03080108 crrY or cupEarlNo r
BUILDING DIVISION PERMIT C
?CONT, CTOR INFOR�MATION:iy�:
BUILDING ADDRESS: A PERFECT CLIMATE PERMIT NO 03080108
n4-1-, rOTPV A17
OWNER'S NAME: 10570 S DEANZA BLVD PERMEP ISSUE DATE
L (408) 861-9545 SANITARY NO. CONTROL NO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELER PLUMB Mr;CH
0 0 0 0
+Op LICENSED
?imLIC EN"SEDCONTRACTOR SDECLARATION
F Ihereby affirm that Iam licensed under provisions ofshap
er9fmmmcnemg Job Description
with Section 7000)of DivisionlofNC Business and Prdcssi.ns
Cods antl myliccnsc is
>>� MraumeeaMaf REPLACE FURNACE
J,v�2 Licnsc Cl DN-/ Lick
��CSDECL
ARCHITECTS DECLARATION �®
J < 1 understand my plans shall M used as public m<nrdx .
JyU
C
Licensed Professional JAN
N
S OWNER-BUILDER DECLARATION I 5 2004
a y 1 hereby affirm she I am exempt from the Contractor's UcCam Law for the
a O following reason.(Section 7031.5,Business and Professions Code:Any city or county
e m which requires a permit in construct,alter,improve,demolish,or repair any starch, Roman
finonn its issmnm,alsu mquire,flaaPidicam Ro Bash pernarw Me.41 statement
< that he is licensed pursuamlothe provisions oftheContractor's License Law(Chapter9 Sq. Ft. Floor Area aluatlon
u_O (commencingwith Section 780(8 of Division 3 nflhe Businessand Profusions Cmk)or
a 3 Nal he is exempt thcrefmm and due basis for the alleged esemption,Any violauon of 3 1629017 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to acivil penalty of APN Number Occupancy Type
mom om than five hundred dollar,($508). P Y YP
❑ Las owner of the property.ar my employees with wages as theirodc compensation,
will do the work.and Be swcturt is not intended ,Offered Bosom(See 70x4,Basinau 3 Ji — XUUGH TTim iS
and Pmfcssinns Code:The Contractor's License Law oma not apply to an owner of 3 0 3 - ROUGH M CHANT ACtI Ons
prolaeny who builds or improves thereon,and who does such work himself or through his
Own employees.provided that such improvements are not intended orofrered for sale.If. 304 — ROUGH ELECTRICAL
however,the building.,improvement is sold within one year of completion,the owner
builder will have the burden of praying that he did not build or Improve fur purpose.( 505 - FINAL ELECTRICAL
sale.). 507 - FINAL PLUMBING
L as owner of c, Seefumpeary.amasin.iv ad communing with:)TheMmoomWlarx I.
covwa theeskerpply.oin owner
amprty whoonsdsor improvers
C.nhereon.Li- 508 — FINAL MECHANICAL
cove law cots not apply je am owner ont property who bullas m improves Ncreon,and
whose Lacu for such pvjeeu with a eontranor(s)licensed pursuam so the Contractor's
['tante Law.
❑I am exempt under Sec. .B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby afrlm under penalty of perjury one of the following declarations:
1 have and will maintain a Cenir=am of Consent to self-imsua for Worker's Cumpen
.maxim,as provided for by Section 37,X1 of Ne labor Code,far the performance of the
work f which this pe.mil is issued.
ave and will maintain Worker's Compensation Ivuranm,as required by Section -
f the hour Code.for the performance of the work for which this prrmil is issued.
My Worker's Cn nsation lnsunnce carrier and Policy nuamCpgc-r
Cartier cy No.:T1 I //-• J
CERTIFICATE
OFEXEMPT NFROMWORKERS'
COMPENSATION INSURANCE
Co is swoon neM not M completed Rthe permit is for.nc hundred dollars(Slfq)
m hux)
1 ecnify that in the performance of the work for whidi this permit is issued.1 shall not
employ any person in any manner so ase become subject to the Workers'Compensation
Law'
.f Cailfnrnia.Dale
Applicam
NOTICE TO APPLICANT:If.after making this Certificate of&CMPlfon,you should
become subject 10 the Worker's Compensation provisions Of the Lamar CMT.you must
.JZ forthwith comply with such pomnsions or this Permit shall he deemed evnkrd.
ZO CONSTRUCTION LENDING AGENCY
'r+ Iheeby affirm that there is a construction lending agency lot the Performance of
x the work for which this permit is issued(Sec.3897,Civ.C.)
If] Q Untie a Name
y Lcnder's Adders
� z
J Q 1 certify that 1 have mad this application and sure met the above information is
Fsorest.1 agree to comply with all city and county ordinances and state laws elating to
U building construction,and hereby rotation representatives of this city to enter upon the
>� W aMvo-mentioned PMNfLy for ivpcction Ptupoecs.
(We)agree to save,immorally and keep harmless she City of CUPCoiro against
F' , Iiabiliun;judgments,costs an do penes which they in ony way acme against mid City
J Z in consequence of the graminThis
^ AP LICANT UNDERST S AND COMPLY WITH ALL ON-POINT Issued by: Date
SO RCEREGULAT n
y Re-roofs
Signature of Applica o actor Dam
ARDOUS MATERIALS DISCLOSURE Type of Roof
Will the app t am ter forum building occupant sere or handle Health ad
Safety l
v acrncJ by IM1c Cupertino Municipal Code.Chapter 9.12,and the Health and Safny
6"strict?
de,Sertion 25531(a)l All roofs shall be inspected prior to an roofing material beim
❑vex P P Y g g installed.
Will the applicant., mg Occupant use equipment or dcvims which If a roof is installed without first obtaining an inspection,I agree to remove
tit hx.ok ue air contaminant [fined by the Bay Arca Air Quality Management all new materials for inspection.
OYcs
1 have read the hamnlous materials requirements under Chapter 6.95 of the Califon
nia Health Y Safely Code,Sections 255)5.15511 and 25534.1 understand tha if IM building
dors not rumind ha rat. a it is my nexponsihility a notify Ibe acupans of the
mquir=ncria h sl ro . ceofacerurc Pan= Signature of Applicant Date
n ,�x an �9 72;1 All rooF coverings [o be Class "B" or better
0 izcdag,rd /� a