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06100127 CITY OF CUPERTINO BUILDING DIVISIONPERMIT � �� �l I 01': M€� • BUILDING ADDRESS: A PERFECT CLIMATE PERMIT NO. 06100127 10510 DAVISON AV OWNER'S NAME: PERMIT ISSUE DATE BILL OGDEN 10570 NE: SANITARY NO. CONTROL NO. (408)86119545 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O Z LICENSED CONTRACTOR'S DECLARATION U I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description Z with Section 7000)of Division 3 of die Business and Professions Cade,and my license is !=y in full force and effect. Q L� ---� �g - NEW AIR CONDITIONING ? License Class h w Date 76. Contractor F a e LA ,VA e ARCHITECTS DECLARATION I understand my plans shall be used as public records ,a O H Licensed Professional i rn OWNER-BUILDER DECLARATION j e I hereby affirm that I am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county %m which requires a permit to 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 to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation I=- in (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 arty applicant for a permit subjects the applicant to a civil penalty of 3AW Raiiar- 0 0 Occupancy Type not more than five hundred dollars(5500). ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q P 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 that he did not build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- ccnse Law docs 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. ❑1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: rl 1 have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. L�-I 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 gmpens Lion/Insurance carrier and Policy number are: Carrier. ���S u,4� Policy No.: 'vY�Sf/OG(3 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Phis section need not be completed if the permit is for one hundred dollars($100) or less.) I certify diet in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. z h"' CONSTRUCTION LENDING AGENCY Fr nom+ 1 hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) aA Lender's Name a Z Lender's Address U Q I certify that I have read this application and state that the above information is CL . correct.1 agree to comply with all city and county ordinances and state laws relating to O U building conswction•and hereby authorize representatives of this city to enter upon the Wabove-mentioned property for inspection purposes. 1-4 C4 (We)agree to save,indemnify and keep harmless the City of Cupertino against "I C4 liabilities,judgments•costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. ►" APPLI ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S44-21t�zwDate SO RREGULA ONS G 4-6 Re-roofs Signature of Applirant/Conuactor 01 Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)7 ❑Yes —eNo All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes �No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understartd that if ncc building does not currently have a tenant,that it is my responsibility to notify the occupant of the req,ut�eps which must be met r issuance of a Certificate of Occupancy. Signature Of Applicant Date Ks�ri �� �Q 7 All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO 01F FUR.NA.CE/AC D--UPRINO PERMIT APPLICATION FORM APN # j 67 0 3 C Date: O!/ l 1D Building Address: 6 ©S7da t) ov� Al . Owner's Nae., Phone#: ` �� � ��.t� • ams- / go Phone: License#: va `Fr69S Contact: Phone: Cupertino Business License#: 0 9 �r �O�• ass �,// �� o�// Building Permit In o: Bldg ❑ Elect 02-' Plumb l:J' Mech Job Description: Residential Commercial ❑ For Residential Installations: Attic ❑ 1St floor ❑ 2nd floor❑ Adhere to min set back requirement 9-- For Commercial Installations: Replacement same weight ❑ Additional weight (structuralEl calcs) Structural Calculations required for new installation El New installation Planning Approval Required ❑ Cost of Project: Type of Construction: Occupancy group: $ (09_a-7 AcId - 3 Strapped 4D- On Platform Q" Bonded Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfin 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 BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING