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07010097�0O ewE=V ul Z H adz we a t4 F ray �co emrA 1r ..y _z>• YFG ,RE EVILDIMG DIVISION pEi FMIT BUILDING ADDRESS: 10845 DRYDEN AV OWNER's NAME: MCCRORY JOHN ONE: ARCHITECTIENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profession Code, and my license is in full force and effe 3 License Tau Lic. A Date Contractor ARCHITECTS DECLARA N I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior u) its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's license Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 1, as owner of the property, or my employees with wages az their sole compensation. will do the work, and the structure is not intended or offered for sale (Sec. 7041, Business and Professions Code. The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or thmugh his own employees, provided that such improvements are not intended or offered for We. 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 contracting with licensed contractors to construct the project (See. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and . who contracts for such projects with a contractor(s) licensed pursuant to the Contractor s License Law. ❑ I am exempt under Sec. B & P C for this reason I Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 9I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance caardr-. Policy num r are: 'r CarrieL�nlf ]Harr r No.: 2> CE CATE O EMP ION FROM WORKEPUT COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so az to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must ❑ `,L forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY E -r rte. I hereby affirm that there is a construction lending agency for the performance of IY > the work for which this permit is issued (Sec. 3097, Civ. C.) W A Lender's Name z Lendees Address V Q 1 certify that 1 have read this application and state that the above information is w " correct. 1 agree to comply with all city and county ordinances and state laws relating to 0 U building construction, and hereby authorise representatives of this city to enter upon the W ahove-mentioned property for inspection purposes. C1.r (We) agree to save, indemnify and keep harmless the City of Cupertino against ►Fr liabilities, judgments, costs and expenses which may in any way accrue against said City V z in consequence of the granting of this permit. 0� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULAAONS. of Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store of handle hazardous material as defined by the Cupertino Munici adc, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑ Yes o Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants az dcfr y the Bay Area Air Quality Management District? ❑ Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which prior w issuance a t rtiIli teof Occupancy. 1' Owner or authorized agc Date PERMIT NO. 1y 10570 S DEANZA BLVD 01/17/2007 SANITARY NO. CONTROL NO. (408)86119545 BUILDING PERMIT INFO BLDG ELECT' PLUMB Job Description REPLACE FURNACE AND ADD A/C 3561401: .w Issued by Re -roofs Type of R oof Floor Area Valuation $13617 Required Inspections Occupancy "l'ype All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new rr aterials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better CITY OF CUPERTINO FUR -'N ACE/AC �UPEkTINO PERMIT APPLICATION FORM 0701009q APN # Date: 10 Building Address: BREMFURN Furnace MECHANICAL Owner's Name: Phone #: MECHANICAL w1. Ly o Contract Phone: License #: BREMRECEPT R. -c tl, Switch & Outlets Contact: n (Phone. Cupertino Business License #: BUILDING L o� 7• G Scismic Commercial Building Permit Info: EPERMITFEE Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: Mech Permit Issuance c444 c t G�-�l ✓� L Residential Commercial ❑ Plumbing Permit Issue For ResidentialIn, Rations: El St ALJ BPERMFEE Attic flo 2"d floor ❑ BUILDING Adhere to min set back requirement Plan Check Fee For Commercial Installations: BPGAS Replacement same weight ❑ Additional weight (si ructural calcs) ❑ PLUMBING Structural Calculations required for new installation ❑ Business License New installation Planning Approval Required ❑ Cost of Project: Type of Const ion: Occupancy group: Strapped On Platform. -D- Bond Sq.Ft. Floor Area: New Location �2r Replacement �— Qty. if Applicable Fee ID Fee Descrintion Fee (;rnim BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A'C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A'C Units <= 10, 000 cfm MECHANICAL BREMRECEPT R. -c tl, Switch & Outlets ELECTRICAL BSEISMICRE Scismic Fee Res BUILDING BSEISMICOM Scismic Commercial BUILIDNG EPERMITFEE E; ec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS G is Piping System Fee PLUMBING BUSLIC Business License BUILDING