02060060BUILDING DIVISION PERMIT
Bt111,pT Ap"I BLANEY AV
MASARU AND TAMOE
PHONE:
INFORMATION:
ATLAS HEATING
155 SAN LAZARO AVE
(408)739-0516
Q O O ARCHITECT/ENGINEER:
u; ya.a
o h Z LICENSED CONTRACTOR'S DECLARATION
Z In 1 hereby a(Brm that 1 am licensed under provisions of Chapter 9 (commencing
.4C with Section 7W0)of Division 3ufthe Bosinessand Professions Code. and mylicense
is in loll forte and of _ r
i e < License CI ss Lic N
7 3 °W' H Date Contractor
ARCHITECT'S DECLARATION
0 ; 1 understand my plans shall be used as public records
5 6 p O Lsensed Professional
' o OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
C b < following reason. (Section 7031.5. Business and Professions Code: Any city or only
ceO which requires a permit to constrvet, alter, improve, demolish, or repair any souaure
Irc�s � prior to its mtcurce, eb.fiequires theapp em,for such permit to fileasigned smmment
that he is licensed pursomrt so the provisions of the Contractors License law (Chapter 9
(commecncing with Sevion(7")of Division 3 of the Bupinss and Professions Code) �r j'
orthai he is exempt therefr`oid'and the basis for the alleged nomption. Any violation
Of Section 7031:5 by any applicant fora permit subjects the applicant o a civil penalty
iof not more than five hundred dollars ($50o).
NO. 02060060
NO. CONTROL NO.
BLDG ELECT PLUMB MECH
1a �-wya 1
BUIL®IVGoo
❑I, as owner of the property, or my employees with wages as their sole compensation, 304 — ROUGH ELECTRI AL
will do'Ihe work, and the stme9ureis not intended or offered for sale (Sec. 7044;
Businoxs'and Professions Code: The Ci ntmctor's License Use 505 _ does not apply to an cnon5',' ' --
owner of progeny Who builds or improves thereon, and who does such work himself 508 - F I NAL M C L
of through his own employees, provided that such improvements are not intended or
complefor 'sale. IEhowever-the ll (din gob Improvementn Id withind one year of
completion, the owner bu (der well have the burden of proving that he did not build or - -
improve for purpose of sale.).
❑I as owner .fabs rwith
p Sec. 7 am exclusively a comractmg I licensed Contractor's to
License the project (sec, 7044 Business and Professions Code:) The Commreon, t
Creams Law does not rapplysuch
m an owner of property who) Ids se Improves thereon,
_road .wha sLicets for such_projttu. wiN.e comracmr(s) licensed pursuant m the. _ . _..._... .. ....-...._... _..... ._...... ... ... . ... -. _.. __.
Cola cies License Law. _i,
... an 'S Sec " ".B &PC,for.hisreason
❑lames _ .
Own Date
WORKER'S COMPENSATION DECLARATION
I hereby adorn Coder penafy of perjury one of the following declarations:
❑ 1 have arx& will maintain a Cenificate'of Consent to self -insure for Worker's
Compensation, as provided -far by Section 37W of the Labor Code, for the
lpero mance of the work for which this permit is issued. „
111 have and will'I maintain Worker's Compensation Inm'rance, as required by Section
.. -. _ 370o'of the Libor Code. for the nerfor.naoaa b('ihr w..k for -I m1..,... 4 m
LAG v"
COMPENSATION INSURANCE °
O bb"Ol tlori need not be completed i( the permit is for one hundred dollars
($loo) or less.)
I certify that in the perf rmance of 7the work for which this permit is issued, I
aliall not employ any gerson'I- any manner so Is td become subject to 0e Workets'
mrthwnh comply with such provisions or this permit shall be deemed revoked.
'I.:, °r '"1'I -CONSTRUCTION LENDING AGENCY
O1 1 hereby ff'= that then is a construction lending agency for the performance
Of the rk forwhich thisgerm t i sued (S 3097, Civ. C )
Ladder's Name' .. .° -:.:. e .....,.. m- v
Lender's Address' '..
s, ,, „1 cenify.that 1 have read this application and stale that the above information is
W building consntibiion; and I
the above-mentioned.......
(We) agree to 'ace, in,
liabilities, judgments, costs ai
City In'CO equebce of the ggrr
APPUI IUNDERSTANI
EOUI:A 0 5
Sig mr of ApplicanUC.' o
HAZ RC
W111 the applieaht r(u
as defined by the Cupen o N
Code Section 255321.)
❑Yas
W11 th it Er tote
Iemaiiet? No air cobmm liar
DislncR I -
❑Ys
d keep harmless the City of Cupertino against
s which may in any way accru11.1 against said
his permit -11
VILLCOMPLY WITH ALLNO -P INT'
M1 A nn l
oat
n
Issued by: Date
Data ''
TERIALS DISCLOSURE -'
Re -roofs
ng occupant store or handle haiardoes male sial
- .'IyPe of Roof _
:nae soapier 9 12, arta the Health arta safety
r
l',
All roofs shall,be inspected � prior to.an xoofin matenal bei. installed.
P P Y g g
ing occupant use equ priefir or devices whim
ted by
If a roof is installed'without first obtaining an inspection; I agree:roliemove
the Buy Arco Air Quality Management
.. ..
all new materials for inspection._, A_ ppllcant understands and.will comply with
... ..,. .
_ ....�
all non -point source regulaaons:. ,
rials requirements under Chapter ii.95,of the
r .'
ns 25505; 8533 and 25534. 1 understand that
tenants of n rs myrespo b ity t notify the
in be talo. to i.,ue n O iocat'
` Vit
Si f A 1'D
g ore o pp can ate
mo
no... .1 ag t , ,,, gate All roof coverings to be Class "B" or'better -
:!.. .: OFFICE "---