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05050109CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTFURINFRMATIO BUILDING ADDRESS: A PERFECT CLIMATE P.MITNob5050109 OWNER'S NAME: PERMIT ISSUE DATE ONE: SANITARY C OL NO. ARCHITEC tENGINEER:BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O 19 ONTRA LICENSED CONTRACTORS Job DCS ®�� under provision I hereby affirm that 1 em under provisions of Chapter Y (commencing �yyD with Section 7") of Division 3 of the Beaten and Professtons Code, and my heense is imm�ra ' `a, Z sasses i� Lrense lee Lw. N REPLACE FURNACE & A/C Dam Co..ARCHITEC - ATION I understand my plans shell W need asspub lc reenrds -� ( G/ 2005 L p��®� Licensed Professional 3 nz OWNER -BUILDER DECLARATION {®J i I hname .(Tian I em exempt from ins Contractors License Law for u¢ b o 2 Cade: Any city or county following damn. (Seita ](131.; Busin..s and Oar on 8 f are. deruns which requbea • Permit a construct, alter, improve, &mulish, or any tatemure e a sig its issuance. Alto the applicant far each Compactor' License Leed statement Chapter thnhcucccneedpuution7 Sq. F[. Fl00rArea Valuation Z< 20 thtrm parental to the t ofDivisioofdeeConlncaceindenscWo Code) or de)or Division roar thea eg eircuantl PmfcAny of therefrom and the aper fu the alleged exemption.in Any that he is (commencingwiththerefrom and the that r 3 ? 8nhS10 0 Occupancy Type l pennon Section 7031.5 by any applicant fora permit subject, the applicant m a civil penalty of io 31.5 b not mom Nen fl. hundred dollen ($300). ❑ 1, as owner of the property, or my employees wide wages as deer sale eompenueon. Required Inspections will do the wart, and eamunure la not intended moRV W Imsar (Sec. 7044, Busircu and Professions Code: The Cantncmrk License Law does not apply in an owner of Property who bull&m improves theman, and whedoessuch work himeelfor Waugh his awn employees, provided Nat such Improvements tae not Intended or offered for sale. If. lament, the building or Improvement is sold within ma year of completion, the awner- bullder. will have ate aurden of proving that he did rot build or improve for purpose of ale.I. ❑ 1, as owner of dee property am exclusively connecting with lianud conuamn to construct the project (Sec. 7014. Realnw and Professional Cade:) The Coauacmo's U. cense Law does not apply to an owner of property who builds or improves thereon. and who contracts for such prejecu with a conuutor(s) licensed poorest to the Consumers License Law. ❑ l am exempt under See .B&PC for this moon ner Dam WORKER'S COMPENSATION DECLARATION I hereby aBirm under penalty of perjury one plum following deelantions: I ham and will maintain a Certificate of Consent to selFinsud for Worker'sCompen- due. u provided far by Section 3700 of the labor Code, fm the performance of me 137.W rk for which thb permit Is issued. I haw and will maintain Worker's Compensation Insurance, pe required by Section of the tabu Cotle. far the performaeafthe work far which Nr permit is issuedyWalpss Compefnssaattion Insurance carrier ad Policy number arerderjeG.✓✓nl%S PoIIryNo,E11.q`4-3?- CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (71d.sectiae need nm Wcomplemd ifdee permit is far.. hundred dollan(SIM) or rat) I certify thus in the performance of use work fu which this permit r leaned, I shall am employ any person in any mantra as at bccomeabject to the Worken Compensadon Laws of Ctlifomia. Dam Applicant - NOTICE TO APPLICANT: If. after making this Omiacaw of Exemption, you should become subject to the Worker's CompcnsNon provisions of the Lahr Codc, you most forthwith 0 ke comply with such provisions or this permit shall M deemed naked Pi CONSTRUCTION LENDING AGENCY I hereby affirm that then is a construction tending a gamy for the puformeraeof > the work for which this permit Is Issued (Sec. 3097. Civ. C.) Nome alender's - lender's Address z Q I certify than 1 haw mad this application and sum that the show infmmatiun in; co�cL I agree m comply with all city ad aunty ordinances and sum Nes relating to E building construction. ad hereby auhodue reprcmm�iws of Om city m emu upon due W show -mentioned property for Inspection Purposes. S (We) agree to saw. indemnify and kap karmkas the City of Cupertim, agalml lag Ilatellitia,judgments, eau ad expanua which may In my soy acne against seed City 7 In cmnequence of IM goeting of this permit. r'n APPL�jjCjAN/gT;�U^NDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date ` / SO/ 4J Aar 0 V.G✓ 7 -.2�'d� . Re -roofs >a�gnnud ofAppliceHAZARDO Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof or hasAans mawrial Will dee or furore building or ban an th , 9.1 U &Baud by ea Cupertino Mune, al Code. CNpwr 9.12, and ea HaIN and Safety n Captains, a Chap otic, Schon 25J32(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yee u If a roof is installed without first obtaining an inspection, I agree to remove Will the applicat ser uwre Wilding oeeupant useequipment or &vices which h hWArdaa air contaminaM pe rind by ata Bry Ama Air Quality Maagameml all new materials for inspection. isuigT ❑ Yu u 1 haw readthehaatdrws mawdais mquinmenu underChapwr6.95 ofthe Califor- niaHuith&Safety Cade,Sadou25503,25533wW25534.1undcnu ftifeabuilding docs not currently hem a tenat. that it is my responnnlllty to notify the corep o, of the aqui,�%gnu which mum betel Piz to inn aCaroll of (Occupancy, Signature of Applicant Date ��Q�?a fir' II } All roof coverings to be Class "B" or better osW 6aw'r'," Own—Win authodmd a gent _�_ Data 1 I am not using any subcontractors: ,, ancG , V.Q.L'c aP 5- 020 -D SignaturV Date Please check applicable subcontractors and complete the following information Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal 4Sheet Rock Tile Owner/ Contractor Signature Date �UPERTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM ,S�S-z 1°7 APN # Date: 54 1 Energy BUILDING Building Address: BREMFURN 22 aSo✓✓lace ✓e,) MECHANICAL Owner's N e: a. Pho e #: 4i aus- Ll 99 a Contract Phone: License #: & l' r1a,51s Contact: one: Cupertino Business License #: Building Permit Info: Rec tl, Switch & Outlets Bldg ❑ Elect Plumb ❑ Mech Job Description: Seismic Fee Res C Residential Commercial ❑ Seismic Commercial For Residential Installations: ❑ ❑ ❑ Attic I" floor 2"d floor Elec Permit Issuance Adhere to min set back requirement ❑ MPERMITFEE For Commercial Installations: Replacement same weight ❑ Additional weight (structural talcs) ❑ MECHANICAL Structural Calculations required for new installation Plumbing Permit Issue New installation Planning Approval Required ❑ Cost of Project: Tyne of Constru�#io�n Occupancy group: +n 50'� 7 l d�, jtl e Ytp tk.) 'i jxM0 e¢ 1 oCah Strapped On Platform Bonded LJ Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if Annlirahle Fee, M Fee Description Fee Group -r el BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAMHAN 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 IJ BUILDING . 0 -r