01050125 CITY OF CUPERTINO
q CONTRACTOR INFO MATION:,
w
.nuu.owcurvlslo" PERMIT
BUILDING ADDRESS , PERMIT NO.
0110 .ADE_HE I'D' CT SOUTH HRY, REFRIGERPTCM1 010501125
OWNER'S NAME • APPLICATION SUB DATE
<{ TRANKLE-,'THOMAS L AND .,IAPIET L 461 F'F_t3RYMOh11 ». ',-,. tae ;�5'/ i41,.GV70i
PHONE SANITARY NO CONTROL NO
(408)279-19,111,,,
e ARCH1T'ECT,ENCIRIERR ^• a' EUILDINC PERMIT INFO ,
' BLDG ELECT PLUMB 'MECII
F Z .;.' • .. , 'a'• 7 ICI I:CI PLUMB
I'_I
a
LICENSED CONTRACT'OR'S DECLARATION Y
.8z!4,,� 1 here. Iran Ina l am licensed.noel rend r vlcnmmen .' Job Description
y a pmrl,Inn,n Chapter erns -. 4
,ga,.w with Seen,70(eynt Dlvasmn lofthe Bu,me,and Pndeseon Gide,I Igyllceroe
gy m ninonit,,,a «y�'yyy.,,1 ��� /(lYpp_ - GAS LINE, FURNACE ..AND R/C;, & 'DUCTS. ; —
K 6 Leeme Class N_JCI LIL W .J TT"kJ
X a U Date Cnnlracnrt
X.3 H ARCHITECT'S DECLAI1'ATION
it,C "r 1 mWermand ety plan,,hall M1e uwd as puhla¢wNs
boo "Llecli,eJPrnfe„tonal FINALED
UN'NEH-BUILDER DECLARATION
e '4—o pl h,mhy`d ram than I aria eaemp from the Cunmmtnn's Lmcnse Law for the
E' < fellow Ing cruses (Seuum 7011 5,Business and Profenatons Code Any say or count)
o which......eon:net lmI1ncar,hirt,..]let,roprn, daunt dr,or repair an)structure
. ” MAY 2 4' 2001
pno,toll,issuance,nls0re.m,n the applicant fnr,aeh permit In file.,Igned,mmment - _ -
that hel,haamedprwantI,Its Provision,at the Count Win,La,moc Law I Chapter 9 Sq. Ft. Floor Area .Valuation
'.(cormt near,with Section 700(1,of D....Ion3of the Buanes,and Profession,Code) B ILDING
or that he I,esrnapl themfmm dad the m,I,for the hill a,ampeo Ala,violation .'. $14450 ,
of Section 7031.5 M1y an)Tatman,fare m a ad,....the npphcam m a civil penalr _-
of not core than rise marked dollars(s50(n APN,Ndmber - .. Occupancy Type, ..
0 a,nwrou-- seprepenya;rmyemployee,swal wa,,asLear .toamopen,aoa�, :'.',5709028. 00
^ xfll do the work,and the,vuclur,I,net Intended ill offered for sale(Sea 7011.
Buanes,and Profession,CrWe:The CnnhaLWC,Llcensc Law does oat apply to an ` ' Required Inspections
—rin,of pnlpery Vill holds or Imposes therein,and 1h)drel,ach 1011,himself
ROUGHi
or mrnnsn nn,.1,employer,pmemea that wish improvement,are not.mended nl .PLUMB I NG- .
'offered In sale If,hexeser,the mill of nnpro,emem is sold within one)'ear of
• p
303 — ROUGH MECHANICAL anpmeeaq ran e,vael-nadderw have ice nnndea nr,mag to he aid not n .
a",..ln,pleenm .'�
'
304 - ROUGH ELECTRICAL
❑La.nwnereflhepope,t)..ImeaWUSnvelyenlauacang wnl licensed contractors tO °05 — FINAL ELECTRICRI
L...loud the pngnl(So,.7044,Bolos,and Pu,&s ion,Code I The Ctinracmr', ,,, '
nene Law aae,netapid,to an ex nor of property who mild,e,aafaprnvr m....... 5071 — FINAL RLlJMB I-NG - '
and of.poor...,for such protects cull a wnty Lkall) hLemed pulsuam•w the ,-a
"Cemmalr,License Law, -.508 —.'FINAL MECHANICAL
D l am nsempl under So, B&P C for this me,on ,
Owner Data :• •, ,
WORKER'S COMPENSATION DF.CI,ARA'I'ION
I hereby efi rn nude,penalty of pe Jury In te of me fanatic,di la us*,sermconame.t I haw and will maintain a Cemreate of Consent r ,elbmwre for Worker's
Conpen,,Ihan, r pro,Wed inns by Section,3700 nl the Lanor Cnde, for the
the work fm ahnh In,perm,[fs nmcJ
❑1 It,,,and x11]mammun N'mi,Compensation hum nnce!61 Ie.rmd by Section 1
3700 of the Lahr CnJe,for the p,rfonm..v lit the cork for which this peon
issue) MyWor ',Con,f[t1'ar...a lremneC wmerand Policy number ar^e��� '
Crier�zCP'.X/4f/4{ Policy No tl��j
.,. CF.RTIFICA[ION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This station need not It cnnplen d If the pe,mn Is for one bondred dollars
(SI(IUl ens hale)' 's,- 4, 1 . t.•
I wmfy that In Ihe'perlortname of the work for xtrick this Penn..owed.I -
'hall not employ any pecan m any manner so us r heconm ab,,,,In the Worker.'
Compensation Law,of Cuhfomui Date I I -
Applicant .c , ,
NOTICETOMPLICAN'f lL aLLer nmAing ibis CcnlliLme of Eaempuon,you should
Zbecome subject to Nodes Compensation pmvmon,of the Labor Code,you noun
O
deaths,fill comply is III such pmefsmn,Inc this permit shall he deemed re,liked• '?
o
^F F
CONS'TRUC'UON LENDING AGENCY, `e _ ..• '
W I herehY off m OaauM1erc i,a con,tiucI a lemmn,nl6ency for the pennnnan e
of the work lot,lach this pemul I.i,wed(Sec 3@)7,Cie C n
Q Lender',Name
.,me to Iomfivc read ml,cry unamn i nJ dmas p and Itia,launnenon
kT+'[r correct I agree in comply wuh rhy ny and e[Rr1y oWmanes,aiW scam law,relining e all Q zJ mnu1lJing cnnanntinv„mdheor aumonze reprnemawes of this mivmcnmr upon
} W the ala ""' coned pops•..'or npecuon Purposes t ` .
F. Pt IN'el t�recrosave,ode IY?nJ keep
hat mlewme Otv-I CL ag.nna (t'
iL) Vi "'c"he" J rents,ma,a pens,on mnY In any way aeerue apema,aid '
L) City .nee of th e ' its of ran peat„ a '+., •G--�� - • f
.APP C. UNOF 1 AND WILL COMPLY N'ITI{pLL NO"PO T
.ART cul.n r . � }'`' . ' Issued by: � :'•�� Date
S r/' rte
sl an nlnppinaI , door D( Re-roofs .
f f1 ALABDOUS MATERIALS DISCLOSURE
Will life1"ItLacl nl once MWmns ceeamnnwron,handle haemdon,raarnal Type of Roof: . ' ,
r defined by Ina Caucamn Mon-Pal Cede,Chapter)12:and the Health and Safety '
Cole.Sectmn:5512(af? '
DYe, 0No All'roofs shall be inspected prior to any roofing material being Installed.
•Wall the applteamprf amhaldmgo.,mp.ml use e.utpm6,fnr devices which If a roof is installed without first obtaining an inspection„I agree io'remove
craft hazardous an,uantamm,nn,a,defined by his Bay At,,,Ai,Quubly Manasemern
Disinter H all new materials for inspection. Applicant understands and will comply with
eve, ❑Nn all non-poirit'source regulations. r
s I hale reaA Ihe;lmzmdnr mama sn1.under�Chapler F YS of the
Calihirntu He51me&uo I'ety Cale,Send 5 25533 amJ 25534. uvJenLmJ iha
doe hulldfng Joe, tcurrcntly base; I plain 1,my rcnpnmthlW Ian Jy the
necupam oft Henn xhmh n I met prior I"Ismance of Cen care of
OLLnpancy �r� e - I '
• � r . �-� Signa[urepf Applicant � � � Dale '
opaet or amitimd I,,,T rrrrule ' _'All,roof eoverings to be Class"B" or better � -
,t t r OFFICE , .,