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03030067 CITY OF CUPERTINO �" �' BUILDING DIVISION PERMIT dCONTRAC Ira, NFOItMA'I'ION , BUILDING ADDRESS: PERMIT NO. ,S'(-'IIA UjV]ANN AIR CONDITIONIN 2233 OWNER'S NAME: HEATING & .PLUMBING INCPERNITIMU LOHSE JIM (408) 428-0640 SANITARY No. /13:3LNG. BUILDING PERMIT INFO ARCHITECTIENOINEER: - BLDGELECT PLUMB MECH Loc LICENSED CONTRACTOR'S DECLARATION Job Description - u 1 hereby affrm that 1 am licensed under provisions of Chapter 9(commencing Zj wBh Secti ](g1U)or Divixion3of de Bus arta Profeaxianx Code,antl mylicenx is < MON .n erc e so A/C ADD ON 1�,11 B jai Lltty� L- C•20. Lk.• t - � �Ie�A��e�® j F De Co trot Ev ARCH S LARATION records APR fl 1 J ft flR 1 5 2003 td3 I undc t o hell uxtr pis tic )C r LLT3bousecrProlessinfinal 'O OWNER-BUILDER DECLARATIONftCmasco pypy 1 ...(Siect that 1 1. exempt Stem ted Csshms o License Law for the BUILDING `p G following xasoa(Salon RD L5,Business end Improve. duinu Cede:Any city s county - 5 m� which requires a Permit m mnstmct,alcor,improve,demolish,or repair any structure trialeisiiafuanee,e nt,olmcpl ipplieanlfWConh rmltlOfilco,La.clotionenl ��`� thuheislieeucdPununtmthcProvisiounfNeConwcmr'alimrucUw(Chaper4 Sq.Ft. Floor Area Luton e (commencing with Section 700D)of Division 3 of NC Rusin=and Proreuions Code)or $ Net he a eseropt •rriefrom and the basis for the alleged esempdon,My violation of Section 1031.5 by any applicant fora p,.It aubjccu the applicant to a civil penally of 39VUt4*7r. O O Occupancy Type not more Nan five hundred dollars(8500). 1,u owner of Ne proRnY•or my employccs wIN wegu u tbok sok campcnssdon, willdo thcworK anetheawnurtanotmended oroffemA roraak(See.]04a,Busircss 303 — ROUGHR@'fX0iaTlh4€2AbnS and Professions Cade:The CMuscbts Liceue Law dao not apply k an owner of propenywho bull&w improves Merton.and whodoes such work himselfur through his 304 - ROUGH ELECTRICAL own employees.provided Nat such improvements us not intended An offered for telaq SOS — FINAL ELECTRICAL however.the building m Improvement is old within one year of completion,the owner- , builder will Itaw du:burden Of proving Nat he did Mt build ar improve tsar propose of 508 - FINAL MECHANICAL sale.). 0 1,as Owner of the property.am exclusively contracting with licensed contractors in consumer the pmject(Sec.70".Business and Professions Code:)The Comrumr's Li- cense Law does not apply to an owner of property who Wolds or improves Barman,and Who contracts for such projects Whirs mntrsemr(s)licensed punum to On Camromes License law. 0 larnmemptundcr Sac .BkPCforthismason Ow er Data WORKER'S COMPENSATION DECLARATION ✓ 1 hereby aifnm under penally of perjury one of the following deelaradou: .. - �� have and will maintain a CerdEcae of Consent to self-Inco for Worker's Compen- iuion,u provided for by Section 3700 of But Lahr Code,for the perromlance of the work for which this permit os issued ❑I have and will maintain Workees Compensation luurance,u mqumed by Section 3900 of the Lahr cars.for the pefomuneeo A for which this permit u issued. ' MY Workces Compensation insurance ort Or and liry number art: Cyon 1.<n!141 Policy�!LNo..CERTIFICATE OF E%EMPf10N FROM WORKERS' COMPENSATION INSURANCE (rus section need notal rompleed if the Permit is for one hundred dollars(SIM) or kcs.) 1 certify Neu In dm in toy mane.Of the work for which this Permit is tsseed,l shall not Laws o any person in toy menncrso u te become subject Newartrn'Campewdon Laws of California Date Applicant NOTICE TO APPLICANT:If,after ., making thisCertificate E rryou should becomem the Workers Compensation provisions of the ab Curle,you must O foMwirh comply with such Provisions or this retort hall bo seemed revoked. - z.~�. CONSTRUCTION LENDING AGENCY �-+ I heteby affirm Nat Vert is a construction lending agency for the Pufunnancc of 7i the work for which this pennlr is issued(Sec.3097,Civ.C.) - W A Undoes Name =z Lander.Addmss - U Q 1 cenify Nn I have read this application and sou that On above information to U.P correct.I agree to comply with all tory and county ordinances and one laws misting On 0 U building construction.and hereby authodae Tapmsentafiwa of this city to enter upon the shove-memimed property for inspection purposes. iy (We)agree to Nw,indcanmfy And keep harmles,the City of Cupenlna against N liabilidu,judgments.cosu and expenw which may in anyway acme agahrot old City U z in consequence of the framing of this permit °•� APPLICANT UNDERSTANDS AND WILL COMPLY,WITH ALL 14N-POINT Issued b `9 y: Date OURCE REGULATIONS. Z4_� /.t _/ /�•p aturto Applman anuxtm Due � Re-roots ' HAZARDOUS MATERIALS DISCLOSURE Type Of Roof Will Ne applicant or forum Wilding necuPant atone or hand].havudoua material As defined by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety We,Semon 25532([)] ❑Ye © All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It hocardous air contaminants u defined by the Bay AMA Air Quality Management all new materials for inspection. nricR ❑Yes (]H� - - IhavertadthehvarOrmsmaterialsrequirementsunderC r6.95oflhcCalifor- n HcalthiSafad Codc,SeLtium 75505.25533 and 25534.1 undcu Nu tithe Wilding tt s .t cunendy have a enan4 Nel it is my msPomihility m notify •cupant of Nc o men[which must et our to tssuanee ofd Certif¢ae of Q an -ry. Signature of Applicant Date ' Owner or aulhod7zd agent - Dae All roof coverings to be Class "B"or better