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03090177 (2) CITY OF CUPERTINO *�" BUILUINC DIVISION PERMIT �4CONTRACTOZINFORMATION nuaolNC ADUREss: SAN• JOSE AIR CONDITIONING PERMITNO03090177 OWNER'S NAME: 880 N. 8TH ST. PERMIT ISSUEDATE MELI 2003 NE: (408) 286-2047 SANITARY NO. CONTROL NO. ARCHnECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ?op /• LICENSED CONTRACTOR'S DECLARATION 'u❑ Incirm that 1 no licensed under provisions of Chapter 9(commencing Job Description .Zw with See bo if",, D;vLaoyjofmc Bus s@qd Qfofesri, $Cod dmylittnsciLouts !qZ inffullf c oder@P� a OVkpk-�',p°' - REPLACE FURNACE & ADD A/C, ELECT. -/ fro - `` nt for ARCH TtRATION mad, undcrsanJ my ]ads shla uic record, iU / eOk Licensed Professional ` / I OWNER DECLARATION � <S I hereby affirm that 1 am exempt from the Contractor's License Law for the O O following reason.(Sctfiun 7131.5,Business and Professions Cndc:Any city or county m which requires a permit to construct,alter,improve,demolish,or repair any smetum 87650 _Zr prior In its issuenec.elm mymres the applicant forsuch ermil to Elca signed statement :z< that he is licensed pursuant to me provisions of the Contractor's Liecom Law(Chapter 9 S Ft. Floor Area Valuation 210 (commencing with Section 70007 of Division 3 of the B minale) s and Professions Caur q 3 that he is exempt therefrom and the buffs for the alleged exemption.Any violation of 3 5 9 2 901S . 00 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of ApN Number _ not mere than Five hundred dollars($500). - - .. Occupancy Type El 1,as owner of the propcny,or my employees with wages as Nei,sol.compenantian, will do the work,and the structure is not intended or offered for ale(See 704,1,Business and Professions Code:The Conant License,Law dos not apply in an owner of 3 03 - ROUGH LUOfIS pmpeny who builds or improves menton.and who does such work himself or through his P.1laI own cmploym,provided that such improvements are not ntended or offered for sale.If, 3O4 — ROUGH ELECTRICAL however,the building Or improvement is sold within one year of completion.Ne owner builder will have the burden of proving that he did not build or improve for purpose of 505 - FINAL ELECTRICAL :ale,), 507 - FINAL PLUMBING ❑I,as owner of the property,,am Bain=and contracting with licensed contractors to construct we es boa apply o an Ener of and Professions holds i The Correctors u� SOH — FINAL MECHANICAL whomose,c Law en.a not apply les an owner of property who builds or improves demon.and who LacLL for such projects with a eonVltmr(x)Iicertse0 pursuant to Ne,COnVaetofs Cleans.law. ❑1 am exempt under See. ,B h P C for this rcuon Owner Date WORKER'S COMPENSATION DECLARATION _ I hereby affirm under penalty of perjury one of the following Ccclaraticere I haw and will maintain a Ccnifieate ofCommnL to self-insure for Worker's Confer. sauo 1,as provided for by Section 37M of the labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Sectio 3700 of Ne labor Code,for the peRormanee of the work for which this Permit is issued. My Work cr'IC nm ualion hnatua a�ncc hoar' PP�l e,numbe Ca� cay CERTIFIC COMPENSATION NFROM ORKERS' COMPENSATION INSURANCE (This scumn med nor hecompletcd ifihe Permit is rorone hundred dollars(Elm) e less.) I testify that in the perronomece Or the work for which this Permit is issued.l shall not employ any Word;n any mannerso as us became subject to the wodai Compeuatipn Laws of Cahforoia.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should bumot suhjecl to the Worker's Compensation provisions or the Labor Cndc,you must � z forthwith comply with--In p,nvisinns or this pcopit.m.11 be r ecmeJ revink.d. Z'O CONSTRUCTION LENDING AGENCY 1 hereby from that Them iso coutructinn lending agency fon the Performance of Y the work fur which this permit is issued IS.c,3097,Civ.C.) 0 Lenders Name z Under.Address C) I acedy that 1 have mad this application and sum that the about information is y Fconfit.I agree to comply with all city and county ordinances and show laws relating to �U building commuction,and hereby aultoom wprcaenutivcs of this city to enter upon the ty Lal above-mentioned phe grantinInspection hiPerpurposes. y d (We)agree Io save,indemnify and keep harmless the City of Cupertino against p3 Imbilided.judgmenu,costs and expenses which may in any way accme against said Cary Z cPAPPLICANT of DERST ng of this pc WI ~ SOURCE GULATIONS.NOS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dat 'granum of Applicam/Ca ,actor - Re-roofs Dare HAZARDOUS MATERIALS DISCLOSURE Type of Roof L Will the applicant or future building occupant sort o handle hararecus maerial u defined by the Cupc.in.Monte Code,Chapter 9.11,and the Health and Safely Code.Section 25532(a)? [3 YO, All roofs shall be inspected prior to any roofing material being installed. Wm the applicant of future buddi ocupent use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove I barardnus eco-eonuminans u der d by the Bay Arca Air Quality Manag.m<nl all new materials for inspection. Uis0ict? ❑Yes N [ban read the M1aand om materials rcyoircmcnu under Chapter 6.95 order Califor- nia Health A Safcry Code,Sccuas 25505.25533 and 25534.1 undersand Nat if tie tuiWing does bol curendy have a tenant.Nat it o my spuns;bdily to nnti l'y the oecuparu of the requirementswhich mus Mmct mol isstrame ora Ccntfc focc arty. /�-./lN�1 (Y. Signature of Applicant Date Owner of aathnri.cd agent Daw All roof coverings to be Class "B"or better r. CITY OF CUPERTINO o i 7 7 FURNACE/AC o3 CUPEf�TINO PERMIT APPLICATION FORM APN # Date: Building Address: , 1(ou CT , Owner's Name: � M q 1 M S Phone#:fig a S-7 3a Contractor: '- `.3©S� �G Phone: 4°$ 2$� � � License#:p� Lo( ! �_�� Contact: �i�nl�� c 6 Phone: Cupertino Business License#: Building Permit Info: \ Bld ElElect Plum 4ecthi A� Job Description: f � �'1�/Y✓r`'f� `— �� 1 �L�L�✓L�iA'�. � �`�— Residential �1 Commercial ❑ For Residential Instillations: . Attic ❑ 151 floor V 2"d floor❑ "v Adhere to min setback requirement[� G For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning A roval Required ❑ Cost of project- p0 Type of Constructio Occupancy grou l Strapped ❑ On Platform Bonded Sq.Ft. Floor New Location ❑ Replacement ��IA�QTI�CG� Qty ca 1 lN Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAMIAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING 141 EPERMTTFEE 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