02080002BUILDING DIVISION PERMIT
BUILDING ADDRESS:
10625 CORDOVA RD
OWNER'S NAME:
ROZ HO
PHONE:
Z
i LICENSED CONTRACTOR'S DECLARATION
ZO Z = - 1 herby m ria that 1 am li-mod qq�der provisions of Chapter 9 (commencing
P 52t with Section7W0) of Division 3 of the EI.lpLand Pmfeasions Code, and my license
a�yG isin ruff a t. J
m li:Y I. ens 1 S Lia M- O
3 E u Dine Co AN
s .ARCHITECT'S C A N
Frt+�= y undersmM my plans shall W used n public records
um! 6 p Licensed Professional
te n'
OWNER- R DECLARATION 1 (fim that I am exempt from the Cosor
s License Law for the
k: following moon. 7031.5. Busineand Professions Cade: My city or county
which requirta a permitto construct, al¢r. improve, deaolish.
or repair any swnurt
3$-pimroita iuumce, elsrequ ..a the eppliamfar inch pemur to fikaugrcd wremrnr
.ad the basis fm the alleged mRml
Tom for a pe.I,subjeca she applicr
dol'am (55W).
e my employees with wages as their
that such imorovemenu are not
CONTRACTOR INFORMATION:
A PERFECT CLIMATE
10570 S DEANZA BLVD
(408) 861-9545
nsCode) I CON
violation
to
the owner -builder will have the burden of proving that he did not build or
purpose of sale.).
U I o owner .',Me property, am o.Io.ly cmdrec4ng whh imetived contactors to
construct the pinna. (Sec. 7W. Business and Professions Code:) The Contractor's
License law does net apply man owner of pmpeny who builds or improves thereon,
.--and who.contncu.fmsuch.pmjecla:.wiN.a. covsrmmt(s) IiumN,prounat_to im
j
Contractor's License La Sl lh f't : I E'L q"
r 131 am exempt udder Set, B A P C fonhis reason
OWn r 1' el
WT ORKER'S COMPENSATTON DECLARATION
I herebydEm uMtt "
penalty of perjury osrc of she following duiamions:
❑ 1 hive oid'wilr maintiin'e'Ceriifieule-af'Conxent'to xlf-insure for Worker's
_
Compensation, as provided -for -by -Section 3700 of the'Iabm Code, forhe
J
❑006f d Ir Ctxae, Wohe.e Comae or
theid mdse
3700 r th< labor Codi f r she peiformeece f N weh 1
yFi vee M Wohefs Com n nra
on In unce card enJ PoII
GameroltcYN ( 4 RS .--. ._ss___s _••.Y �. t1�t �y is r' s ] _r,.'J •.-__ .-._. -'P :i... :;: s1;4 - - __._
}t (r CERTIFI ATI NO EXEMPTION MWORKB
COMPENSATION'I RANG'
I I'
v (Tho vection nodnoibe'coinplefed if the pe .it is for one hundred dollar: '•\'I \`""' "_t `— \?IIs'(.• Iyp
($ IM) or levJ
.- ....,.v.
...-
`' 1 vend y an in the n in aImy manner
v:as.i for which Nu pannus i
shell riot employ any person in my manner. m ni'to'Eccame lubjecs to Ne Worker -
um mton Laws f GI fomid: Det
Appl
INOTICETO APPLICANT: .If. after makrna this CeniOcmebf Esemotion.'vou should
_
NEW A/C UNIT
NO.
02080002
MON SUB DATE
08/01/2002
BLDG ELECT
J C
Job Description
TT( iyl' n
$6544
PLUMB . MECH
301"{'"IFt9TM
101
R()
PLUMBIN
";::,r.„ v txjjaaak:y 4yyt,
AT,
-
304 -
TPH
ROUGH
MECT-TANT
EL1MM1JtI17>;pPctions""''=Br=`'
505 -
FINAL
ELECTRICAL__
507 -
FINAL
PLUMBING ,—;::; it — — <<. nza, V,
508 -
FINAL
,
MECHANICAL
.... -
e hame or future b Ildir occu ms esu u1 ment or devices which
PP , 8 es p
,shall
" _
If a roof Is installed without first obtaining an inspechonl I'agree to remove
y,n nC1C :\5`11:60
all new materials for inspection Applicant understands and will comply with
No
�Q a �o�,'Im
_.._ __ _--
'----------
J' -h J�N,��i 2003 -- ----- -- --' --
asint Gumnd ,have o Tenant; that it is my responsibility to notify the
BUILDING
^OS'P', CONSTRUCTION LENDING AGENCY,
:by affirm that there is a comtivailoi lending egenry for n1e pe'rfomaince
for which tM pemli is i@ved (Sec. 3W7 Civ C )
I
Urea
I
-..-.. _-..-_..... ....... ...r_.., _. ... _.._. ..... .......
..-
mem ostP ens expense wb n, y n uny y me ngamxt nein
e c th gmm ng of th 6 pemmt.'
'VIT
_
D R TAND$ ANP WILL t:ON'l AL N(POINT"'
LA ',y' l
Issued by: Da e
s ,ere i
tee c� arm ra• a mte ,
��
Re-roofsIf
ROOUfMATERIALS DISCLOSURE }.
ea is orfuturE bdlltLngyccupamstomorhandlehazeNova mmuial
-_Typo of Roof_ ......
Ne Nv Mum pd Cqde Chapstt 913 end shell alth and Safety
fi5"2faly
t w •+1
iy,
a
All roofs be Inspected prior to.any_roofing material.being installed....-_
.... -
e hame or future b Ildir occu ms esu u1 ment or devices which
PP , 8 es p
,shall
" _
If a roof Is installed without first obtaining an inspechonl I'agree to remove
e
iser mnmm win m fined by the Bay Arw Nr Quality Management
all new materials for inspection Applicant understands and will comply with
No
all non -point source iegulation�,i Ir ,
;read:the bmaidousmaifnals uqu mmem, adc, Charier 695 of the
olm'k Safety Code, Sections 25505:25533 and 8534,1 uvdersm ni that
asint Gumnd ,have o Tenant; that it is my responsibility to notify the
-
ie mquircm w h miai'be'met pdmdb too. of a Ceniticzat f
'
=
Signature of A , Date
- ._-,--_
roof coverings to be Class B ort,tietter
ipdred•age t-
._OFFICE...._.
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CON.TRACTnR INFORMATION `-
BUILDING ADDRESS: A PERFECT CLIMATE PERMIT NO 02080002
625 CQRDC�114 RQ
OWNER'S NAME: 10570 S DEANZA BLVD PERMIT MUE DATE
1207, 140
NE:
(408) 861-9545 SANITARY NO, CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
s00 LICENSED CONTRACTOR'S DECLARATION
£'e FF 1 hereby affirm that I am licensed toddler provisions of Chapref 9(commencing Job Description 2W with Section70[XB of Division 3 oldie Business and Professions Code.and my license is
_o% in full force and effect.
:qg License Class 1Jc.k NEW A/C UNIT ^ ��
�r� Date Contractor /fes
ARCHITECTS DECLARATION
I understand my plans shallall thebe used as public recordsU q 't �QOr1
Licensed Pmfcssomid 1 AN p 1 J
OS OWNER-BUILDER DECLARATION Jl'S
a P I hereby off rm Thal 1 ant exempt from the C aOors C's c:Any c Law for the
my
00 following I hereby
on that I mexe iness exempt
dhe Cmions Code'.cense city or forty
5 m which requires;a pctmil m construct,alter.improve,demolish,m repair any structure
_Zy prior m its issuance,also teidime the applicant for such Permiuo file a signed sulcmem
Ezo` that he is licensed pursu.nllothe pmvisimmeofthe Cormicim'xLl.rxlaw(Chapter 9 Sq. Ft. Floor Area Valuation
Ya- (commencing with Section 7D)O)of Division 3o the B usiness and Professions Cole)or
i $ that he is exempt mcrtfrom and the basis for the alleged exemption.Any violation of 34222103 . 00
Section 7031.5 by any applicant for a permit subjects the applicant tu a civil Penally of ccu ane APN Number OType
not mom than five hundred dollars(3500). Occupancy YP
T,as owner of the p open,or my employees with wages in thch sole compensation,
will do the work,and the structure is not intended of offered for sale(See.70sa,Business ii��tfyy77pp�77��TT
and Pmfessiom Code:The Commoner License law dors oat apply Ip an owner of tlTTC3 tR5 C[IODS
property who builds orimproves themon,and who does such work himeelror through his 303 — ROUGH M CHANI AL
own employees,provided that such improvements ace not ntended or offered for sale.If, 3O4 — ROUGH ELECTRICAL
however,the building or improvement is sold within one year of completion,the owned
builder will have he burden or striving 6.1 he did no,Wild or improve for pommon of 505 - FINAL ELECTRICAL
axle.).
0 I.as Owner of the progeny,am exclusively contracting with licensed contractors to 507 - FINAL PLUMBING
construct the pmjcct(See 7W Business and Professions Code:)no Contractor's Li 508 — FINAL MECHANICAL
anus law it.not apply an an owner of graben,who builds or improves thereon,and
who comncu for such projects with a contnclor(s)licensed pursuant o the Contractor's
Licpnm Law.
I amnaempttondcr Sec. ,B&PCfmdu..n
toner Dateffir
WORKER'S COMPENSATION DECLARATION
1 hereby am under penally of perjury one of the following declarations:
have and will maintain a Certificate of Couern to sel6insum fm Worker's Compen-
sation,as provided for by Section 3]00 of the Labor Code,for me performance of the
work for which this permit is issued.
❑1 have and will maintain Wmkcrs Compensation Insurance,asry
duined by Section
3700 of the labor Co le,for the perfuanance or the work for which this permit is issued.
My Worker's Compensation Insurance artier and Policy number am-
Cam,
rt:
Cartier: Policy No.: -
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
dila section need tut hecompleted ifthe fermis is forone hundred dnlhrs(31(X))
or It
I certify that In the pefformanec or the work for which this permit Is Issued,I shall not
employ any person in any manner was in become subject to[be Workers'Compctuation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,afmf making this Cenificate of Exemption,you should
became subject to the Workers Cmxpersmion provisions of Ne Labor Cole,you must
.J 0 fgMwiin comply with such provisions of this permit shall he deemed mvokcd.
Z y CONSTRUCTION LENDING AGENCY
[-� I hereby affirm that them is a concession lending agency lot the Nerfurmance of
ai the work fur which this permit is issued(Sec.3097,Civ.C.)
aQ Underi Nemc
D
z Under's Address
U C) 1 certify that I have read this application and ionic that the above information is
t3,r^ correct,I nice to comply with all city and county ordinances and state laws misting to
0 building construction,and hereby authorise representatives of this city to enter upon the
W ahovcmcmiuncJ propertycosts
ford exile ses purpowhichms.
gy (Wo)agree to save,indemnify and keep befmless the City of Cupertino against
N incons
liabilities.consequence
of the granting
expenses es which they in any way acerae against sail City
t.) 7, in eoscseyuence of me Framing of this Pcfmil.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of APNLcaHAZARDO Dam
HAZARDOUS MATERIALS Occupant
DISCLOSURE Type of Roof
Will the applicant tar forum building e,Chapter
or handle Health
material
as defined by the 32ta)?nn Municipal Code,ChaNur 9.11,and the Ilcallh and Safety
GWC,Scmion 153]3(x)?
❑Ye. ON. All roofs shall be inspected prior to any roofing material being installed.
Will thea Applicant or future building If a roof is installed without firs[obtaining an inspection,I agree to remove
PP 6 arupam mss equipment or Jcvims winch g P g
1d=
ha aAnus it codominants as defined by me Bay Area Air Quality Management all new materials for inspection.
❑Yes ❑Nu
l new read the w.a dims ocmfials reyWmmenq under Ch ipscr,595 of the Califor-
nith&Sofsty Cmle,Secdonl5N)3.15533and1553.lundcmwdthmiOhc Wilding
notcurrently have a tun on.Nt it a my responsibility m nodly the Occupant ofNe
rement.which must ltc met pour to issuance of Ccmr1cam of occupancy. Signature of Applicant Date
Owner matunmri.m agent Date All roof coverings to be Class "B" or better