADD A/C (2 TON) a��`))) LC derstanJ my planRshall�he u�seB icmcnrds i Liconmd Pmfcuional OWNER-BUIMER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the city nr county' following reason. (Section 703 1.5, Busimcss and Professions Code: construct, which requires a to consct, alter. improve, demolish, or m ab an tm aclgm permit prior to its issuance, xim rcqui. the applicant Romah permit to file a signed netemchL that he is licensed pursuant to the prevision, of the Contranmr'c License Law (Chepicr9a IIn d � 11 l(S &a/iSq I'FI?".FIOor'ACea Valuat on (commencing with Section 7000) of Division 3 of the Businaesand Professions Code) Lir that he is exempt therefrom and the bssis for the alleged exemption. Any violation of 3 rxuAi�#r..w-A.�rO 0 Fl3Nf lB' Occupancy Type Seeder 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not mare than five hundred dollen (550(). - .Tli 0 I, as owner of the property, or my employees with wages as dwlr sole compensation, e Required Inspections 9 p will do the work, and the structure is not intended or offered retain (Sec. 7044, Business and Professions Code: The CornerstonesLieenm docs not donot apply w an owner of property who builds or improves themon, and who dose s uch work hl msel f or thmugb his awn employces, provided Nat such impmwments arc notinwnded oroffemd forulm lf, however, the building or improvement is sold within one year of completion, the owner- builder will have Ne burden of proving that he did not build or improve for purpose of tile.). 0 1, as owner of the property, am exclusively contracting with licensed contractors in comtroct the project (Sec. 7044, Business and Professions Code:) The Contracwrs Li- cense Law dors not apply to an owner of property who builds or improv thereon, and who ornament for imch projects with can VBebr(s) licanted puraaant in this C'ontractor's License law. 0 l am exempt under Sea ,B&P C for this won Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby aRmh under Penalty of Perjury one of the fallowing declarations: have and will maintain a Certificate of Consent to self-iasum for Workc'sCampen- n, u provided for by Section 3700 of the Labor Code. for the performance of the t for which this Permit is issued. 1037.1'1 _ have and will maintain Workers Compensation Insurance, as occulted by Section of the Labor Cade,for the perianmana of Ne work farwhich Nis pemhit isissuetl. Workcra o nsetlan ins rano tamerandPolicy :uc�A' r. Vh Po' Na.: V r CERTIFICATE FEXEM FROMWORKERS' COMPENSATI INSURANCE (This section recd not be Completed if the lemhit is fur ane hundred dollars($100) or less.) 1 certify that in the Performance of the work for which this permit is issued, I shall not employ any person in any mannersn as in become subject in the Workers' Compensation 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 Chat. you must forthwith Comply with such provisions or this permit shall be decreed ranked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that them is a construction lending agency for the Performance of the work for which this permit is issued (Sec. 3097, Civ, C.) Lenders Name Lender's Address 1 ccrdfy that 1 haw read this application and stow that the above information in— correct. I agree to comply with all city and county ordinances and state laws relating to - building construction, and hereby authorize representatives of this city to emwfupna the above mentioned property for impaction purposes. (We) agree w saw. indemnify and keep harmless the City of Cupertino against liabilities, judgmens,come and expenses which may in any way accrue against mid City in cansequcnce of the gnou g of dde permit. APPLICANT UNDE AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATI Re -roofs Type Of ROOF ' attire of Applican✓ or Dew HAZARDOUS KAILS DISCLOSURE Will the epPlicanlor forum buil fincocCupantatorc or handle hazardous materiel as claimed by the Cupenino Municipal Code, Chapter 9.12, and the Health and Safety Code. soYos 255320)? All roofs shall be inspected to any roofing material being installed. prior /app+- If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or u1Y ort building Occupant use equipment or dcvicm which it hmanum air contaminants as darned by the Bay Area Air Quality Management all new materials for inspection. rim? ❑secs Nu I haw mad the ham sus materials requirements under Chapter 6.95ofthe Calimr- meHealth &Safi Code. Section 25505, 25533 and 25534.1 understand that if the hviiding dors not currently a knant, that it 4 my responsibility to notify the occupant of the mquircmpme which t metpmr-wismanccofa Cc 'fcawof c Yy Signature of Applicant Date All roof coverings to be Class "B" or better Owner or smhcomd agcrt Daw 0 0 • Rada k rine �Q�acivrI l ono PAs A,L a "a, t4v-c . 4 A �} cq 73o qn l� d-vrvNlc rtPl�cCw.ew� 40? S+c up L. set �po�o A'PRovely !!DICE WITH THE C /lawful to make , 11 11nes and it is u on same Y jttan permission fr changes or literati n the building Dept Ctr The stamping of this plan and paNtno` SHALL NOT be held to Godo gatio' s approvsl of the violallanpol anyior to he a d eny City Ordinance or to pYuutattf state Law. SCGV�'L V�+IT +u P4 . 11.34411 ;vt a ZOR—p Sw%4&L. rJ Apr -12-04 0813an From -PALM INC • April 12, 2004 408-878-2560 T-067 P.01/02 F-543 • Monta Vista Woods, Inc. 10090 Pasadena Avenue Cupertino, CA 95014 This letter is our authorization for Mr. and Mrs. Bhadury (of unit A-4) to have an air conditioning unit installed outside the building (•adjacentto where two other units are already in place). Sincerely, nary Jones Presik:q is 0 / Y'. r �I ' l / it Sf Treasurer rRQ51 CITY OF UPERTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM APN #A F Date: Building Addressbo 9�0 P r Owner's Name: 2 �,Cj L V A �� e, �a� n �.e Phone #: p F Contractor: Phone: age Dros. (.Ike , YV ( 73 04,v Lice se #: N7s Contact: Phone: Cupertino Business License #: Building Permit Info: A/C Units <= 10, 000 cfm Bldg EY— Elect is--- Plumb Mech Job Description: ELECTRICAL Residential ❑ Commercial ❑ Seismic Fee Res For Residential Installations: ❑ floor ❑ 2"d floor ❑ BSEISMICOM Attic 1't BUILIDNG ikkdhere to min set back requirement ❑ Elec Permit Issuance or Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ MPERMITFEE Structural Calculations required for new installation MECHANICAL New Inst tion lannin Approval Required ❑ -- —> Plumbing Permit Issue Cost o o'e t: Type of Construction: Occupancy group• Strappe ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area------. ❑ Plan Check Fee New Location Replacement BUSLIC ADDUcable) Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfrn 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 CITY OF CUPERTINO 7777, ,n "` r -TOW! BUILDING DIVISION PERMIT BUILDING ADDRESS: HUSSEY BROS INC PERMITNOOY0i010S OWNER'S NAME: PERMIT ISSUE DATE OE:S ANITARY OL NO. I ARCHIIECT/ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH I� LICENSED CONTRACTOR'S DECLARATION - Job Description 1 hereby affirm that 1 em licensed under provisions of Chapter 9 (commencing amnd Professions Code andetylimmais LfnLiao %SIG withSmdm.d [� ry�� REPLACE FURNACE/ADD A/C (2 TONqUNQTQ1aLEARCHam KA.11�publi"2cords MAY 27 2004 Licensed Professional DECLARATION ONaffirmOWNER-BUILDER DECLARATI OWNER-BUILDER I hereby affirm that I from the License Lew for the BUILDING rollowing mason. (Section 7131.5, Business and Professions Code: Any city Or county which require a Permit in construct, alter. improve, demolish, or repair any structure prior to its issuance. also requires the applicant forsuch permit W file a signed statement Net he is licensed pursuant to the provisions ofthe Commetres Licemc Law (Charter 9 Sq. Ft. Floor Area VIE luat on (commencing with Section 7800) of Division 3 of the Businessand Proressiom Code) or that M is attempt therefrom aid ate basis for the alleged exempton. Any violation of 3 "Izr0 0 OccupancyType yp Section 7831.5 by any applicant for a permit subjects the applicant o a civil penalty of not mom than five hundred dollen ($5001. _9VV- O 1, as owner of the property, in my employees with wages as their sole compensation, Required Inspections will do the work, and the structure is not intended m offered for sale (Sm. Business and Professions Code: The Contractor's License Law does not apply WOwner of e nsan Q p property who builds or improves thereon, and who doessuch work himsslf or trough his own employees, provided that such improvements are not Intended oro@ad for pia IL however. the building or improvement is sold within one year of completion. the mine- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1, as owner of the property, am exclusively contracting with licensed contractoa to conslmet the project (Sec. 7044. Business and Profusions Code) The Contri Lt. cameLaw docs not apply to an owner of property who builds or improves ihemon, and, who contracts for such projects with a contractor(s) licensed puauam W the Contractor's License Law. 0 1 am exempt under Sec. . 8 & P C for this maven wnu Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following decimations: 0.1 have and will melanin a Certireste of consent W scif-insure for WmkersCompon- satlon, as provided for by Settle. 3700 of hhe labor Code, for the pecrom encs of the work for which this permit is issued. 0 1 have and will maintain Workces Compensation Insurance, as required by Section 3700 of the labor Code, for the performance of the work for which this permit is Issued. My Wmkefs o ensatIon ins nn. carrier end Policy -44 a c VM Po NO CERTIFICATE M FROM WORKERS' COMPENSATIO INSURANCE , (Thu section need notlmcomplcied ifthe permitu femme hundred dollars (5180) or Vss.) 1 certify that in the performance of the work for which this permit is issued. I shall not employ any pecan in any mamterso a W become subject o the Workeri Compemation Laws of California. DOW Applicant NOTICE TO APPLICANT: If, after making this Certificates of Exemption, you should become subject 10 the Workefs COmpem then provisions of the Labor Code, you most forthwith comply with such previsions "is pmmit shall M deemed revoked. CONSMUCT10N LENDING AGENCY I herchy ocean that them Ise construction lending agemy Wine perluramn. of the work for which this pmmit is issued (Sec. 3097. CO. C.) Lender's Name _ Underi Addmes 1 certify that 1 have mad this application and sate that the above information I. correct. I agree to comply with all city and county ordinariness and sues laws relating W building constree ion, and hereby suthori a mp sseoutives Of this city to emmupnn the above-mentioned property for impaction purposes (We) some m save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, coast and expenses which may in anyway accme against said City permit. in comrquenee ofntm APPLICANT UND WILL COMPLY WITH ALL NON-POINT Issued by:9412�&o Date SOURCE REGUL Re-roofs Type of Roof �444 awrc of DaWAT IS DISCLOSURE Will lhcapl in occupant store or handle hpardous material as dented by We Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Cade, SoYG 25532(x)7 All roofs shall be inspected to any roofing material being installed. prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicam or sal ilding Occupant use equipment or devices which emit hesardous air contaminants as dcrned by the Bay Area Air Quality Management all new materials for inspection. District? ❑YesNu Ihavemadthehav nusmamrialsmquimmonmun&rCMpwr6.95ofdWCalifor- nia Hcalth & 5archycode, Sectrop25505,M533 tend 25534.1 understand thatifWc Milding dam nos currently a want, that it u my responsibility te redly the Occupant or the mquimmcros whit t maprioneiasusnmofacc Thesteor e ' /.0 t' Signature of Applicant Date All roof coverings to be Class "B" or better Owner Or auto. a.d Ogen, Date