02060154 TY
C`BUILDING DIVC'ISiONVOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7572 BOLLINGER RD A PERFECT CLIMATE 02060154
OWNER'S NAME: APPLICATION SUB DATE
STEVEN REN 10570 5 DEANZA BLVD 06/24/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 861-9545
ARCHITECTIENGINEER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
G:1 CJ L7
Z v i LICENSED CONTRACTOR'S DECLARATION Job Description
O Z- 1 ecmby aRm,lira I am licensed under provisions of Chapter 9leommencing
withScetion]000)o(Division3 of the Busines dProfeaionsCWe.and mylicense ADD A/C UNIT.
g in full fort n 7
0 i Licen Lic.
a In Date ARCHITECT'S DEPLARATIOW
O m4AS 1 nderstan0 my plain shall be used es public rccoNs
d oO Licensed Professional
= OWNER-BUILDER DECLARATION
1 hereby airline that I am exempt from the Contractor's License Law for the
t5 Z< following uaon.(Section 703 L5,Business and Professions Code:Any city or county
Y F❑ which requires a permit to constmct,.Iter,improve,demolish,or repair any structure. $3400
u°13�—prior to its issuame,also requires the applicant for such pa iuo Bk asigoW statement, - - -
16htheB,licenyeJpuhudNS011rlpmvkionao(theConuucm(sLicenuLaw(Chapmr9 Valuation
(commencing wish section,]000)of DivisionatShe Brp(ne2s,m;ahf ' nsCWe) l"3 yL 0 �:''V V> 1 - '
or Sect fie is 31:5 b my
ap li and the basis for the subjects
the u applicant
Ze Any violation I
-of Section]031:5 by any upplicamfore permit subjects the applicant tea civil penalty-
of
��rr rop�bbee
of not more than rive hundred dollars(S500). 3OlAPN R6ift PLUMBINGOccupancy Type
❑I,es owner ofdrc ad the structure
ru my cmp.1 in with wages ,their sole le SZ,C vtion. mppiiin
w II Business
for wo$-scions Curl
Contractor's not intended or a Law foes no (Sec:]Dai;' ,i -
mTmin
'Business reopen ire horm CWe:The i.License o d does h apply m an 304 — ROUGH EL W ¢tions
owner of pmts ov Who builds. improves thereon,end who does such work h ed Gtr
or through his own employees. building
Nat such improvements is suls ate not intended m _.SOS- _ .FINAL FINAL—ELECTRICAL I CAL...._"-
_ _ _ ----------
offered
_.._.-__.._ _.._
'co'completion,
the will
have t Uri of proving
that h did one ywr of
c mpleti"n.Weowner-builder will have the burden of proving that he did not builder 507 - FINAL PLUMBING
improve for purpose of sale.).
io --- --- mex - ---- licensed- nt ct - — - .5.0,8_ -. FINAL .MECHAN.ICAL.. — -- —
t7huowner miee propmy,4.Business
and ntmeisions Code)
Contractor
�. • .':< i T
License the does no(Sec.]040.Business and Professions GWo'.)The Cor thereon,a
..c
License Law doer not apply, rj owner of property who builds or improves thto the
.. ,.: . aWaho.c"nhuls lcov.,h.pm/ecu.wiN a-contracmrtsl licenud.pursumtm the. _.._. __..__.._.
Comractols Licenu Law..
❑I am exempt under Sec. - ,B,&P C for this reason c
Own - Date
WORKER 5 COMPENSATION DECLARATION l•'
I hereby affirm under penalty of perjury one of She following declaauons:
❑ 1 havdand will maintain's Cedificare of Consent to self insure for Worker's
Compensation. as provided for by Section 3100 of the Labor Code;for the i
perfomwce of chi work for which this permit is issued. ,, -
❑(have vnd will mainmin WoFker'i Compensation Insurance,u required by Section
3700 of the labor Code,for the performance of the work for which this Permit is
issued ._MY W rkefs Com em t T Insu c carrier and Policy number ere_
r P, N WORK Sy 6 ';O,v 7
,,,BERT FICA ONOF A "'IONRANC WOR''R' j - s ..
COMPENSATION INSURANCE.s`,"' ` ' I' _
iTbix section need not Ise completed if the permit is for one hundred dollar ` .i--
(SIM)or less.
1 comfy that in the ed.rance of Ne work for which m s pcmut ix is W'I
shalltnm
ot employ any person in any manner so as to become subj=to the Workers '
Compete...ion Lows of California.Date
,Ap.. ,.
after
ld
-N clime su O APPLICANT If,Compensation
this CemificaeM Exemption,o d you,you must
QZ bechwith jenm the Worker's Compensation perout shall She Leber Code, must
forthwith comply with such provisions or this permit shall be deemed revoke].
LENDING AGENCY'.
>ZiQy - I hereby hithat there isisna ng' nO Y f the Performance
Nework for which thispermit s issued(S c.309] Co,.C
Lender Name_ . _ - -
snder's'Address
i
•r
v �•,•., `i
, q
I camify that 1 have rend this application and state that the above information is
correct.1 agree to comply with all city and county ordinances and state laws relating
Q t) to building con.omction,and hereby authoiis mpmaenmives ofthis city to enter upon
y, r� thepbove-mentioned .,my forimpeaion purpaes.
(We)egrce msave.indemnify and keep hamrlesx the Ciiy of Cupertino-against
rA liahilities,ju ramm costs and expenses which may in any way acerae against said
U.ZJ. iiin in con qu nce of the granting ofihis permit. '
APF'LICA P ND TAND,SAND WILL COMPLY WRHALL NON!-POINT Issued by: ra Date
soUURCf .;ULAT NS... y
i
�dcl�.,]d
pplicandC ator., Dae Re-roofs
HA AR QUS MATERIALS DISCLOSUREsm
1lthe uppl n t e w l ing ec p nt t rc m heWie haaadoes imnenal .. Type of Roof,bythe Cupm n M t1 Cod Chapt 9 12, nd th Health and Safety eSaS on 2551(¢3 i (• I ',1'` � F5) .Y.,-t - sir
D ._AII roofs shall be inspected.prlor_to_any-roofing material being installed ,
Will the.filic ntorfuture building occupant use eq pment or devices which If a roof is instal led'without first obtaining an inspection;I agree to"remove
¢maid?rdou¢it,
corm is as defined bytec Bay A� Quality Management
Di men all new materials for inspection. Applicant understands and will comply with
❑Yx ::"- ` "; -- ,. all-non-point source regulations'. , -
I hise lead the hazardous maim s requirements under Chapter 6.95 of tie
California Health&Safety Coda.Sections 25505.25533 and 25534.1 uWentand that ,-
ifthebuildingdoes mtomemly;moc a tenant.that it is my responsibility to antif"he -
od opera a requirement which must be met prior to issuance m a Cnttificntc of
Pan
Signature of Applicant Date
wnero thodaedag Lie All roof coverings to be Class,"B" or.better
OFFICE