01120070 CITY OF CUPERTINO
nmI,DING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: i, PERMIT NO.
10117 ADRIANA AV A PERFECT CLIMATE " ` 01120070
-"I OWNER'S NAME - -�_--�--� —� —� - APPLICATION SUB DATE
•GURU GANESAN 10570 S DEANZA BLVD 1 12/ 18/2001
p {ONE (SANITARY NO CONTROL NO
(408) 861-9545
°z0 Z° ARCHIT UffiNGINEER: BUILDING PERMIT INFO
sir BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARA'T'ION
-' Ihemb Cron that Iam Blamed under of Chapter 9reommencin JobDescrilpion
'„'O yes ”`°`t°°°`° p" g INSTALL FURNACE IN EXISTING LOCAITON
;-Coy' wnh Section 7pfgl ofDy't�� n3 of the BUOness and Prafexrom Gde.a my licence
;ofy' 'm hill force
ILl^ ���
merre
Lie a
units da
I LL O rn ❑um—1-ta f L'I ARC( HITECT'S DECLARATION
i g I understand my plan.shall be used ac public metaWs
I of O O Laensed Professional
ofy Oat[ad,BUILDER m the CtA'TION
hereby (Sect on [ Burin from the Emmons Co License law for the 11pp//�\../J���� 94 9 0
2?Q follow mg rtni,a Iseomn 7031.5....Business and Professions Code Any coy or county
P ❑ which rcywres v pemot m conwruct alter,tmpmse,demolish,in Tapir any slrudure O
of
a 3`_° prio nits im mrad: alsorequims lheupplianl fniamb iermn In Measincedsu em
tem -
Nm liS is lammed ba"Tor tit made mvismas of the Cmmmclor's License law(Chapter 9 pp pp7,� ///yyy/���jjjr���s...��al
0mnmm�cmg with Section 70100)of Division 3°she Business and Porfassiom Code) _ . '3 Y$ bV,�.9r.�fl, _ t //•,•"'l/
.,,but he is esempl themfroln and the basis for the alleged eaemptimn Any addition /(•
of Secuon 7011.5 by try a,,hram for a pennn xuWjats the apphcam m a civil Penalty
of nut more than fi�e hundred dollars(SSW). 301�PNN2@911UH, PLUMBI "n Typ
=. ❑I,as°wnorofthepomeny,ormyemplo yeeswithwagesastheirsolecompenmuon, - --"' 303- ROUGH--MECHANICA
will Bus ne the work,and the stmaure is net do,, d as offered Law for sale(sae 7o a 3 04 — ROUGH ER&PTtRlIlE�ations v
Business and Prolessm the Coda:T'he is not nten License Law does ale apply to an
wiserofpropeny Who build,ortmprm c,Hmeon,and who does such ward,himself 505 — FINAL ELECTRICAL _
m through his own employees.provided such normwem re ents a nod intended or
dflem,1 for sale If,however the budding or improvement is sold within one year of 507 — FINAL PLUMBING '
aompeorm the owner-builder will have the burden of prang that he did not build or
n""of putp0seonale,6 508 — FINAL MECHANICAL
❑h as owner F Nat pmpeny,am esclusrvely xmmaumg with hwn..d amrauon In
ommtn the prn)cct tsec,7044,Business and Processions Code.)The Commicum%
License Law does nod apply to as owner of pmpcny who builds or rmpmves do less,
and who contracts for such pumas wnh a cnntiucmrl0 licensed purauunt to the -.-
Cnmmame,Licen¢I..
❑lam ex Pt under sac . Ir''� 1 v B& Cfor Inn reawn
Owner - are l[�I I p���
WON' 1'S 'O IP NSATI ND LAR TION
1 hareby of can under penally of perjury one ofthe following declarations-
1 have and will maintain a Cenificate or Consent to self msum for Worker's
Compensation, as provided for by second 3700 of the Labor Code, for the
performance of the woo,for which tNS perms is issued,
❑1 have and will maintain Worker's Compensation Insurance,as mqutred by Section
3700 of the labor Code,for the performance of due work for which this Permit is
issued M W°d1alr'spCo(y�p�m/aI Insurance comer and PPoolicy number are:
Carver' (f.`�.l/3�� P.B"Nq: Ill
I CERTIFICATION OF EXEMPTION FROM WORKERS', -
COMPENSATION INSURANCE ., -, -_
This section need of he completed tithe perm,is for one hundred dNlars
ISILml ur loc.)
1 candy hat in the performance of the work for which Nis perms is issued,l
shall ism employ any person in any manner so as to hconm subject to the Workers' '
Compensation Laws of California Dam
Apphcanl
NOTICE.TO APPLICANT If,aficr mvkmg this Cemficere of Exemption,you should
Q Obecome subject to the Workers Compensation pmvisiom of the Labor Code.you must
forthwith comply wnh such pmsrours or this perm Holl he daemcd revoked
FCONSTRUC'NON[.ENDING AGENCY
a ' 1 herby of0mt that there is ennsurnew n Icndin8 agency for the performance
(z7 of the work for which his permit rs tuved/sec.3097.Cr,C)
L Q Lender's Name '
7 G Lender's Address
U I remfy that I have read this application and state that the above information is
Res P correct 1 agree to comply with all city and county ordinances and sum laws relating
C U to building cutamform and hereby authorize representatives of ding city to enter upon
'y 0. the eb(we)u me la progeny for inspection, ad ke purposes
y IWe)agrccroscosts and which the Cnyofcom against
U V1 I City in consequence,judgments,fthe and eapensa wean may in any way vacate agemst said
V APy a ANT U D of the guesting D this perms.
SOURCE REGULATIONS, Issued WILL COMPLY WITH ALL NON POINT Issuedb t JS .G-.—__ Date 12
SOURCE REGULATIONS, Y' _
Signature of ApPhcaMCnmmaor. Date Re-roofs `-
HAZARDOUS MATERIALS DISCLOSURE.
Will the amladdnt or hand Wilding occupant store or handle doommor mamnal 'Type of Roof
as defined by the'CupemnoMunimpal e,Chapter 9.13.and NC Health and Safety
Code,Section 25532a)?
El Yc' °, All roofs shall beinspected prior to any roofing material being installed.
Will the applicant or tenure building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
not hazardous ter contaminants as defined by the Bay Am Air Quality Management
oamc? g�„ all new materials for inspection. Applicant understands and will comply with
all non-point source regulations. i`
4 1 hose read the hazardous materials requirements under Chapter fi 95 of the
Cal fomm Health&Safety Code,Sections 25505,25533 and 25534 1 understand Ihm
if the W.H dug does not currently have a lenrnl,that it is my responsibility to dmify the
occupanty I�the regmrenren which most be met Prior to tsauanee of a Cemfteme of
Xcupan p n
� �� Signature of Applicant Date
GwWt dr Nonzed agent U Date All roof coverings to be Class "B" or better
'- _ OFFICE