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04110110 ,CITY OF CUPERTINO BUILDING DIVISION PERMIT M.s CONTRACTOWINFORMA - BUILDING ADDRESS: A PERFECT CLIMATE PERMITNIh4110110 1218 BB UBRD VV _- OW NEWS NAME: PERMIT ISSUE DATE Adh WEI LU 10570 S DEANZ ONE: SANITARY NO. CONTROL NO. (408) 861-9545 ARCHITECT/ENGINEER: BUILDING PERMIT INFO - - BLDG ELECT—.-PLUMB _-MECH_ �Oij LICENSED CONTRACTOR'S DECLARATION >(� rA: ��© u 1 Nrtby affirm INS 1 am TA under DELLA of Chapter 9(commencing Jobµ�S If1lftjt�lVnyn W with Section and e)ec DivisionJof the Busin Band Profcuiuns CoM.and myliccnx is 1111 in full roma antl effete. REPLACE" FURNACE _ _ � �,�b Liccnu grC.- _?- �) � Dale—Cutaneous ARCHITECTS DECLARATION DGtu /3 2OOT ¢ I understand my plans shall W used as public records 7yU LLa G Licensed Pndcssiunal 1111 OWNER-BUILDER DECLARATION MOM`©�� II� 1 Nrthy atnrm Thal 1 am exempt form the Ciamom e.Licenu law for IN fr'LI- V\\VI' et o o following mason.(Section 7101.5.Business and Profculuns Coati:Any city Of county _ x$f which mquims a Pmmit to cnrtareact.alRr,improve,demolksh,ar repair any strvcur e -- - �iy prior m its issuantt.alau requires theapplieanl for such permitm file aligned shaman - _ - < that he is licensed purism to the provisions of Om Commcmri Limnx Law(Chader9 Sq.Ft. Floor Area Valuation (commencing with Section 7")of Invision Sof NC Boamesand Pmfcdinns Code)or -"- -- y N E Wl he is exempt IMmfmm and the basis for dR alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant in a civil Penalty of Occupancy Type not mom than five hundred dollars(550(1). _ ❑I.re owner of the property,or my employers with wages as their spin compensation, will do Ne work,and the structure is not intended or offered for sale(Sen.7014,Business and Professions Cade:Th Coma ter,Lm.Law does nOf apply m an owner or _: _. - Y Required Inspections property who builds or impravcs thereon,and who does such work himself or Nmugh his Own employ=,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the bode.of proving that he did not Wild or improve for puryme,of - --- ---— - aale 7. I.as crane,of dm property.am exclusively contracting with licensed contractors to _ continues the project(Sec.7(sl Business and Professions Code:)The Convacwh Li cense Law docs not apply to an miner of property who builds or uniform Merton,and who comrscts for such projects with a confroctona,licensed peasant to the Conractofs License law. I am exempt under Sec. B A,P C for this rtaron Owner Dale WO ER'$COMPENSATION DECLARATION 1 secretary affirm under parody of perjury one of tN fallowing declarations: I Nva end will maintain a Cenifiwm of Consent in self-imam for Waimea COmpcn- lion,as provided far by Section 371X1 of the Tabor Code,for the Performance of the 7C37W ork for which this pefruit is issued. - 1 have and will maintain Worker's Compensation Insurance,u required by Section ' of the Lamm Code,for the performance of the work for which this permit i,issued. y Worker's CamPensmian Insurance cannot,and Policy tamper artartier Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not m complerd if th.permit is forme,hundred unit.(SIM) or las.) 1 emery thm in the Performance of the work for which this rermin is issued.1 shall not employ any person in any monster an as in become subject to the Worke,i Compensation Laws of California,Dam Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become subject in fee Workers Compensation previsions of On LaMrc Code,you must � Z forthwith comply with such provisions or this permit shall4 dccmW sankcd. 'Z O CONSTRUCTION LENDING AGENCY 7- heresy affirm Nat flat.is a construction lending apemY for the Imformaae of cd the work or which this permit is issued(Sec.3097,Civ.CJ !y lender's Namc Z Lr:ndcr's Address V Q I R.fifyee Nal I have Rad Thisty ad tiun and we that the above Information is 0 U building 1 agar to comply with all city and cauaty odinanca and slag laws relating e U atirwonmennswctiroend herebyamhonprposes. natives of this city menmrupon the � F57 alwvc(We) ed gree to averty for inspectionnitmc,then f, C (Wc)agme I,sere,indemnify and kith harmless the City n Cupertino against rA liabilities,judgments,costs and of expenses may in any way accrue against said City of me V z APPLICANTeUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIOfIS. )' / T SlgnOfAPPlm Con /n/Date Re-roofs mm HAZARDOUS MATERIALS DISCLOSURE Type of Roof s Will the applicant or future building oceupermsmrt or handle haaadons material Cs dented by Ne Cupertino Municipal Code.Chapter 9.12,add the Health and Safety 0y. cotic. 2is32(a)7 �}Nu All roofs shall be inspected prior to any roofing material being installed. Yes Will the applicant or future building occupant tut equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit herardous air contaminants as defined by 0„Bay Area Air Quality Management all new materials for inspection. 7,Cn istrict] ❑Yes Fu I have mad the hamduusmaterials mquiromcros underChaptei 6.95 of the Califor, ice Hcalthh Sdf,yCWc,Scc6om25505,25533and25534.1undasundthatifthc Wilding ors non cunendy Nva a tenant Thal it is my mspmmihility w nndty Nt acupwt.Telae quirm,f h;chm be met m,lulaauenceoraCednestem up cy. Signature of Applicant Date C�i� , In71e Owner tar authomcd agent Dam All roof coverings to be Class"B"or better