01010099 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: PERMIT NO.
1190 CRESTLINE DR ATLAS HEATING 01010099
OWNER'S NAME APPLICAI]ONS A '
CAMPBELL ALBERT H AND L RAINE 155 SAN LAZARO AVE �Y3/^2001
PHONE: - SAN]LARY NO. : CON'IROI,NO
(408)739-0516
ARCHI TEC'I IENGINEER: it ti. BUILDING PERMIT INFO
BLDG ELEcr PLUMB rMECH .
�J-
w N "LICENSED CON'TRACI Olt'S DECIARAI'ION .
z$4 I mncn !firm than 1 of f eased under g - Job Description
Oy_ ya Is Prideof Chnnue9nd myl ices - „
F:t J isinflliorceandefDivi.ion3nfthefiucincssandProCession+Crile, Jmyliccnse REPLACE' FURNACE AND ADD A/C
a i`in fall force and erne
mcn+e clod., . /° 20 Lie.x ( a
ARCI{I1'ECT'S DI[CLARA'I ION
f-u.O I udNcntan0 m 1 halt he used
ryyqe'�y g Y plans.v as public rtanA,
WWWWWW �` OWNER BUILDER DLCLARNUON
I hereby affirm that l am exempt from the Contractor's LiceLicens,Law Rome /
7031 S Illusion', d Profession,Cal Any city county
p n , t ❑ p fit, p r 4 y-t acture 3Q
$ p'ot t 1, nqur th ppli I
that he I hroto tl ng J,rcmem - - "
Livern.LawhChni Sq. FL Floor Area .Valuation
(n g lhS ct 7tNNp fD 3 ph R JP f. s Calel $�
III he n exeopt herrffom and the te,s for thL,Ilsgid emmpl on.Any vlolmion
orsced 17th 1,5 by any appuc,tldI f a icanit subject,(he appfalln to a civil penalty - • Occupancy Type
of'ounore than five lmnaam doll n($stn). APN Number
01..,III of the nn.n,nt ratemployeesrg pension. 36224037. 00
. 1 th Y r,i, lammed
i es as ed lin, mm
„ will i o sl work and the ode The is not Intended e olTetrnl 0th suiu(Sea m no r _
Business unJ Profeasinns Code The CanOucmr's Licen+c Low docs not apply m an Required Inspee[iSmn y"
ow'nernf pmpeny Whn builJc nr improves memon.and who m,c.+vuch xnrk himself 301 — ROUGH PLUMBING
' or through his own employees.provided that such improvements art not intended or
orrered rot sale.R,However,me building or impmvemcm Ia sold wimin one year of 303 — ROUGH MECHANICAL
nmpletin I.the owner-murder will have Inc burden nl pawing that be did not build or-
improvefor pn�f901d"'°')' 304 — ROUGH ELECTRICAL .
❑Lasowncrorthe pmpeny'amexclusively contmcdnswith licensed comrterarso 505 — FINAL ELECTRICAL
L,mwn he police,Ism,7(A4,Eu,mea,and Pnntssion,Code:)Of,Commetor,
imrise Low doe,not apply to an owner of Inopeny who build,or improves hereon, 507 — F I NAL 'PLUMBING .
.ad who contracts for such propels xith a eomramgs)Reensed pm,um
ant to ` 508 — FINAL MECHANICAL
0C ntranar',License Law.
1 am exempt ummr see, ,R&p c rat nth rensorl e ' r> .
Owner Dae
WORKER'S c6MPENSATION UrCLARATION .. '
Iloomy.Minn under pe unityol'pcej.,y loco!the following dcelmutlnna: '
p- 0 1 have and will maintain a Certificate of Consent to self-insure for Worker's .
Contpensmimb as provided for by Semon 3700 d the Labor Code, No the n
prr mnnsu,c of lie work sur calami firs onail is l+ailed:
0 have and will mainwin Worker's Compensation Insurance,as required by Section ..
3700 of the Labor code,for the performance of the work for winch this permit is ,
issued:My Worker's Gmdpemmion lasnnullw carri�er�nn l Pooliiccyynumner are:: l� "
cmim, ��- �1. Poli,)%(n/l�4CIy(�-{Jill '
CF.RIgCTIONOIs EKEMPu I'R. (WORKERS'
,COMPENSATION INSURANCE -
IT hi.s section need not he completed if he permit is for one Imndred dol(urs `
(SIOO)or R,xj j
s I certify mat In the pmlintru ce of IIIc work fnr which this pcmdt Is issued,I .,.
shall not employ any peram in any manner sn ay-in Mcome subjwt m the Workers'
Compensation Laws of California.Date 7+�
Applicant T -
NUTICIi TO APPI.ICAN'I1 1L oiler making Ibis Cenil inne o(lixengnlon,you should
0 0 ne<omccuhjat m the Worker's Cnmpeneutinn provhnns of the Lubar Code,you must t
forthwith comply with suchpmvisiuns or this permit shell be decided rnvkeA. /^ l
CONSI RUCTION LENDING AGENCY
a ' Ilmahy uffnn Ill.[mere in a cummriloa fradmpnguncy l'olthe pe,fnnnunw r ,.
el the work for which this tumult is issued(Sec.3097.Civ.C.)
lender's Nanw
z Lender's Address ._ •
I I oface in r I havecomply read llh.Heat unit inn and xMil t., uM,am la rtnatiun is - -
fz U correct.1,voce m comply with all ciry and county eumbox—fold nae laws mlating
0 U hrobdingncalimctiumann,harhereby vumoneerepmenmtive.v of dhis ciry[n neer ulwn
C6 the obove-InemionW prupendtuninspectionl)hanle
(fir tY (We)agree b.tow indemnity I,N andbe,keewhich
handless in anyhe a of enum.Cuper,air,,
against,sid -
fn liabilities Judgments,suns and tnpenses which may in any way ecente again.0 mid '
City in mnsegmenw of the graining of this permit.
APPLICANTUNDERSTANDS•AND '11.1.COMPLYWIT� LN POINT Issued by: Y'>= _ 'Date
SOURC CGU 'IONS. D' ,
Signammof ApplicunVCumracmr Date Re-roofs
HAZARDOU MATIi MALS DISCLOSURIi
W,
Ina ophhcllm ohtlttl nttuainf;,.conaa morn
aue nnaawal:Inhtcdul Type of Roof .
as defined by the Cupertino Mu mipal Coll.,Chapter 9.12,and the 1{ealth and Safety
Cure.Section 25532m1!
oyes ON. .All roofs shall be inspected prior to any roofing material being installed.
Will ine appfieam o,funlre ramming tlecnpanl ow,liptn€Inondcvim—Il h If a roof is installed without first obtaining.an inspection, I agree to remove
emil hmardam,air combinational,as defined by the Buy A.Air Quality Menagcmem
ce
Dismall new materials for inspection. Applicant understands and will comply with
0Ye, '_ .ON. .- all non-point source regulations.
1 have read the harzNnu.O mamrials requirements under Chapter 695 of the
Calimmia Health&Safety Calc,Smiuns 25585.25533 and 25534,1 undemmnd that '
r me huilding Joe,nm camemly Timm.mnun6 that it i,lay m,ponsibility.to mon,me ,
ocupanl of Inc eequimormal which most Ica met print Io Issu Ince It a Centi Deme uI
cclop:mcr. -
Signature of Applicant Date -
OwnurornuR,orxmllgn,t Datq , All roof coverings to be Class "B•' or better -
OFFICE ' .,
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: PERMIT NO.
1190 CRESTLINE DR ATLAS HEATING 01010099
OWNER'S NAME APPLICAI]ONS A '
CAMPBELL ALBERT H AND L RAINE 155 SAN LAZARO AVE �Y3/^2001
PHONE: - SAN]LARY NO. : CON'IROI,NO
(408)739-0516
ARCHI TEC'I IENGINEER: it ti. BUILDING PERMIT INFO
BLDG ELEcr PLUMB rMECH .
�J-
w N "LICENSED CON'TRACI Olt'S DECIARAI'ION .
z$4 I mncn !firm than 1 of f eased under g - Job Description
Oy_ ya Is Prideof Chnnue9nd myl ices - „
F:t J isinflliorceandefDivi.ion3nfthefiucincssandProCession+Crile, Jmyliccnse REPLACE' FURNACE AND ADD A/C
a i`in fall force and erne
mcn+e clod., . /° 20 Lie.x ( a
ARCI{I1'ECT'S DI[CLARA'I ION
f-u.O I udNcntan0 m 1 halt he used
ryyqe'�y g Y plans.v as public rtanA,
WWWWWW �` OWNER BUILDER DLCLARNUON
I hereby affirm that l am exempt from the Contractor's LiceLicens,Law Rome /
7031 S Illusion', d Profession,Cal Any city county
p n , t ❑ p fit, p r 4 y-t acture 3Q
$ p'ot t 1, nqur th ppli I
that he I hroto tl ng J,rcmem - - "
Livern.LawhChni Sq. FL Floor Area .Valuation
(n g lhS ct 7tNNp fD 3 ph R JP f. s Calel $�
III he n exeopt herrffom and the te,s for thL,Ilsgid emmpl on.Any vlolmion
orsced 17th 1,5 by any appuc,tldI f a icanit subject,(he appfalln to a civil penalty - • Occupancy Type
of'ounore than five lmnaam doll n($stn). APN Number
01..,III of the nn.n,nt ratemployeesrg pension. 36224037. 00
. 1 th Y r,i, lammed
i es as ed lin, mm
„ will i o sl work and the ode The is not Intended e olTetrnl 0th suiu(Sea m no r _
Business unJ Profeasinns Code The CanOucmr's Licen+c Low docs not apply m an Required Inspee[iSmn y"
ow'nernf pmpeny Whn builJc nr improves memon.and who m,c.+vuch xnrk himself 301 — ROUGH PLUMBING
' or through his own employees.provided that such improvements art not intended or
orrered rot sale.R,However,me building or impmvemcm Ia sold wimin one year of 303 — ROUGH MECHANICAL
nmpletin I.the owner-murder will have Inc burden nl pawing that be did not build or-
improvefor pn�f901d"'°')' 304 — ROUGH ELECTRICAL .
❑Lasowncrorthe pmpeny'amexclusively contmcdnswith licensed comrterarso 505 — FINAL ELECTRICAL
L,mwn he police,Ism,7(A4,Eu,mea,and Pnntssion,Code:)Of,Commetor,
imrise Low doe,not apply to an owner of Inopeny who build,or improves hereon, 507 — F I NAL 'PLUMBING .
.ad who contracts for such propels xith a eomramgs)Reensed pm,um
ant to ` 508 — FINAL MECHANICAL
0C ntranar',License Law.
1 am exempt ummr see, ,R&p c rat nth rensorl e ' r> .
Owner Dae
WORKER'S c6MPENSATION UrCLARATION .. '
Iloomy.Minn under pe unityol'pcej.,y loco!the following dcelmutlnna: '
p- 0 1 have and will maintain a Certificate of Consent to self-insure for Worker's .
Contpensmimb as provided for by Semon 3700 d the Labor Code, No the n
prr mnnsu,c of lie work sur calami firs onail is l+ailed:
0 have and will mainwin Worker's Compensation Insurance,as required by Section ..
3700 of the Labor code,for the performance of the work for winch this permit is ,
issued:My Worker's Gmdpemmion lasnnullw carri�er�nn l Pooliiccyynumner are:: l� "
cmim, ��- �1. Poli,)%(n/l�4CIy(�-{Jill '
CF.RIgCTIONOIs EKEMPu I'R. (WORKERS'
,COMPENSATION INSURANCE -
IT hi.s section need not he completed if he permit is for one Imndred dol(urs `
(SIOO)or R,xj j
s I certify mat In the pmlintru ce of IIIc work fnr which this pcmdt Is issued,I .,.
shall not employ any peram in any manner sn ay-in Mcome subjwt m the Workers'
Compensation Laws of California.Date 7+�
Applicant T -
NUTICIi TO APPI.ICAN'I1 1L oiler making Ibis Cenil inne o(lixengnlon,you should
0 0 ne<omccuhjat m the Worker's Cnmpeneutinn provhnns of the Lubar Code,you must t
forthwith comply with suchpmvisiuns or this permit shell be decided rnvkeA. /^ l
CONSI RUCTION LENDING AGENCY
a ' Ilmahy uffnn Ill.[mere in a cummriloa fradmpnguncy l'olthe pe,fnnnunw r ,.
el the work for which this tumult is issued(Sec.3097.Civ.C.)
lender's Nanw
z Lender's Address ._ •
I I oface in r I havecomply read llh.Heat unit inn and xMil t., uM,am la rtnatiun is - -
fz U correct.1,voce m comply with all ciry and county eumbox—fold nae laws mlating
0 U hrobdingncalimctiumann,harhereby vumoneerepmenmtive.v of dhis ciry[n neer ulwn
C6 the obove-InemionW prupendtuninspectionl)hanle
(fir tY (We)agree b.tow indemnity I,N andbe,keewhich
handless in anyhe a of enum.Cuper,air,,
against,sid -
fn liabilities Judgments,suns and tnpenses which may in any way ecente again.0 mid '
City in mnsegmenw of the graining of this permit.
APPLICANTUNDERSTANDS•AND '11.1.COMPLYWIT� LN POINT Issued by: Y'>= _ 'Date
SOURC CGU 'IONS. D' ,
Signammof ApplicunVCumracmr Date Re-roofs
HAZARDOU MATIi MALS DISCLOSURIi
W,
Ina ophhcllm ohtlttl nttuainf;,.conaa morn
aue nnaawal:Inhtcdul Type of Roof .
as defined by the Cupertino Mu mipal Coll.,Chapter 9.12,and the 1{ealth and Safety
Cure.Section 25532m1!
oyes ON. .All roofs shall be inspected prior to any roofing material being installed.
Will ine appfieam o,funlre ramming tlecnpanl ow,liptn€Inondcvim—Il h If a roof is installed without first obtaining.an inspection, I agree to remove
emil hmardam,air combinational,as defined by the Buy A.Air Quality Menagcmem
ce
Dismall new materials for inspection. Applicant understands and will comply with
0Ye, '_ .ON. .- all non-point source regulations.
1 have read the harzNnu.O mamrials requirements under Chapter 695 of the
Calimmia Health&Safety Calc,Smiuns 25585.25533 and 25534,1 undemmnd that '
r me huilding Joe,nm camemly Timm.mnun6 that it i,lay m,ponsibility.to mon,me ,
ocupanl of Inc eequimormal which most Ica met print Io Issu Ince It a Centi Deme uI
cclop:mcr. -
Signature of Applicant Date -
OwnurornuR,orxmllgn,t Datq , All roof coverings to be Class "B•' or better -
OFFICE ' .,