01100119VITY. OF CUPERTIN07
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
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B61LD[NGADDRXSS;'-,,,,,., "l: ,z I �.
PERMIT ':NO.,,: 'Ji 'i
-10396_`ANSON,vAV..- -T—
_._A_PERFECT CT. _CL I MATE. _2
1-._0110.0.119._.___..
OWNER'S NAME:
SMITH DONALD W AND,BERTHA M,TR
10570 S DEANZA BLVD- t
APPLICATION Sp. DATE
10/23/2001
(408) 861-9545
SANITARY NO CONTROL No.
ARCImECT,EqGINEER.
BUILDING PERMIT INF:
BLDG 'ELECT PLUMB
�H
_J
a LI(i CONTRACTOR'S DECLARATION
thereby 'rf
Job Description
a an meci under provisions of Chapter 9 (commemaing
i with Scrumi.XII)l)) of Division 3 f,hc Business and Prof.ions Code, and any her..
FURNACE CHANGE OUT.
\iamf men
I m=
Clam
�Ir 1111 Lli.4c
i
F a NALED,,
ARCHITIECT'S D lr�C LrooRA'
I DUN
rde,,I.d my plans mull be used as public records
I;
MAY •3 20 Z
5 Licensed Professional
, OWNER -BUILDER DECLARATION0
I hentby affircon that I am exempt from the Crancriaturr's License Law for the
.1 county
$2050
smort..
iumbeal.
—....—BUILDING
....... — ... ....
Valuation
M1 pre 9
raceade)
MATIO
..... .
violation
x ` `
or5mion ]031.3 by any appbcam for a perms subjects Ne appbcem m a civil penalty'
301APN1WW9HiiPLUMBIN
(_tIiti;' Occupancy Type
-303--ROUGH
... ....
win du th k. and m"straerure is not hmeaam or v.ered ter sale Is«. ]oda.
'304 - ROUGH EIFEjJ�WadfiApTaCtjorI§-i, �!P. I
hirmalf
or Nrough his own employees, that such improvements arc not mudeffor
SOS - FINAL ELECTRICAL
c�� howitcr.... r 111111 ing iffiran"Immund is sold within one year of-
S07 FINAL P LUMB I NG T.
eirin,irnmr,harownerbuilderisvii) have the burden ofpmving that he did not build or
,W
unprovenorporreiciarsult.),
508 FINAL MECHANICAL
r 0 1; -a —act of the Profit for exclusive], contracting with licensed contractors 1.
construct the poiject (Sm. 704k4, Business and Professions CWc:) The Contractor s
License Law does on apply to an owner of property who builds or improves thereon.
0 U.f I
and who contracts for such projects with a commuctora).licamad purstrant.ho the,
_ i.]_.......
Cmrcmcbar. License Low.
[Ilionixerninunder Scc,"s :B&PClint this reason
cr Dint
WORICER'S COMPENSATION DECLARATION
I humb, WT .. inuaccr pe Pry of .. .. .
perjury one of the following declamations:
❑ I have and will inninuu. a Cert ificare' of Con to self -insure for Worker's
Cim,costali... as provided for by Section 37M of the Labor Conle, for the
indenture, of the work for which, permiloi,4,_
I . h,i ib� his it i, . Permit I , ,
0 1 have and will WA&'r Compensation Insurance, as required by Section
'°r
non
90 of b. Latin, Code; for the of the WoA Fiat which this paratiCis
ssand
, uand;M, W ;kers cmipat n Insurance imf and Policyrumber care— I'
cam c,
i -z
if CER TIFICA CA ION OF, EXEMPT [ON FROM WORKERS
A i .1. 1
COMPENSATION INSURANCE'
rnii; s-tim need not be c,omP,ietW,rfftha pe'rom, is-fornme hundral dollars
. . .........
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Of Imhof.).
I certify that in the pert of the work for which this s isoi16,4sued I
permit iet
ihall not employ any personin any Water so as to become sub)it to the W'
Comper,mion Laws ofCaliforria Data
Appican
NOTICE TO APPLICAN I 11. after mosmit this Carl of Exemption. you should
b-cromin subject to the Workei's Compensation previsions of the Labor Code, you must
forthwith comply with'stich Provisions or this pronnit shall the deemed rawlawL
'CONS
I hereby CONSTRUCTION LENDING C'
y affirrin that tuneis a boi6truction cialunggency for the perfortmon,
AGENCY..)
of the ismV far which dits is &wd (Sic 3097. C.
..I,
Lairdel's Name
,met v �.me
,3 ;., _.
7 :1
. I citify that I have need lhis application and state marine above information is
cifirect. I figne,to comply, with all city and countyordinances and state Laws of
to building construction: and hereby authorize representatives of this city to enter upon
the iflonve-mentioned pim,eirty far impeelum proPoses.
hammy our
liabilities. judgments. costs suff estimates save dem fyand which may in my way accrue ag a,
. ain't said
-
Or irtonsequen re ofthb� graming of this I I . I I
!701
t
ICAM DERSTAND D LPLPLY,
SR RE ONS. 'p, NT
Issued by: Date
,gnat,P i .
t*
normz
. U .
' HAZARDOUS MATER'I'A'IS GISCIo 1
Re -roofs
r., I 5 R E
boilb —,a ... "
udii;�a - '
Type of Roof
as defined by ducCupratino Municipal Code. Chapter 9.1',-md. the Health an=
Code, Siction 25532u)1 �,' it . .� � , ;
" * I'le"VI I ...... 1.11 , 0--
.-
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0 Y's [IN. -
I
�-ii�ro10,fs-�s�-al�l':6e-insoected.prior .to. any, roofing being installed.
Will the appt a r future building occupant use equipment or dt wifich
forhi laxnrihous air candiformarts as derined by the B Arla Air Quality Management
'
-materiall
If a roof is irisialled'fdvithout. first obtaining an inspection; agree to remove
.
materials
Diuriel? r 1 ! : . * . '. 11, - I . il — . ..
x, -.0y.
- -new
all for inspection: -Applicant understands rs nd and will comply with-,
tas
. .
ll'n6n-06int source regulations:"
1 ha read iSe hazardous renals egmrctocnts bride 'Ch
purr
California Health & Safety Codr, Sec tions 25505,'25533 and 25534. 1 understand that
i fthe building does not currently have a tenant. that it it my irsponsibility to ratify the
fire repuermants'which must be met prior to issuance of a Certifies, of
c;
4E_
Si gnature.of Applicant Date
o K 7! unnim, . in, , agnfml_�i q 14
All roof coverings to be Class "B" or better
OFFICE