Loading...
0404007330, w �E �q Cru , 0 ; �� �Op km� al�v 5� W CITY OF CUPERTINO BUILDING DIVISION PERMIT '- v, '''�• - t,CO TOR INFORMATION. BUILDING ADDRESS: 0268 ORANrF. AV A PERFECT CLIMATE PER M"004040073 OWNER'S NAME: PERMITISSUEDATE ROLAND LEE 10570 s nFAN7A BLVD -"2' ONE: SANITARY N0. CONTROL NO. ' (408) 861-9545 ARCHITECT/ENGINEER: - BUILDING PERMIT INFO - BLDG ELECT PLUMB MUCH t� LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that l licensed Chapter 9 (mmmencmg J. Job De$Crlptl am prnvis lies or wit�Sledqp 7W10of Divixlon3rd`t Bt si s nal Pmfcssions Cndc, and myliccnsc is i in rt%Lfgrfb ands m. X.3 Liccns Class Lk.n REPLACE FURNACE. - 'ZQQQ. APR 23 Data— Co Lt. L l rr - A CIIITEG PION 1 uttl mY plans eM1all M u¢d as a records - BUILDING YNp Liccnscd Professional OWNER -BUILDER DECLARATION 1 hereby affirm that am exempt from the Contractor's License Low fur the following recent. (Section )(131.5, Business and Prnfess;nns Code; Any city or calmly which requires a pennit(n construct, alter, improve, demolish or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant n the provisions of the Contractor's I.ldc nu Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or hoot he is exempt therefrom and the basis for me alleged exemption. Any violation of Section 7113 L5 by any applicant rot a permit subjects the applicant to a civil penally of 35Yi�u7n'bet0 0 QCCU Typenot more than rive hundred dollars(5500 anC ❑ 1, es owner of the property, or my employees with wages as their sale compensation, will dome work, and me structure is not intended or offered for sale (See 7044, 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 nor 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 that he did not build or improve for purpose of sale.). [:) 1, as owner of the property, am exclusively Caron ng with licensed contramrs to emormacuhe Proper (See. 7044, Business and Professions Code:)The Contractor's Li. cense Law does not apply to an owner of property who builds or improves diamond, and who contracts for such projects with a conlractor(s) ficenscd pursuant o Ne Contractors License Law. ❑ I ern exempt under See. ,B& P C for this reason Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penally of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insum for Worker's Compete season, as provided for by Section 3700 of the Labor Code. for Nma e performance of the work for which this p trout is issued. El have and will maintain Worker's Compensation Insurance, as required by Section PW of thc Labor Code. rot me Performance of dee work for permit its issued. rwwhich gthis My kcr'3 gnmpensa raY mT\IL-1 Carrier lily NO CERTIFICATE OF ON FROM WORKERS' COMPE IONINSURANCE (This section need not becompleted if (hc Fermi, is foronc hundred dollars (SIM) Or less.) IUniry that in the perfotmanec or the work for which this permit is issued,, shall he, employ any person in any manner so as to become subjco to the Workcri Compensation Laws of Calirmnia. Date Applicant _ NOTICE TO APPLICANT: if, alter making ,his Certificate or Exemption, you should become subject to the Worker's Campcnsation provisions or the tabor Cook, you must rormwi th comply with such provisions or this perm;tahall he deemed clinked CON STRUCPI ON LENDING AGENCY I hereby affirm Nal there is a construction lending agency for the Performance or Ne work far which this permit Is issucd'(Sec. 3097, Civ. C.) Lender's Name Lender's Address I ccnify that 1 have read this application and same that the above information is - - entrecl. I agree to comply with all city and county ordi notices and state laws mlali ng to In doing eonsuuction, and hereby authorize mpmacnudives of this city to enter upon the shove -mentioned property far inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, and expenses which may in any way accrue against said City into ce of the gran in eonsequcnce of the granting of this permit. APPLICANT UNDERSTANDS AIJq WILL COMPLY WITH ALL NON -POINT REG LAT19NS. /' I p Issued by: Date �SOURC l Re-roofs r of ApplicamiCtmethrtor Dale HAZARDOUS MATERIALS DIS OSURE Type of Roof Will the applicanl.drfuturc building oeaparnlstorc orhandtc hazardous material as declined by the Cupeninn Municipal Code, Chapter 9.11, and the Health and Safety nJe. Section 25532(4)? o ❑m3 pl"va All roofs shall be inspected prior to an roofing material being p p� y g g installed. use ea or devices which Will me applicant m fnture'definedby If a roof is installed without first obtainingan inspection, I agree to remove P g the B it harardnus air contaminants aevJefincd by the Bay Area Air Quality Management Air Qu all new materials for inspection. n? ❑ Ycs No I have mad me hma nusmaeriels requirements under Chapter 6.95 or the Carrot. nit. Hcaf ph A, Safety Code. Sections 155115,25533 and 15534.1 understand mm if dm Nolding doc nnl -mous y havC 61Cnanl,1 hes myW�sNn�My',it'..nodIfyC MCdFantofthrcyuim cn hnmaxt{ll,rxmpTor issuaPy�Signature U�ate of Applicant Date - All roof coverings to be Class "B" or better sion, r L 4 CITY 0P UPEkTINO I Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRES IT # � \ u K 0 VL -C, J.e A� p b'D OWNER'S NAME. i le PHO cQ 3 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date _ Please check applicable subcontractors and complete the following informatinre I am not using any subcontractors: Signature Date _ Please check applicable subcontractors and complete the following informatinre SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating a Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock , OZ/Contractor Signature Date Tile OZ/Contractor Signature Date �„WYC�k✓ �v of UPEcirI�TINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM APN # Date: Buildin Address: �-, � c,4 151W Clwner\ Name: ��� Phone #: Contractor: c\ \ v� one' Q 1 ^� s� � License #: -1 z3 tS� Contact: i Pho e: lovl�� 8co t �iS�l S Cupertino Business License #: 2 I Iy Building Permit Info: A/C Units <=10, 000 cfm Bldg ❑ Elect,© Plumb ❑ Mech Job Description: ��u ✓Lv�—fie ce2_{�LQ ELECTRICAL Residential Commercial ❑ Seismic Fee Res For Residential Installations: BSEISMICOM Attic ❑ 1" floor ❑ 2nd floor ❑ BUILIDNG dhere to min set back requirement ❑ Elec Permit Issuance or Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ MPERMITFEE Structural Calculations required for new installation ❑ MECHANICAL New installation Planning Approval Required ❑ Plumbing Permit Issue Cost of Projact: 3 i (oO o'Type of Construction: Occupancy group: Strapped LS On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Plan Check Fee Qty. if �nnlirahlr Fre m Fee Descrintion Fee Group BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfnl 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 BUSLIC Business License BUlLDING 472.-37