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03100123 CITY OF CUPERTINO = t ` Hun.niNc DrvisioN PERMIT tl CONTRACT(712INF(7RMATI`QN BUILDING ADDRESS: A PERFECT CLIMATE PERMIT NO.03100123 OWNER'S NAME: 10570 S DEANZA BLVD PERMITISSUEDATE NE: (408) 861-9545 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH 100 LICENSED CONTRACTOR'S DECLARATION - (_J O O O I u 1 hereby affirm that I am licensed under previsions of Chapter 9(commencing Job Description ;mam` with Scaia (Kg1 fDivision3o(the Busincsss,gv dc,and myliccnsc is / <. in toll force an f CU °= Lmene ud.x REPLACE FURNACE & ADD A C 'NALED Date Cunoac ARCHITECTS. L A ON ' I understand my plans shall he.swi ss public rccard, Q Licensed Professional JAN 15 2004 OWNER-BUILDER DECLARATION <M I hereby affirm that 1 am exempt from the Contractor's License Lew for the :0 O following reason.(Section 7031.5,Business and Professions Code:Any city nr county BUILDIN <2� which acquires a permit ha enW nsct.alma improve,pro ,demolish,or repair any sticture 4j- prison its issuance,also requires lhcapplicamforsuch permit to filcasigned statement 3�o that he is licensed pursuanuo the provisions of the Contractor's License Law(Chapter 9 SCI. Ft.Floor Area Valuation 2 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $ that he is exempt tlacrtfrom and the basis for the alleged exemption.Any violation of 3261cz)n46 on Section 7031.5 by any applicant for a prom,subjects the applicant o a civil penalty of APN Number Occupancy Type not more than five hundred dollars($500). P Y YP ❑1,ss owner of the property,or my employees with wages v Ncir sole compenvllon, will do the work,and Ne Imcturc is not intinded mi ffercd fora.).(Sec.7064,Business and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If. however,the building or improvement is sold within one year of completion,the owner. builder will have the burden of proving thm he did not build or improve for purpose of .1c.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to consumer the project(Sec.70",Business and Professions Code:)The Contractor's Li. cense law does not apply to an owner of property who builds or improves human,and, who contracts for such projects with a eontramor(s)licensed pursuant to the Contractors License Law. ❑ l am exempt under Sec. ,B&P C for this reason Owner Dem WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declensions: I have and will maintain a Cerificom of Consent to self-insure for Worker's Comport- 7clo, on,as provided for by Section 37W of the labor Code,for the performance of the h for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,as nyuirctl by Section W of the labor Cade.for the performance of the work for which this permit is issued. Wol rr/yfo e a'on I urane carrier and Policy n/.as�rr{�rn�d��yyyVayy1s;'ryI///y�����.I9ZIrtier: r 1 Policy No.: ' V�, CERTIFICATE OF MPfION FROM WORKERS' COMPENS ION INSURANCE This eection need not bd completed if the permit is for one hundred dollars(SI W) or loss.) I certify that in the performance of the work for which this permit is issued,I shut l not employ any person in any mannerso as to become subject to the Workers'Compensation Laws of California.Date r Applicant NOTICE TO APPLICANT:If.after making His Ccnifc.le of Exemption, on should become subject to the Worker's Compensation provisions of the Labor end.,you must �O forthwith comply with such provisions or this permit shall be decreed revoked. 4 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of 3:7 the work for which this permit is issued(Sec.3097,Civ,C.) YA Under' Name - z Lender's Address I 0 ttnee Na,i have read this application and sum that the above information miinis E-a cording 1 agree m comply with y city and county ordinances and sum laws mining up. t e l ZU bhove-mentioned VmNrLyad homey euthorim rcprcsema,ivcs of his city,o cnmrupnn the g G hove-mentioned pmpcny for inspection purpo ti (We)agree to save,i mnmfy lint n p to. Ne City of Cupertino against fn liebili,iea,judgmcnu,c�s red cape whic ay in any way rm,againstsaidcity J 7 IAnPPLscgAeMnccofN RSnungu rNDPerm ILL COMPLY WITH A NON-POINT Issued by: Date I� ~v t� SOURC Re-roofs signaw Applican tarDue HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or fuwre ilJing occupant awrc nr handle hemrtlous mamrial ,. ss defncd by the Cupenin M pal Cuda Chapter 9,1],and the Health and Safely Code,sedEen 25532(a)9 All roofs shall be inspected prior to any roofing material being installed. ❑Yes Nu Will the applicant r fist building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove omit District' us air coma moan d cd by the Bay Arca Air Quality Management all new materials for inspeirtion. District? ❑Yes Hentrend,hehavaNnuama sial immcturn dcr Chapmrb.95ofthe Califon nix Hcalth&Safety Coda Secbmxs , 5 Sand 35534.1 undcnund that lithe building does no,- oily he a mnam a is y responsjoility m m ly h cannam or the require ntswme SL poor. dna,,.fxCrmre�re'�1 n dr. Signature of Applicant Date Owner or hwwni.c gent ((� D,a All roof coverings to be Class "B"or better CITY OF CUPERTINO 3 b L) Z ScumFURNACE/AC CUPERTINO PERMIT APPLICATION FORM APN# 32� n— �� Date: B}ri�l�d}ng Address: l�/ `` ll-�� 6>jrGA 0% Name: ne#: W-, CX¢3c� Contractor: )Wl�_ Pho : I Li e 31 s© Contact: one: Cupertino Business License#: I Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech Job Description: �y�\��p �y Ct4 " v}-tQ, Residential Commercial ❑ For Rep�ssidential In Mations: Attic LJ ls` floor 11 2nd floor❑ Adhere to min set back requirement❑ For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required Costpf Pro �� Type of Construction: Occupanc group: � �l ❑ On Platform ❑ Bonded LJSq. . Floor Area: Location E3EReplacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIltIIAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMTTFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING