01040158 CITY OF CUPERTINO
BUILDING mvtstON .PERMIT CONTRACTOR INFORMATION:
Hu1LOw."'DO 5470 'A'I:NSWORTH ,DR" A A. A FURNACE COMPF"Ir� 1n'N° 0].040]58
• OW'NER'S NANI• ^ ' ' - - - APPLLICAI ION 1 DASD
I "
HANG. JAMES T El', AL —• 1.7,]2 GTONIE •AVE,° •I ' ,; flte-.:r0L2o0]
.IPHONE f SANITARY NO CONTROL NO
, (4 08)�293-47171
G p o ARCHITECrIENGINEER - , BUILDING PERNUT INFO
P t' BLDG ELECT PLUMH MECH
n
R y LICENSED CONTRACTOR'S DECLARATION Job Desdrlptlon "
0 Z 1 hereby allirnt thin I an hcen,edmnder prm,.um,of Charter 9 111mmenung
,-
is Semen 7000,nfD,crv1011 3 of the Huvne„and Piolenemm Col and Illy hence
—d smmbfmceaf CHANGE FURNACE. & DUCTS,
1.teen,ecm„ ADD A/C. '
.•w s LL cr,mmcmL''( ✓w�L�,r N C, -
A•CIII'I'ECr'S DECLA AI ON
`t_i ; 1 i ndemwnd my Plan,shall he u,.d in liable,raonl,
y
[t�Ll p C Laensed ProossdnW r '
J o w OWN[R-BUILDER DECLARATION ' -
13i 7 1 hereny affirm than I xm enco l fiam the Contmc,o,'v Lme,i,e Law lot the
C'�4 talowdg'thin (Section 70315,Busses,end Proteamn,Code Any city on ttmnty
,i a xInch require,a Eaton'to cotnouel,alter,improve,dentnlnh,or,repmr any Interne
s7 Pnollmm—w...I,eI,o mgmre.,heapTlaan'I oroall gonad,,life a ,tiodaalemenl
'
that bcl,lien.edparstanitn the Provisions of the Contracton Li.....Law(Chapter 4 Sq. Ft. Floor Area Valuation,
Ictnnmoncag with Sedum 71,)(1101 Du awn 3 ui the Huanms and Pmfa d.as Code) -
tr thel he i,e.emT,thendiont end the nao,for the allegd...ntpnon Any Motion li
of Second 70115 by ally aRAir,rt filleTmml wnyccl„he The,lot to anvJ penalty ty Er f`
ofmil mine drat die ha dn,•d anal...ta500,, APN Number 'Occupancy '�
nPhi of the rd h,y,onnpenlpinyce,wnn x s offehcn,olde(Se 7(Dal. _ • "
B..Jo,he vim A,and the oad, Th 1.not raided a d Law for sole(Sec ]fW4. i5G6`i 6V.tkt J eqi i
.vooeof and ro,W1o,t.aide'T n ntn,m,mr',Loan,Law Jne.nth ork h,o en - Regmred Inspections .
x nl ptnpcnp\Vhf loy,us or fact at ach„md wen doe.such wort nded or
or(hough hw awn ho"evyecs bolded i... wee im tent is col me not intended or
' oaerell foi sore If,hnwta1de,w budding or mden of noo„'sold wnnm one year of
�omTlctoee Pa Ewenf le)will have the harden of ptnv,ng than he did not huJd or t '
ptPrn,caf Pr,pnw of ale) � 30.i. - RGUert NIECHaNICaL�- • - .
D 1,e,ownerot the pogterty,a mlu.nely conmaelotg,war bc.m,eit Ille.1 1.1to 304- — `ROUGH "ELECTRICAL
Lndarn,taiePIN,l(So, 7aN,nf,lea.and Prole„,nn.Cedr',Tn&Coritanlnr, 50S — FINIAL. F_I_ECl'RI',C'FIL _.
icense Law does not apply to nn owner of property is hi)holds m ortnines thereon, ,
and who eontra�k Ior wdi project, with a camraaonv beamed prrwatt to be 507 — FINAL PLUMBING
c6ora r,l.uen:,I.aw,
D la in eaelnrladde,Se,. B&P C to,tin:re a...., 508 '— FINAL N'IECI-IANICAL r '
Owner -. ENS '
WORKER'S COMPENSATION DECLARATION i •' '
r.
I hereby afli,m under pemdp of perjury one of the lollowmg Jeahutbon, +
Cl 1 rii, and ill maintdn a Certificate
fly Se'c of Commet w wLabor e by Winker the ” , , ' ♦ °
Compe ne,,o he eekf.. Ior by Se,red 37 00 nl ,hc Labor Cade, tar the
Performance of the wink firwM,h lhr lmrmn,.l.med
have and will mdntdn Worker's Campenwuun Insdmnce,of re,piired by Sealmn
3700 it the Labor Clair,for,he Pctlooil of Ina work Ior wh,U Ihn Tend,r.
awed.My Worker,Cnmren.ban In,bmn,t,'a"er and Pomp further are -
e
Cnrncr;.ejW city NO. R ••�� c -
CE TIFICATIO O EXEMPT ON FROM W ORKE S'
COMPENSATION INSURANCE s . -
,Th,,ecbun need not ne contple ed If,he per,s for nnc hundred dollar, }- '
(8100,or less P
I certify tho,,n the performance of the work tar wo,fi,her penny is nmeJ,1 e r
shall not nnploy any person in any manner so:n to become sanjoct d the Wodari ,
Compen,cat on Laws of Cattleman Date - -
NOTICE IO APPLICANT fl,after making the,Calficrtc of E.empbon,you ddid
become wblecvo the Workers Co npensatmn Nr%k is of(lie Labor Cute,you must
O O fonhwdh oro,l,with w,h Pm...,on,or this pennll,hall he deemed reeked o '• t
` V]
CONS tfhroa (Ion LENDING AGENCe . - -
W(~ Ieerebl attar thnpcoo,l r,ared(See lcndutg egmay for the perfurinance t •• ,
ti TendersMoorr whi,h The,Ferman„wed,Sec 30117,Co C, K.
a Lender's Addt
Lender's AJJC
V' I cenly Per l ha.e lead,hn ii PP bunion and state thannc abus n
e information -
+
W r tohool 1agreentrrnn fly wuhall it,and o,Tremda,,esooml,Of,lux,er aart late O U
to ohno-ca van,on,Ina n rell.1ahnn.e llplol man.e.m m„ajy to enter apart
•the abo(We)a Wo Ill rrnreny for fy and m pmpnsc,.
Hd M'e,aincem,ave, ,oldnF,r,e, 1rhaollcw,he Ely of Cupemmouga,n,l
Vrn City ac,,rao,unnts,casts and e,pemro wens may or any xay uicmc apmmt nand _
� City,n conscyncn,m u11he granm,g nl'ihe,Penml. •. r .
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
a. .'Issued by: � Dale
� ?,!5;L-0
CE /
_
dbdaer,n Pl,nmZARDOU �' Dote f � Re-roofs'°
' HAZARDGp$MAtgo,,rLSt ell,DISCLOSURE
Will Jby t e Caper e,Nl,,nc bndl Code, upda,iot 12 nd fire m,.althand aemtl Type Of Roof
m definers hp the Cupenmo Mun,c,pal CuJq Chnpdr9l?,and rm HeaBh and Sa1'cry
Cade.Section 25532ho l e
❑Ye, - rvo All roofs shall be inspected prior to any'roofing•material being installed. . -
Wrud;capowantortnmtclttJdmg reerpamt.eegdpm,:dl air de„ee,wmen If a roof is installed without first obtaining an inspection, ,•agree to remove
` ern h:ecado avcmnamunn„as JefineJ ny the Hay A,en Au Qunh,y NWn,,cacn, r
Diln,t"' ��„, all new materials for,inspectiml Applicant understands and will comply with'
D'`•' lam"° all non-point source regulations.- - -
I hace read the ho.onla,rnaanals regd,mnem,,orl ChaNe,or 95 of the > '+ • S
C:thfo rta Heol,h&Sotep Code.Sendm 25505,35533 odd 25534.1 u We,Iand neat -
.1hl'bmldingdoe,nn,cn,reell,havcatedan,,ihul„n my re+....... yin only tic I ?.
//T'art or the,aqua emend,soeh ana he ,le,Prior to 4,anoe of I,Cernijicad u1 : • - ' 't
l re, p',�. -7U�G7 Signature of Applicant' r' Date
ahmnn.,d agar Date , "All roof coverings to be-Class `•B”or better
et or - .. OFFICE • . -