02050115 INO
CITY ofcnmSIot DIVISION PERMIT CONTRACTOR INFORMATION:
Bui1Mff79F .NDLEY DR AIR QUALITY HEATING & AIMW 02050115
"tbVtWT`INO-BROWN INVESTMENT 1233 PEDRO ST Ap5ffft`YY6]52
{ ?HONE: (408) 293-7138 SANITARY NO. CONTROL NO,
GOO ARCHITECDENGINEER: BUILDING PERMIT INFO
he BLDG ELECT PLUMB MUCH
m i LICENSED CONTRACTOR'S DECLARATION nh.D05Criptlop
Ihereby affirm hmTam licensed under p visions ofChapter 9(commencing INSTALL A/C UNTI'i'S
wensectmn]Iwearniv;amn3rermeBmsmeaProresainnacreae.an ,rbmen.`e (3) 5 TON & (1) 25 TON
;yp� is in full lac{ d c /_ ��
z e a Lic n CICS an Lic x �0 Y.l%
Comas
.u O RCHITECpS UEC e r ION t a/'}i /
1 undemand my plans shall he ussd as blit¢cords
r
i O0 Licensed Professional OWNER-BUILDER DECLARATION
v5 I hereby affirm that 1 am exempt from,he Contractor's License Law for the
C? following reason.(Section 7031.5.Business and Professions Code:Any city or comedy
O which requires a permit to construe,,alter,improve,demolish,or repair any sesame,
aim prior t also q d ppllunt fur m<h permi,mflea signed,estemem _ _ __S77000
thin hesleeved Panama,mtbe pr nzonne Contractors Leense la.(Clefrer9 „ l3 Sq. FL,FIoor Area, , . , ,;-., Valuation
(commencing h Section]IXp)of D' Sion 3 of,he Business and Profesnons Code) ? 13 2"6 3 3'1'0 2:X0.0._'
or bathe is sxemp,the from and the bass for the alleged cxelit i Any violation '
-of Section 003L5 by any applicum roe a permit subjects the applicant o a civil penalty APN Number ... .�
sof aot mom than rive hundred dollars($580). Occupancy Type
❑1.asoenaroftheproperty.ormyemployceswithwage.astheirsolecompensation, 101 - FOUNDATION
"will do[he work.and the summers,is am intended or offered for sale(See:7044,
Busineis and Professions Code:The Contractor's License Law does no,apply to an Required Inspections 0' '
owner of property Whobuildsp es thereon.and who does such workhimself 103 — UFER
or through his own employees.prosided that such improvements am not intended or
offered for sale B howevi,r.the b la g tor Improvement is sold wilhim con-i,=ear mf - ----1-04 -'- .-REBAR ..___... - - . ._.. --._..._... ... ._.
iomplet on,the owner-builder will have theburden of proving that he did not build or
mprove forpurpou, fale.), 105 - ANCHOR BOLTS
- _.. _.... _.._...-_.. 106 .. - SEWER--&-WATER -..._... - -.._.. - - -
= f]basownerof,hepStac.744, ulusis., ,ad tromingwhnlittnuAcmnmaorsm 202 - UNDERFLOOR PLUMBING - -
mswa The project(Sec ]044 Bon nes d P f:.inns Calor The improves
Barbara,License Law docs no,apply roan owner with
a pent' ho builds or improver Nen.th
riawna.emmraens red soon rev.c wire. - nuamogs>.ettmea pursmanrm he .__ ...2.03 -._UNDERFLOOR....MECHANICAL
Contamxe Liceexempt order
204 - UNDERFLOOR-FRAME -
205
_ ❑lam exempt under Spe/' ' ' ' '� `';e&PCfonhis«ason
o:ner - Dme'' "^ 205 — UNDERFLOOR INSULATION
-' WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
."` -Ihereby affi,munder Penalty ofpcjury.one of the followingdeelarations:- 302 - TUB & OR SHOWER
ID 1 have and will maintain a eeaificam of Canoed to sell-inamrc for Workers 3 03 ROUGH MECHANICAL
Compersai.e. as provided for by section 37M of theLabor Code,LBrr he 304 ROUGH ELECTRICAL
peHoremace'c f,he work for which this .it,,issued.
Y4 have am1 w91 mortgid Works",Coh,'n,�iibr hbsymres,as
305 - FRAME
t. pe rcgm;rca Br.senr;on
e 3]00 of the Lather Coda for the perfohni nee of the'work for which his peani,is 3 06 - HOLDOWNS
issued My k' Co pe fon lmmmroaoarriar and Policy mandae,
3.07 _ INSULATION.._
P —R308 iSHEETROCK'� t ,',
ATIO FNSA OM WORK RS ° = t. kJ l 4
FRT( COMPENSATION INSURANCE;"._' - 3O9_._.__EXTERI.OR_LATH'—.._._._ .__
flu'seemnneed nm beenmpiemd f he permit is for one handree dollars 310'`�' ?INTERIOR LATH -'
311.._..-_ SCRATCH COAT
• ' -
11 rtfy,h iln he per? of work hich,h perms" sudI :.. - _ ...
iKgil nt emptor anype Person in any manner ro as to b[eprfle subject to he worked 313 - ROOF NAIL.:.
compAppleasidlL awsorcanfemia:Da« ' 501 - FINAL ELECTRICAL ENERY
NOTICE TO APPLICANT:IL aper making this Catificart of Exemption.you should 502 - FINAL PLUMBING ENERGY---' -- -.. --
Z become subject a chi Workers Compensation provisions of the labor Code,you must '
O O Bran h mplr ithadenp '.ions or(his permitshmlbedeemed vokoe, 503 - FINAL MECHANICAL ENERGY
t `'CONSTRUCTION LENDING AGENCY '504 - - -"FINAL 'BUILDING--ENERGIb- . . ---
W_� (hereby affirm chid Tend
ids iismeduaion lending agency for he performantt 505 - FINAL ELECTRICAL
yti of he work for winch th perm t ued(Sec 309] Civ.C.) "
'°I� Lenders Na ri '' ..•'•_. '. ....- -"506 --- GAS -TEST
LcntlttsAddress ,.
507 - FINAL PLUMBING•i '('
V O (certify that i have read,his application and state that the above information is
W.F eiimmL 1 agree ei comply with all city and county ordinances and state laws relating 508 - FINAL MECHAN I CAL
Ot to building consnueeon:andhereby motorizercp«sentahvesollhiicityroemerupon 509 - FINAL GRADE
}_W the above-mamboed pmpeny for inspection purposes..
E...0. (w) ga<t . -r'a nfya and pn l he City fc Peri i.,mis, 510 - FINAL PLANNING
liabilities judgment,.ecto.,and expenses w thich may any way against said
city n consequence of he granting g of this pe mtr
'APPLICANT UNDERSTANDS AY WILL COMPLY NIT AL NO PONT S14 rs- NA WORK`S
So c ons Issued by: Dale
mat Applicant ? , Re-roofs
HA' RDOUS'MATERIALS DISCLOSURE
Wreh alibi rr bmla- gornpan, 16R car M1aalhirmmusmate,ul Type.ofRoof_._
ss def d by,the Cupertino Municipal Coe Chapter 9.12 and the Health and Safcry r
? S❑cY 255j2o.)( N r\ .. ,'. -t I 1 t 1, r ,. g I .. . . i ., -..
Cd
. /`}1�,, is
. . _All,.roofg shall_be inspected prior to any roofing material being Installed. . .,_. .-_
W 11th ppl , f t h le g p , egm;p , de c which If a roof 3s installed without first obtaining an inspection;('agree to remove
D 1 h rd a m , d fined by,h B y A A Q lit'M agent m
rte allhon- ore[source re u]a[lons. _ understands and will comply with
� � ❑Y p PP .
y _ a new materials fo_r_ins inspection. Applicant u
the h z rdous mamma" q emend unde Chapter 6.95'of the p g '
Califomra Hiehh&Safety Code Sections 25505.25533 and 2553a 1 uneas,and tbar
if the building does not cuaamly have m ort.that it is my responsibility to notify the
keup_ra rtheregoircm , wh'ch ui,be mee p' miswan e'7 Cnifca¢pf ---- -
I
y - - .
Signature of Applicant Date
o ire amrenzcaage , " ;• ., Date All roof coverings to be Class "B" or better '
' te
OFFICE-