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06010005 (2) LBU�ILDING ITY OF CUPERTINOres- ' - �,•s BUILDING DIVISION PERMIT "4CONTRACTORINFORMATION zr ,tet. �, ADDRESS: AAA FURNACE & AIR CONDITI igU4006010005 910 WTT,T)FT,0WRR CIT NE0.'S NAME: PERMIT f5513E DATE MING LOW 1712 STONE AVE 01/02/2006 )NE: SANITARY NO. CONTROL NO. (408) 293-4717 ARCHITEC(ENGINEER: BUILDING PERMIT INFO qq BLDG v4, ELECI'pp� PLUMB MECH ilk®( O �O0 LICENSED CONTRACTOR'S DECLARATION U U❑ Vd 1 wicby affum that 1 am licensed antler provisions of Chapter 9(commencing Job Description 1ZE with Section 7")of Division 3 of the Business and Professions Code.and my license is .1 << inbrumm 4eBe 4 REPLACE FURNACE 2006 Lieenu Clea Lica Contractor r EE ARCHITECTS DECLARKI RON fa ry` W U 1 understand my plans shall he used as public records BUY LI lltlly Iptl/)L'f,{M o Lkcnuti Professional 3 OWNER-BUILDER DECLARATION Cont ION .�<S 1 hctehy a(Bon on I am exempt from Nc fesumnCo e:Any c Law for the - O O following massa Permit t 7(131.5,Business sed ere.do o l Code:Any city st county which requires a pnmit re cores the alcor,impmsc,demolish.ri mash any statement $2500 –Zi oor haL tis,its issuence.also dpursantto to the forsuch Contrarmiuoicensle a e ned aw(Chptei) < thathcisliccnuJPursuanllnNcPmvisiouofthe Contmcmr'sUccnselaw(ChaPmr9 Sq.F[. Floor Area Valuation ii- (mmmewing with Section 7")of Division Sof the Busbassand Professioe Code)or 59 tm oba u exempt theufrom and On bub for the allcgcA exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil pcully Of OGGD Int more Nan five hundred dollars(S50Uk , Occupancy Type ❑1,az owner of the property,or my employees with wage u unchaste compensation, will do the work,end the structure is not intended moRee d forsale(Sec.7044,Business and PN(CVIORt Code:The ContrYlO/s LRn(e Law does not apply to an Owner Of Required Inspections progeny who builds or improves thereon,and who does such work himself or through his own employee,provided thatsmh improvements art not intended oroRered forule.IL however,the building or improvement is sold within one year of completion,the owncr- builder ,will have the burden of Proving that be did not build Or improve for purpose of sale.). 0 1,az owner of the propcny,em exclusively convening wish licensed conuacwm m convect On project(Sec.7044,Business and Predations Code:)The Contractors U. cense Law does not apply u an owner of propeny.who builds or improms thereon,and who coneacts for such projects with s eOnhation s)Tieenand pursuant o,die L'Onlrastoes License law. ❑1 am exempt under Sec B&P C for this uuon Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury oro of dm following declarations: 1 have and will maintain a Certificate of Continuo u1f-inaum for Worker'sCounter. 7C337.1W.i`dw on,u provided for by Section 3700 of do,labor Code,for the performance of On rk for which this permit is issued. 1 ham and will maintain WorkcrS Compensation Insurance,az requited by Section Labor Cade,for tiro perorma emsf the work for which this permit is issued. Warkcrs C mpensation 1 umncecomerandPolicynmberarc:rrier.��Polity No.: WORKERS'CERTIFl ATE COMPENSATION INN FROM WORKERS' COMPENSATION INSURANCE (ITh section rcN not be completed ifthe Permit is foranehumdted dollars(1100) or Mu.) 1 certify Nut in the performance of the work for which this Permit or isawd,T shN1 not employ any person in any manner an az b become subjeut to dee Warkeri Compensation Laws of California.Da¢ Applicant NOTICE TO APPLICANT:If,arse,making this CcniBcam of Exemption,you should become suhjcm in the Workers ComPeuation previsions of the labor Codc,you mut .J,Z forthwith comply with such provisions or this permit shall be deemed reveled. Z O CONSTRUCTION LENDING AGENCY cd Thereby affirm that them is a construction lending agency for the Performance of a ? she work for which this permit h issued(Sec.3097,Civ.C.) GIandcrs Name 0 z Lenders Address V Q I cenify that 1 tum lead this application and sum that the above information h U1 F cornett 1 agree to comply with all city and county Ordinances and stem laws relating to 0 building convection,and hereby authorim representatives of this city in enter upon Ne ,r Ul slave-mentioned pmrcrty for inspection purlmus 6, (We)ague to saw,indemnify and keep harmless the City of Cupenino against III liabilities,judgments,costs and expenses which may in any way accme against said City V Z in meequenee of the granting of this permit. " APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date — 2 'YJ G' SOU$CE REGULATIONS. / [q –/--a-- gna uwd ppu�uc`nnbA.' �� Re-roofs HAZARDOUS MATERIALS DISCLOSURE Da Type of Roof Will the applicant or future building occupant smu or handle haaallous material u defined by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety Codc,Section25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Ye Nu Will thea applicant o fmure building occupant u,a If a roof is installed without first obtaining an inspection,I agree to remove nn C P .Ail Qu or device which g P it havardnus air contaminants az dcfinctl by she Bay Ama Air Quality Management all new materials for inspection. vict? _u ❑Yes fr/fs4 I have read the baca dens materials requiumcnu under Chapter 6.95 of the Califor. 7�dms Heap &SafelyCode.Sections 25505.25533 and 25534.1 understand Nm if we Wilding not currently hast a tenantm that it is my responsibility notify the Occupant of the mems which met WMMMeett poor m issuance of a Ccrtieeam of Occupawy. Signature Of Applicant 'Date er or embonmd agent I Dam s_ All roof coverings to be Class"B"or better Community Development �1_J 10300 Torre Avenue -, Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building Department JOB ADDRESS: /n� PERMIT # 30 tl��U D / 9 ,;" o S OWNER'S NAME: PHO # - 9A GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information 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 FURNACE/AC v 6,e> vs CUPEI�TINO PERMIT APPLICATION FORM APN# 3(� s Date: �i-off-off Building Address: 11 (03d Owner's Name: Phone #: Low /6✓'X6.3- �P� Contractor: A,4 ,# a i-A. Z License #: Contact: ' Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech PC Job Description: p GL O e pP0 p Residential Commercial ❑ For Residential Instal ations: Attic ❑ Is` floor 2°a floor❑ An 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 ❑ Cost of Project: Type of Construction: Occupancy group: Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if A licable Fee ID Fee Description Fee Group BENERGY Energy 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 EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING J BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING