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06010033 C ITY OF CUPERTINO BUILDING DIVISION PERMIT , CONTRACTORINF'ORMATIQ� :� a7>x'vkm "r.^"iP;�:. :e-..t. . .. .E BUILDING ADDRESS: A & H HEATING 1ERMITNo.06010033 W NER'S NAME: PERMIT ISSUE DATE EMI NAKAHARA 770 CHESTNUT ST 01/06/2006 NE: SANITARY NO. CONTROL NO. (408) 279-0722 RCHmicr/ENGINEER: BURRING PERMR INFO BLDG ELECT PLUMBMECH 3dc LICENSED CONTRACnOA'SDECLARATION JobDescri tion �+ 1 herion 7 affirm that 1 am licensed under and Pri ane anChapter 9(commencingmytiesis p ith Section 7alU)o(Diviaion]of du Business um0 Profesdoas Co@,erW my littme is ^� imm�rareeanaert HEAT COOL UNIT & GAS LINE, qz LkenhaG�assT� �Lic.¢ ;DYa(T Z Dam_L�Gg� :..tmcwr 220 CIRCUIT IN BACKYARD ON GROUND oil ARCHRELT'S DECI.a ATI—oF i understand my plans shall M used As public records y G Licensed Professional OW NER-BUILDER DECLARATION 1 hereby tram that I em exempt from the Conuam e.License law Tar the O o following ruson.(Section 703 1.3,Business end Professions Code:Any city at county 9 which requires a p unit in onestruc4 slur.Impraw,demolish,w repair any structure prior in its issuance,also mquites the applicant for such permiuo file a signed statement g < thatheislicensedpursuantwUuproviaiors,oftheContracmisLiamLaw(Chapsw9 Sq.Ft.Floor Area Valu im10000 @ $ (eemrancin¢with Section 7000)of Division 3 of Ne Basins and Prefevlors Coda)or Y dist he k exempt therefrom and the bout for Ne allegeA exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of APN Number Occupancy e oat mare than five hundred dollan(MS 35903035 . 00 P yTyp ❑1.ss owner ofthe property,w my cmploym withwa{es as Uub wle eanpena tim, will do the workend th smantme isnot Intended woffered(onak(Sec.7044.Eminates and erty,whom Cade:The Concavities and who law dm not apply lf rt owner of Required Inspections _ propenywyces,pro orlmpwwchimpravndwho Am Annsuch tended iras,eered for ughAsk hta 7 a own employm,provided this such(mprowmentt are wt intended ororfemd for names. however,the have the u denimpof proving is hath within arc year of wmple fo,Uta purpose of Wilder will hew the burden of proving Nat he did not Gold or Improve for purpose o! Asia). C]1, ^ 1, owner^(Ute property.am utiwly contracting with licensed b eed caur construct Ute project(Sec.7044,Business and ProfdmeProfessions Code:)The Contractor'sContractor'sLi. I✓ ccrue law m not apply b an awr of property WImproves builds or Improthereat.and4 , who contracts for such prejec i with aconuacmr(U licensed pursuant in the Communes License law. ❑I am exempt under Sec. ,B&PC Tor this reason Owner Dam WORKERS COMPENSATION DECLARATION 1 hereby&Man under penalty of perjury arc of the following drslantions: I Its.and will maintain a CaNfta^^(eansent to self-harm for Worker's Compact- ion,as Provided for by Section 3700 of the Labor Code,for the Performance of the work for which this permit is Issued. 1 have and will maintain WakeYs Compewtion Inruut¢,as required by Section of the Labw Code,(w Ne performance of the work fan which this permit is Wised. My Worimes Compensation Imex antt carrier and Policy number are: CarrkrtEAtjr a W5 Polity No..AUI to"is CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This amdan recd that becompleud if rite permit G forces hundred"Jim(SIW) or los.) I certify that in the performance of the work fan which this Permit is issued.I shall not employ any person In hay insurer an As to become subject to the Worker'Compensation Laws of Celjkrm%_.Dau Applicant ^. _ NOTICE TO APPLICANT:If,after making thioriricate of Exemption,you should Wcome subject an the Worker's Compeauuon provision of the labor Code,you mot vJO forthwith comply with such prnvisiav w this permit mailW decreed revoked. Z CONSTRUCTION LENDING AGENCY (w IWreby Mrm Nat Nem its construction leading agenry for Ne performance of the work ran which this permit Is ivied(Sec.7097,Civ.C.) Q Lendeh Nunc o z lander'.Addm.. U O 1 ceNfy that 1 have read Udo application and suis that the above Informadon At LL^, conn.l aim to comply with all city and county andinances and sum laws relating to C)rV^ building construction,and hereby nmOdM upmaenudses or Nis city m Cour Open du � W tioned pmpcnY for inspection purposes. aMrc-men (We)agree b ease,indemnify and keep harmlev the City of Cupertino against {,yy Itabilldo,judgmenW ends,and expense.which may in any wayaceme a{aim,stud City ong Of () APPLIICAndNTCUNDERSTANDS Of the Ans pentrah. ND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. S44_0� Signature of Appliceminor Dau Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will gm applicant w Muni building Co aceupant mom or and M h Balm ad as doB ca by me Cut Municipal Code,Chapter 9.U.anis the Hcelth antl Safety nue, Des 2Ss31(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Ser will W.ppueant of future Wilding Occupant ass equipment or devices winch If a roof is installed without first obtaining an inspection,I agree to remove It Wudnm air conuminums,As defmretl by the Bay Area Air Quality Management all new materials for inspection. 7—CA / P❑Yes t�lquI have mW the hasummumeteriahrequiriumns underChapterd.95afthe Califor- Health&SafetyCade,Sections 25505,15533 and25534.1 udrmuM am if the Wilding m that comity haw a unan4 that it is my mspomih icy w notiy tine occupant of the r ennwhichmuseWmetpna award aCemlicimofOceupency. Signature of Applicant Date &-e— Owncror authoriced agent Data All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue 4101 s; Cupertino CA 95014 11 Telephone(408)777-3228 Fax(408)777-3333 OUPEkTINO Building De artment JOB ADDRESS: PERMIT# tF v 1-1 L-V Av6(003? OWNER'S NAME: PHONE # rZYCO--2.3$' GENERAL CONTRACTOR: 4 / FAX# I am not using any subcontractors: �- Signature Date Please check applicable subcontractors and complete the following information: 60 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 Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO $ <<<p' FURNACE/ACCITY Of CUPERTINO PERMIT APPLICATION FORM APN# �J r ;'© 7l�7l Date: `. (0 _Oct--, Building Address: L F Owner's Name: Phone#:Qg6rZ3 atm 1 1.t91�14t�4 Contras rt Phone: 7 a_D 7 Z License#: 3O y 7 Contact: , _ Phone: ! Cupertino Business License#: ,� S Z?4 D72Z Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech Job Description: 'r _ -T �2..W ��.. Residential Commercial ❑ V+� For Residential Installations: Attic ❑ 1" floor 0' 2nd floor❑ Adhere to min set back requirementR For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: dp Type of Construction: Occupancy group: Strapped ❑ On Platform El Bonded ❑ Sq.Ft. Floor Area: New Location Replacement ❑ Qty, if Applicable Fee ID Fee Description Fee Group BENERGY Ener BUILDING BREMFURN 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 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 BPGAS Gas Piping System Fe PLUMBING BUSLIC Business License BUILDING x'176 , 7�