02040104 j ,;,CIT,Y;OF CUPERTINO - -t^• •.:
.'suanlNGutviSl0N PERMIT GONTRACTORINr+,ORMAnoN_-,
BUILDING AD DRESS:
1. ,iipv,'. PERMIT NO. '
ATLAS HEATING 02040104
I 'OWNER'S NAME: - APPLICATION SUB DATE
'HAWN ROBERT E AND ROSANNE K ' 155 SAN LAZARO AVE 04/19/2002
PHONE:' :
SANITARY N0. CONTROL N0.
(408) 739-0516
O
ARC ITECT/ENGINEER:
. BUILDING PERMIT INTO
FF I
BLDG ELECT PLUMB MECH
-Ni 1 LICENSED air'-
DECLARATION Job Description I hereby aThal I an licensed unde&r'Pr provision Of Chapter 9(commencing '
T'y Enwith Section]000)of Division 3 of the Business and Prorc:sions Code,and my license REPLACE FURNACE
isin fullfone andeRtt /m
ere License Clus 'Lic.p U' �0NALED
a. tZ .Date '. L! SIDECLAR
p 5 ,. )'•:,, .t ARCHIL EW.O DECLARATION 1
-�i 5 � ;^'_ayndemand my pias shall bused u public records I
x o o 'Lawnsam P oreamnal g P R 2 4 2002
't. , 'os.OWNER-BUILDERDECLARATION '
�' '�Y II craby afro that l am exempt from the Contractor's Lica.law for the
f z
roll owinin, a(section 7030,auniness and Professions Code:Any city lir county : $2000
f'€O 'which'requires opermit to cons wct.alter.improve."demolish.or repair any sauclun 11'1 BUILDING
.
ve. •prmrt t ss ase.also- qtr rhe pplicam fes such pemul to fleasigsd swe lit. - L - -_-
that he u I ie sed hasua t rode
Icomtn.cp;w Sttls]000)ofD.Ison3oftheBustnusandProfusiosCade) !'13 8-¢Ff• I;:/ a ` tt,3; rTt,t, Valuation
,or that he r exemyt Ificiefmm avid the bull(m the alleged cRemptitn.My vlolal on - - 1
of seedoM'l01IZ by any oppllna for a permit subjects the applicant a a civil peslry-
rnrl;oimolatu,hB.ewndrcdaalda(gsoo). 30t" N-Ki7Ul&rI-I PLUMBIN Occupancy Type
;0 Las owner of the progeny,ur my employee with wages u their sole compensation,
will'do'Ihe work:and the"siiurlure s nal tended;r'orterea-r ulc'(ser.]ow," 3973 AT,
IBusiMr.�and.Piofessions Code:The Conwcmr's License law does nm apply to on 304 - ROUGH E2A0# 1IIRS Vtiohs
awsr of progeny Who builds s impmsxs tWman,and who does such work himself TTa
or IhMu h his own employees,provided IM1eI such impm_vements arc not intended or „5-0,5. .N.INAL_,E LE C 1_SL I CA'
:.Beed for: :If:Howe er, .. Wilding o -. ....... ......-_._. L ._-
g Ps^amen is sold within one year of - --- _
improve the ownerbuilder will have tete burden of proving[but lie did not Wild or 507 - FINAL PLUMBING
moo roprysearpleJ. " 508 - FINAL MECHANICAL
01; - _
tl 'O I ei lie of pmpe_ny,oro exdusly 120 I ni - _ �"_" '--"" -'-'--'-' --- - -
cobsuucl the act(Sec.]Od4,Busness nM Professions t Codc)The Contractors -
- License law does nota m an owner of ro n
;.' oDY D o ywhobuildsled"rexa o,th. •,,..•,.. ^LLP ai. +h-i�CFl
_and.wbso tcues Uamsjorl.... .popcu wiN a.mnlrtnor(s)licenseB.purssm so�Ne. ._._.—___ .
' Controctol LtceseL _.__.______ _____ - ._.
r ❑lam exempt under ser 'Bk PCfor J. 1 ___..
.. _ Ihit,reuon
.. ..:,,._., .... .r. :m'°n''Dam• .'
Owocr
."•+,. .i:arts t.,r .,P'ORKER'S or MPEeeuma-37W of RATION
1 h by affirm ride pesky of pe 1 ry rue of Ibe following decelerations: —
1❑ Mve'soullviil'maintain da'Ccitifcuic'of'Conani to ul6insurt for Workv's
Compewtien:,as'pmvihd'for by-section-3]00 aP 61 he
the '
�performance of the wah for which this perout is iuued, .r -
..t
t eO I have b ill.11 n Werke Coropewt o Is ar,as required by Senion '
3700 of the Labor Cade for the Perfomt lice of Ilia oh'fo hl h N gamut is
sssd.M ohNi C pensad Insure a ern end PolcY number
T ,n.
r L cERT CA XEMPTI .!FV
,
OP EXEMPnON FROM. OAKERS - I ! f ( + f J lit A 1 '13N:l Y l 1
. t11y i COM ENSATION'INSURANCE`
cin viii on and oat b rampmba inne peimn m rn ene naiidre0 eau,rs - .I '> .. 1,s�,,�
Compensation
fsl_ Ic sfy Nat'n Jx perform of me orkf .-•_�.—__ ...—'— ..— _. .._ .—._._
rLh' a^S4 'h ch Iha,mur s issd d i
hell not employ o ,Pen ( ' _-.I1,`.. ' it
Ym y nue so m become b)xl to the Workm-
Lowe of Cat Tom a.Dale,' '
iNU110ETUAPPILCANT.If aftei,Co.-oLng shsCmfcote orEemptonyusould - —" '_-- ._ _... .
Z tieconesubjectnt int WorkerCam ratio ` '•"1"f. r ,
pe prD K f Int"bor you Mag -
Z 0 Tank th comply with urn provisional;..his Permit sh 11 b deemed mokeQ
• Y Thal Ihert n a conswa o Irnd y VqC _..._..._. ._ .
t.., CONSTRUCTION LENDING AGENCY ...._ .._ ._ ....—.. :. ., .._..
_.._._. ....... .
I ..
ii of Ne o L for h BN Hcy far the perforrn b' "v P '!'
�: Ihertb aB'im
tgl. u. Nispc lust ed(Sc309] )
a-� I<ndeYS Name'. r..•._•.... .u._.........,.cn
Lender',Add s
_...
_: .-:.........
W VQ i i ..... I. :r• iJ .:iLtn it
1«sfY d a 1 have read thil applicationend state[hat h bove infarmadOn is
.Ox[� eoeren 1 into m comply wid,all city and county ordinances and sl to laws relating
:Q to bu Idrnslmn on and h a, Ih
the aboe.menate representatives of this c ty to enter upon
,�s W a uo W property(or insreaction p rpexs
[r L{
M`0410--to save,Indem Ry aid FeeP harmless Ne C ry df Cupertino egeisl
.�i h liabilities,dudg Ms.este and eape ser wn ch y.ianyway ac me aganu ujd
V Z' Ciry- nseq...ce of the grant ngof thi e L v
IIS PPLICEBE KCA�NrUt D''t1O�S`Pi a,�DA COtIli' tITttI ALL'. �PoI :r` r
�✓Pr(3d •' Issued by: Date
Signa o(Applicao on tor.;. . .. .Date Tq.• Re-LOOT$ /
HAZARDOUS 1 LRIALS DISCLOSURE', t �
Will the.pplicans wfanit 1 garce,uperstrarmarlounfle hausdals etc al Type Of-Roof .. _
esderned by theCupertinoMat Code Cheese 9'12 and she Neaten endsofry
code S coon
❑Yn i
m ..All.roofs shaIl.be inspected prior to.any roofing.matenal being installed.,- __,__,_
i ".0 WJI the appl caul s future Wilding ser pant use qtr pm lit o des Ices which
omit banrdo Sar cement avuutlef db)me Bey Asea Air Quality Manag mens f is irisialled without fust obtaining an ilispectlon''Iagi•eeao`tem ve
If a roe to o
°into all new materials.fpr r.ins inspection.�YC1 v p Applicant understands and well cam I with
y all non-point source regulations., p y"
I hese read Ju'.barudous inatenve req Irem lits under Chapter 695-o6
Celi(gmu Heehh k Safcry Codes Sections 35505.35533 aM25]34:1 understand that
ifJie
him,ds an. cmrtrNYh ppaamom dui it a mY responsibility to notifythe
occupant of Ne req I 'menu h
must be inn pno m tss to
OdN�Pa.my�rd .. ..
_/`/y/�' .. ._Signature of Applicant Date
L1Data
Al]roof coverings to be Class"B"or better
4 1