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04050069 CITY OF CUPERTINO '"^ ''* ' ``"" BUILDING DIVISION PERMIT CONTRACTOR'-INFORMATION �-_ ra N BUILDING ADDRESS: REDWOOD PLUMBING CO INC PERM"904-050069 OWNER'S NAME: PERMIT EiSUE DATE JOHN N L ONE: SANITARY NO. CONTROL NO. (650) 369-1793 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 L O p LICENSED CONTRACTOR'S DECLARATION y�C 1 Mmby affirm Net 1 em littnua under provisions of Chapter 9(commencing Job Description �Zyr with uo 7000)of Division 3af the Bu' and Profcesrms Code,soa my imenu is '�« mrmlr aerr«�� 53y�/ REPLACE FURNACE & ADD A/C, pn �^ j ? Liccnx n Lk.x p 2�camme,in ow�nD r.fi,.-ei,.�u INSTALL PUMP ROOM A/C TO RO M'�ABOUE G,' �E pp ARCHITECTS D ATION unacrsund my plans shall be used as public mcems zdu C D 2004 3 LLLicensed Professional ' ia S OWNER-BUILDER DECLARATION' f 1 berehy affirm Nat I am exempt from the Conuanors Licenu Law for the pe� 00 following meson.(Seetion?1131.5,Business;and Profecdom Code:Any city or county �IkO����pgq_ sad which requires a permit to co.(.alcor.Improve, mra.huh.m teras,any awemu Y i d as prion.its i.......Is..,.I.lhcapplicati for such remit o file a signed cutement < Nu he is licensed pursuant the provisions of NC Contractors Licenu Law(Chapter 9 Sq.Ft.Floor Area Vah{�tiag675 �5 (commencing with Section]000)of Division 3 of the Business and Professions Coulc)or — that he is exempt thamfrom and he basis for the alleged caemption Any violation of Section 7031.5 by A"applicant fora permit subjects the applicant in a civil Penalty of APN Number Occas Type not mom than fwe hundred dollars($500). Occupancy YP 01.uownuo(thepmpeny,ormyemplayeuwithwmuNeemlecompemflon, 36617090 . 00 will do Inc work and thcawctum isnot intended osoRertd forsale(See.?ON,Business and Professions Code:The Conuxcmri License Law docs Out apply an an owner or Required Inspections property w ho bui Ids m improves therm n,end who dors s uch.,it himself or through his Own employees,previded that such impmvuments are not lmendcd moRered for sale.If. however,the building or improvement is sold within one year of mmpletion,the owner- builder,will have the home.of proving that he did not build or improve I.purpose of sats J. ❑1,as owner of the progeny.am exclusively contracting with Itttmed contactors m construct the project(Sec.?Dar.Business and Professions Code:)The Contractors Li- ttNe Law does not apply to in owner of property who builds or Improves NCRon,and who contracts for such projects with a emu.or(s)licensed pursuant to the Comoseme, License law. ❑1 am exempt under Sec. .B&P C far mia ream. Owner Data WORKERS COMPENSATION DECLARATION 1 hereby affirm under Penalty of perjury,one of the following declarations: L.f I have and will maintain a Certificate of Consent to self-tnsuxfor WorkersGompen- s olo n,as provided for by Section 3700 of the labor Code,for the Nmonnance of the work for which this permit is issued. ❑1 have and will maintain Workcts Compemation Insurance,as,required by Section 3700 of the labor Code,far the performance of the work for which Nis permit is issued. My Wm ,,Compmmuon Insuranm caner and Policy num are: t;r.,P Pa,;a NA: lG 5 $R51 t CERTIFICATE OF EXEMPTION—FROM WORKERS' COMPENSATION INSURANCE (This section need notbecamphned ifrhe permit is forom hundred dollen($1010 or less.) 1 certify that in Ne Nor.....of the work for which this permit is issued.I shell nor employ any person in any manner an as to become subject to the Workers'CoreNnsation Laws of California-Dam Applicant NOTICE TO APPLICANT:If,army making this Ccnificam of Exemption,you should become subject to the wohe/s Compcnvtion provisions of me Lalwr Code,you most .J 0 forthwith comply with such proviuom or this per nitshall to dimmed revoked. z 'i CONSTRUCTION LENDING AGENCY Iz Thereby aRrm that Vert isndSe.Construction lending agency for the performance of rL 7 the work for which this permit is issond(Sm.309?.Civ.C.) Irl Q LndName =z Leendersre, m Aee .< U Q 1 certify that I have,rad ties application and state that the show information is it,f" COMM I agrm to comply with all city and county ordinances and sum laws relating to O V Wilding conSWcllaq and hereby auNmlS mpremmatives or this city In enter upon me 0. mel.mcnuoned property for Inspection pulp..,. ( agree to sae,indemnify and keep harmless the City of Cupertino against Er fA Iiabibfies,judgments,casts and a.,.which may in any way...agriml said City C)z Inconsequence UNDE STANDS Athis ND WILL COMPLY WITH ALL NON-POINT CE REGULA Issued by: Date ` 5 f3 c _f Re-roofs S; a of ApplicanuComracmr HAZARDOUS MATERIALS DISCLOSURE Type of Roof tll the applicant or fumm building omupmn at=or handle huamous material as defined by the Cupenino Municipal Code.Chapter 9.13,and the Health and Surely odic,Section 25533(!)7 Ycs �7f/J/'{ All roofs shall be inspected prior to any roofing material being installed. � l n If a roof is installed without first obtainingan inspection,I agree to remove Will the applicant to future building acupam sex equipment or devices which P g mit haramous air contaminants as defined by Be Bay Arca Air Quality Management all new materials for inspection. District? ❑Yea {(��R/9 1 have read Ne huammismamrials nquixmcros under Chapter 6.95 of the Califor. ma Health&Safety Cade.Seniom 35505,35533 and 35534.1 understand Net if the Wilding docs notc mly have• arta wtau my remeraihility m roily de occupant of the be On tawMcnm n dor m ism.m.fa ccoill, antro Sign ature of Applicant Date Own .r cath. zcdagcm 5 m All roof coverings to be Class "B"or better Community Development ' �� 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 #UPEkTINO Building Department JOB ADDRE �1 p IT # 1435 4n1L2 4,4a- OWNER'S ,4¢OWNER'S NAME: Joi+N L it., PHONE #(65o,) 3 GENERAL CONTRACTOR: FAX # S— I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followm information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating p Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock He /Contractor Signature Date CITY OF CUPERTINO L FL1R1'vACE/AC IUPEkTINO PERMIT APPLICATION FORM t . APN # 3G(,i-7Ogo Datr 5�2 c4 Building Address: � Owner's Name:( Phone#: OS g73- 17(3 Contractor: Phone: License#: PwmBiN� �o G�� 369-/793 5 3v3/ Contact: Phone: Cupertino Business License #: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech a Job Description/,n ms,v ov �,ocn 8n� o nxp can+a 7o Ami o 3;0onO 7 - ` By Atoor pa,"4> Poon. AIL TO �oom Q�vB G�o�a-m Residential © Commercial ❑ For Re idential Installations: Attic l' floor ❑ 2nd floor❑ Aftdhere to min set back requirement 441por Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required Cost of Project: Type of Con ct onj Occupancy i �5 G75 ea 1 Strapped ❑ On Platform-0— Bonded ❑ Sq.Ft. Floor Area: New Location t Replacement if A l ale Fee ID Fee Description Fee Group BENERGY Energy BUILDING Ul BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfrn 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 3 ��. � z