00080228 CITY OF CUPERTINO - -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: - APPLICATION SUB DATE
S HEATING '
00060226 '
Opp j99 NE: 1:311HVIMM" SANITARY NO. CONTROL NO.
AND MLODY 1) N LAZARO AVE 08/31/2000
G O ARcLr Ecr+ — - ' BUILDING PERMIT INFO
BLDG 'LEC;' PI.UMR MEuVr
F a C 9-0516
, O m LICENSED CONTRACTOR'S DECLARATION Job Description
'
O z— I hereby affirm that I am licensed under provisions of Chapter 9(commencing [IOn
ss
full
thI fD 3 fib Bu dP f mCodc dtJ ny limner '
q�qz�6 .c I C,home
anJd effect
1 #JA ,
ca ARCHITECT 5 DI CLARA
V'
1 ndenwnJ n5 Plans ehW6he uce 1 ,public records JJJ AC UNIT
ad seo 0 1.men,ee Prafexdadd -
a' o�y ' OWNER-BUILDER DECLARATION
M at 1 hereby affirm that I am exempt from the CoommtiWs License Law for the
sly Z< following feltwn.(Section 1031 5,Business and PeofcFsioms Cale:Any city circuity
�' ❑ whir requires a permit t .t t R Pr dionfidiorepalray-vucmrc '
3 40, prion a ''.van c al. r quire.th drPll
I 5awshpertn'noM ,c d:mtument
meinalslincenswalpartmandt the provisions of Contractors License Law(chapter 9' Sq. Ft. Floor Area ,Valuation
(wmmene t,wth Section 9010)of Division 3 1 da,Bast act,and Form, :Code)
or that he's escan,it th f d do basis I.,far alleged c.,applinad A y violation
ofSecton]031.5by.tryapplicant lira gait subjects the applicant ora civilpenalty -of not mare man five bttndmd d ilk..(F500). APN Number _ Occupancy Type
❑1.as owner of the property,or my employed,with wages as their o,le',saMematiun, $�
will J thek tl t u
d ct .e' t'nle J 1 offered( s'1 (Sec 1644
t. Bt d Pr f..far,Code:The Contra t :Liters,Law does in,apply in an Required Inspections
ownerf p p ty Who build: iffmoves,theasm,and ho does such work h' If 1 -
or throughti ply .Providedthatinch'np not a not intended or� 32643051 . 00
t off ed 1 It1 thbuilding improvement 1a m' one year of
'eurcletior,the owin-thadde,w ll have too burden attracting teat be did ant build nr -
impro.e for Purpose,lsale.).
303 — ROUGH MECHANICAL
❑Lumeras herofthe pager, raputyatoeusinessandtrivicly Pfid,gwith nc:)Thcaused emulfratuors toandrawami, 304 — ROUGH ELECTRICAL
consumer the project(Sec.]to a owner f pro Profession,Coder The Cuntheocans —
addfico nae,net apply to an et, h property was Haire of mi Omar attire 505 FINAL ELECTR I CAL
and who rs Lied ler such projmts rim v ntmmcmr(e)IicemeJ pumuum m.me
cel maxr LiedaxeLm 508 — FINAL MECHANICAL '
❑1 ma exam t tmJer see. .B&r c rpt m'la ren=oa
owner - .Date
WORKER'S S COMPENSATION DECLARAf10N ,
I hendwalf..a under reacult,off,cart ryor,of billowing d 1"t -
I have and wall naintnm a Cerff t f Consent t If' s rc for W k is
'nap fiat' : provided f by Section 31W of the Labor Code, for the
perfincourawe ofth work for I Worker's
', issued
❑1 have and willmaintainCode,
Woder s C icarim of[ie work
mrequiredhick i by Section \!//
3100 of the Labor Cela,for the perl...adnm of the work for which this permit iv - .�
to
tnrood.My Warkefs Campcasatlan Sumner certicr and Policy number am'. -
r'en IicylW24 L
CI•E FI MION -E .MPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be co nitard lithe permit Is for ohm hundred dollar,
(SIM)or -
I certify thut in the performance of the work for which this permit is i,med,1
shall not employ any person in any manner so as to become snbjem to the Workers' "
Compensation Laws of Calif rma.Data
Applicant
NUI ICE TO APPLICANT:If.afi,r making thle Ceamcane of Exemption,you should -
became subject uothe Worker's Compensation pros ions of the Labor Codus
,you mt
fonbwith comply with such provisions orlhls permit shall he deemed mocked.
z
a Vj COt there to cons LENDING AGENCY ,
G^
hereby which that mereisvcsued(Set, lending agency for perlbnnance
W of Leader's
work far which this permit is issued(Sec.3M1,Civ,CJ
Lender's Name
z Lender',AJdrcss
V 0 I certify that I have mind this applice0on and state that the above Irfrmmino Is -
W E.. correct.I agree to comply with all city and county ordinances end ,are law,relating
[)
to building consvtiction,and hereby authorize representatives ofthix city i,,enter upon '
the vbnve-menunned ptnpeny for inspection purposes.
.(We)agree to save,Indemnify and keep havnle,da,City of Cupifirmegainst
FI toliabilities,judgments,cost,and c,iPenses which may in any way dream against said -
U 4 City Ia consequence of the gaming of his permit. -,
SPPL CANRT UNDRSSTANDS AND WILL COM WITH ALL NON- 1� 155Ued by: Date IONS. yl 11
.Igo Appflcan tCantretar. - ale Re-roofs
HAZARDOUS A1ATE .S DISCLOSIIRP.
Will me audition m future nail din cc upala a...c of Handle corridors materid Type of Roas defined by the Cupenmo Municipal Chapter 9.12,:ad the lbolih add safety -
Cade,Section 25532(a)I -
❑Yes - ON, ' All roofs shall be inspected prior to, any roofing material being installed. - -
W II ith ttppEcaat or future building occupant use equilmand or devices which If a roof is installed without first otaining an inspection, I agree to remove
emit hvmrdoue air conwmndnts a defined by the Bay Area Air Quality Management
strict? - - all new materials for inspection. Applicant understands and will comply with
°vex ❑Na' all non-point source regulations.
1 have read The limitations materials requirement under Chapter 6.95 of lire
California Health&Safety Code,Sections 25505,25533 and 25534.1 understand the,
o boildm•
21hdoest muntly M1uveatennnl.that It is my re,pcnsitdliI tonollfrthe
the I' en¢which nwst be met prior 1 i,: ince of CeT firam of
e ) Signature of Applicant Date .
a age,t / Dale All roof coverings to be'Class `B" or better
OFFICE