02030223CITY BUILDING UpESION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
846 ALDERBROOK LN
UNITED AIR COMFORT
02030223
OWNER'S NAME
APPLICATION SUB DATE
MICHELLE DING
5819 N ANDREWS WAY
03/29/2002
'HONE:
(408)771 -8967
SANITARY NO. CONTROL NO
zo ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
•'1 I -- J 1=7 L=1
i LICENSED CONTRACTOR'S DECLARATION
1 hereby.M. too I am licensed under provisions of Chapter 9 om.,cnert,
Job Description
P
` it Section 7000) of Division 3 of the Boximssend professions Codenal my license
REPLACE FURNACE.
is in all force m
uLarose Class ffs? Lic. a a 7.59 S'
Data Connector
l,
ARCHITECT', DECLARATION
5 I understood my plans shall be used as public neards
OLicensed professional
2 OWNER - BUILDER DECLARATION
1. 1 hereby affirm for 1 am exempt from he Convector's License Law for the
< following reason. (Section 7031.5. Business rob Professions Code: Any city on ..my
D which requires a to improve, demolish,
$1500
permit consumer, alter, or repair any structure
�.. pnor tots ilaticaram. al q ,h pplcnofor inch permit to file asgned smteenct
thin asrcenpdprspit the previsions of to Connectors License taw(Chapter9
(cote g ,h Suu 7000) of Division 3 of to Butrncss arm P ofessams Code)
1� s f ^h "`
( � O X L it S
.� Valuation
or ten he n aemp(tertfrom end the basis for to alleged damotmn Any violation
!�
-of Suuu 7031.5 by any applicant fare permit subjects the applicam m es civil penalty
:of om tome than five hundred dollars ($500)
3 01APN N ®�H PLUMB I G : � � �' +' � i ' ' Occupancy Type
❑1, es owner o!to progeny, ur my employees with wages as fairsole rompemarior.
_ 14 MEC
-will-do the work and to structure is not intended -m offered for sale (Sec: 7044,`
'Business and Profusion Code: The Con,mnor's License Law does not apply to an
304 — ROUGH ERA I 13Prlotions - ` ,(-
owner of progeny Who builds or improves tereon, and who does such work himself
through his n employees provided that such improvements are not intended or
505 — FINAL ELECTRICAL
offered f I If. hbwever, the build n o _ .. -
g v emtsmla ,n on,4amor
compinion, to owner-W Idcr will have the burden of proving that he td not Wild or
. _. ...._. .... _ .._._ . ._ ..___. --- . . __ ____ _ ........
507 - FINAL PLUMBING : "� � ' -
improeeforpurposeofsale.).
508 - FINAL MECHANICAL
❑ 1. as owner of the Pon "m exdusrvsla contracting lh license n
- consumer the (Sm. 7
(gar 7044• Business and Professions Code:) The
a:) The Contract
Contractor's
does n owner
License law dui not apply to oo owner of propcny who Wilds or improve thereon.
improve, ,
'
for such, projects wit a.commemr(s) littmed pursuant to the"
- _. mid- vectors
..__ .__ 4.._.........
License La
' Law.
".. -..._ _ -... _._ . __ .._.._ __ ___ ... -._.. .....__..__
01mafL
_ ❑le pct drge " `.B &PCT this reason
�a sea Apg
Own Dais'
e� R
- 'WORKER'S COMPENSATION DECLARATION
1 hereby M. under penalty, of perjury one of the fallowing declarations.
APR i 'f
APR 1 1 2002
I hlve'andPwill maintain a Cenificme of Consent to self -insure for Worker's
aC mrmanc of provided
ork pad for by Section 3700 of to Labor Code. for Om
Performance f tdwork fw which this perm i s ss d
y'a
BUILDING
h E II malni5: n Work Compe i 1 so an e, requ red by Section
3700 of th Labor'Code, f r to performance of the work for which this permit is
rssuea M o kels C pen n
` „IIannd Policy, numbs -
,uprmie
c�e��dar6hr�fi�'a'W e24 9�S9G
"CERT ICA IONO MPTION FROM WORKERg 1 "' '-1-
-
f (' p�"1•f ) ', �_ ,.,(r' ? t� PMti';; t 'j
C0- MPENSATION INSURANCE' -' • _ - -. '.
('nui ueuon need non be complcica if the permit is for ou hundred dollarss=�1`
- ... `.G i- ✓r'v`d; Ctr .. "Y
(SI00)or less.)
ch t d rfo of he work hch
Y pe t pe' t is issued I
,
,Fall t employ my person in my mann er so as to second, ds b]ut to to Work rs
Compensation laws of California. Data '
Applicant -
NOTICETO AP6 ft k gii
- -
Mromeuh] ecnm the
the Workers Compenieian previsions
ore of the Lahr Code, you nun
it Po
- comply wit such provisions or this pent shell W domed revoked.
i fonh ermi
------
:'CONSTRUCTION
'' AGENCY , fonhe perfo' m an ci
I he by affina that ffi�m is a construcromilanding .
k1w
o".
r the wink h dh h prm is tied (Su 3097, Cis. 'C.)
J.
•:LENDING
1 Lender Name -_ . s_:: u.
_ _.... ._ ... •_ l
I<'ders Atldrcss
_._ .
- --
.1 cenify tat I have read this application and stale that the above information is
�coHmi. I agree m comply with all city oil momy,ordirmsm, and ,tam laws mlal,ng
1 mWilding comet ion. and hereby authonse repreminatives oftiecity to enter upon
'
i the movememionW property for inspection purposes.
r (Wb) agree to save, indemnify and keep Wholeis the Ciry of Cupeninb against
1 ' liobili,iex, judgmems, costs and
-_/
expenses which y in any way accrue against said
CRy inosgen eof thegmmn 's pc t om
APPLICANT UNDERSTAND -
L COMPLY HALL NON O
1 - d�
SOURCE RECUUnorvylt - '^ , ��
Mai. /l
—�
Issued by: Date
Stgnam fApphcootlCO uma r ••• D
HAZARDOUS MATERIALS DISCLOSURE -.
/
Re -roofs
..' Will to appsiarat or future building « pans at. m noodle hL.1dims material
T eof.Roof..
YP
ender Mbyt Cupertino M WI Cod Ch pt 912 and to Hult and Safety
-. _.. _
, - - - '_ °-+-' - - - _ .
Code:SUt 2,5532( 1^ r
'.i O Yes air U 11..
��
a i
d f i
�.; _ .
_.. too s shall be ]n specte4i�pnor [o any_roofing.matenal. being installed,
Will the pplicam f , m building u equipment devices, which
ymcn
- n p ' a`
ii r. a coniamme s tlefncd by t Bey Alen Air Qua(ty Management
, - - -- -
If a roof is ms[alled' without first obtaining an inspection'; I agree,to'iemove
ct,
"""'
ov
all new materials for inspection. Applicant understands and will com I with
` `
i ;-;
all non point source regulations.. -p! .
IIh e' cad the,hex dos teals q rcnams, under Chupte 6.95 of to
-
Caldorma Health & Safety Code: Sections 25505;25533 end 25534 1 undarsuM the,
dNe W Itli does not ruse tl have a ¢net tat , s my respom bJ ry m notify the
y
"' -- -- - - - - - - - -.
[pTube p issuance of tific eof
tRcup y 9 rrt which must be met m to t s ,
i•
OL.
--
.'
Si nature of Applicant
.PP Date
All roof coverings to be Class "B"
owner °utm,:<a e6 D the.
or better
OFFICE--- - -- ..... - ...... ..... - _ _