03090051 (2) CITY OF CUPERTINO +�'� -,aaw '•.atzr " r
BUILDING DIVISION PERMIT C0NTRAGTORANFORMATION -':
BUILDING ADDRESS: PERMIT N003090051
c;71 RRTM WY
OWNER'S NAME: PERMIT ISSUE DATE
ERIC KOO 2003
HE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i x t� 0
Oo LICENSED CONTRACTOR'S DECLARATION -
;,F 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
=N with Scaion]OfAp of Division3of the eu eat nd Pmfe.uml Ccdc.andmyliccnx is
in full fort cffe J
>yz uernx a 'c ADD A/C
i�W m Contract CONTRACTOR: SAN JOSE AIR 1®'I�la���®
ARCHf1EA DEC N
I m U 1 undcrs nd my plans shall he used as puhlie records
°oN LiccnudProessional 0u i 1 ; 2003
g OWNER-BUILDER DECLARATION
<S 1 busby affirm that 1 am exempt from the Contractor's License Law for the !1
00 following rc n.(Section 7031.5,Business and Profrxsions Code:Any city ar county BUILDING m which requires a penuus lt Construct,alms improve,demolish.or repair any.stmewa
Prions its issuance,also acquires the applicant fmsuch Permit to file a signed statement
¢xo that heirficensedpursuant wthe proviswnsoftheContractor's ucenxuw(Chapter 9 Sq. Ft. Floor Area Valuat$1228
dr (commencing with Section 700)of Division 3 of the B usineas and Professions Code)or
that he is exempt thcafrom and the basis for the alleged exemption.Any violation of
Section 703 L5 by any applicant for a Murat subjects the applicant to a civil 3�g(ppdyBerl'00 Penaltyof
not m..mans hundred dollars($500L �- � -..- Occupancy Type
❑ h u owner of the progeny,or my employou with wages as their sole compensation,
will do the work.and the structure is not intended or offered for sale(See 7W.Business R d hS��
and
practical,drofcasaobu Code:The Contractor',becwri nd who Law docs not apply m an rouges of 3 01 - ROUGH PCL B II�7G CtlOn$
Ars,provilds ded
improves theteogandwhodoes
rene tsuch nwmk himulfor throughhis
howownever.the
or improvement
bentissld wBurnot year
of�orortered for xle.If. 303 — ROUGH MECHANICAL
however.Nc building or improvemcm is sob within one year of completion,the owncr-
builder will have the burden of proving that he did not build or improve for purpose of 3 04 — ROUGH ELECTRICAL
rale.). 501 — FINAL ELECTRICAL ENERGY
❑ 1.as owner of ct SeeproPeny.,B exclusively contracting with: Thatlicensed conuactosa w
cenrwnthe esnjen(5ec.nla4,ahe,of ro, ny who
builds
Code:)The Conlaarorm. Li SO2 — FINAL PLUMING ENERGY
caseLow ontmc canpupplywan with
aofprcumps whosedpofimpioves meson.end 503 — FINAL MECHANICAL ENERGY
who contracts for such prgccts wim a convanor(s)licensed pursuant w the Contractor's
E3 lam Law. Date az505 — FINAL ELECTRICAL
❑ lam exempt under See for 507 — FINAL PLUMBING
Owner WORKERS COMPENSATION DECLARATION 508 — FINAL MECHANICAL
1 hereby affsm under penalty of perjury one of he following declarations:
1 have and will maintain a Cur ificate of Conserv to selGinsua for Worker'sCompen-
IC1751W
on,u provided for by Section 37M of dw labor Code,for the pofonnance of the _
k for which this Permit is issued. '
1 have and will maintain Worker's Compensnion Insurance,as required by Section
of he Labor Code,for the performance of the work far which this permit is issued.
Workcr's Compensation Insumnee carrier end Poly�umber are:
C,_ -PolityrvpS+v CERTIFICATE OF Eioril 'PROM WORKERS'
COMPENSATION INSURANCE
to tell.)This.claim need not he completed if the Iennil is for one hundred dollars IS 100)
I certify Nat in the performance of the work for which this permit is haved.l shall not
employ any pcnon in any manner so az w ACCome subject to the Workers'Compensation
Law,of California.Date
Applicant
NOTICE TO APPLICANT:if,aper making this Certlfie 4c of Exemption,you should
become subject to the Worker a Compensation provisions of the Labor Code,you mus
.Z forlbwi to Comply with such Powsomis of this perm it shall be deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
I hereby affirm that mem is a coasVYetinn lending spoor,fm the Performance of
�14 > he work fur which this permit is issued(Sec.189],Civ,C.)
1 Lender.Name
z Leadcr's Address
j Q 1 ramify that 1 have read this application and sate that the above information is
1.P correct.l gore to comply with all city and county ordinances and sate laws relating to
Z)V building consruction.and hereby authorne aprcaenmivcs of this city to enter upon the
W alwvbmentioned Property for inspection purposes,
ti y (We)agree he save,indemnify and kttp humless the City of Cuprnino against
h y t
Iiabilitia.judgments,costs and expenses which may in any way accrue against said City
;J ',z in consequence of the granting of this permit.
^ APPLICANT NDERSTANDS AND L COMPLY WITH ALL NON-POINT Issued b
SOU ESC ATIONS.
fs
ignition, pplicanOC tmctoo a Re-rooignition, HAZ ATERIALS DISCLOSURE Type of Roof
Will applicant orfuwrc building uccupam stere or handle haamrdous material
ode.Section 25332(a)?
y the Cupertino Municipal Cock,Chapter 9.12.and the Health and Safely
0Yes ef'N. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant of future buildingou:a quip If a roof is installed without first obtaining an inspection,I agree to remove
pant esu equipment at devices which g
.0ws air contaminants as Jcfincd by 1M Bay Arca Air Quality Management all new materials for inspection.
:strict?tero
C Yca Nu
1 have read he humorous materials requirements under Chapter 6.95 of the Curl.,
not Herlth@Safety Caddo.scent.25505.25533 and 25574.1 undcrsund mm if thc Wilding
does not currently hat a mmnt,that t y rcspursihility m omit,the nccuPant of the - l
quint 'h mull be met vanee of a CeNficam of Occupancy.
S' t re of plican Date
owner am axed a nt D e 11 roof coverings to be Class "B"or better
CITY OF CUPERTINO
FURNACE/AC
OF
CUPERTINO PERMIT APPLICATION FORM
APN# Date: n
Building Address: /
Owner's Name: Phone#:
Contractor: Phone: License#: C-Z
Contact: Phone: Cupertino Business License#:
Building Permit Info:
2
Bldg ❑ Elect PI m Mech <�
Job Description:
i C.SW �i
Residential Commercial ❑
For Re idential Insta ations:
Attic f ls` floor 2nd floor❑
Adhere to min set back requirement❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculatio or new installation ❑
New installatio annin A r v e uired ❑
Cost oft: ype of Construction: Occupancy cup:
Apo
Strapped jL11 On Plat ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location Re lacemen
Qty. if
Applic4lv 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
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
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