01060130 INO
CIBUOFN ISUDP ION
IPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1134 KENTWOOD AV A A A FURNACE COMPANY 01060130
OWNER'S NAME: APPLICATION SUB DATE `
MAJID MOSTOFI 1712 STONE AVE 06/22/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 293-4717
IWI ARCHITECUENGINEF.R: BUILDING PERMIT INFO
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5 y n LICENSED CONTRACTOR'S DECLARATION Job Descri tion
QZ H C ercby affirm that 1 nm li<enmA under provisions of Chapto9(commencing
s<mm�7lgq]er 3 ofine Badness and PrafeWi n.Cade,and my license CHANG FURNACE & ADD A C.
Ems We
BOB
FURNACE 80, 000 BTU &
-re ianse Cl a Lic.p
e - Convector n
3� ARCHITECT'S DECLAR U� /L A/C 36, 000 BTU-FINALED
t O
nr 1 understand my plans shalt he used as public records
o n o Licensed Pnifcssianal J U L 1 0
,Io
OWNER-BUILDER 2001
1 hereby of rat that I om exempt from the Commctor's Licenx Ww for the C (J'I
!_'0 following reason.(Section 7031-!5.Busin<ss and Professions Code Any city calummty
which requires o permit to conswn,alter,improve,demolish,or repair any swclurc
or 3 prior to its issuance,also requires the ppl t Bar suit terraria tfile a signed statement ` -- -
thaip slu t It : at the G n - fill ( t t -L n It (Chapmrn ,Stl.-,FL FJool:Area ,�I p i V'luation
(a e nigin:set n7opnerDdi.' J Im gtapt«. ,eProrpa.an.caae3 f'f};A�'i, ,3, 1 ,.k,, ., , , 'i�. ..t,..i:,''s; $3004
or that be is exempt themfmm end the basis for the allcied esempdon.Any violnuon
-of Section a than v any hundred
dam for o permit subjens the applicnm to n civil pewlty 3 5 9 33"'b4! ,
.of net more than by nna,ficauaa asWl. f: ., Occupancy Type
❑1,as owner of the property,or my employees with wages as their Sale compensation.
Business
ss an Prk;and the strucruode,T e is not intendedrs Li orofferedLaw for snot appy toga, 3 0 3 — ROUGH ME@�$�Ik�' Cft
Boli do t e work;and the
Code:The is Contractor sLicense Law does not( I to an CIlOf1S' '
curner of property Who builds ar improves thereon,and who does such work himself
or through his own employees.provided that such improvements am not intended or 304 - ROUGH ELECTRICAL
"_. _.". _._._" _"___.__._._._..
'offered for sale-ILhasve.eLl wllhivcte fmpmof Prov is abler within m;a end or -"" - 505 - FINAL ELECTRICAL '"a''
completion,due
poxe m'bsai'c,r will here the burden of proving that he did not buil)or
Improve parpoxa 508 — FINAL MECHANICAL
❑L ns owner of the property,San Business a contracting with licensed c Commusra 's n 'i!' - i Tie,I:'r"v
- construct the does
project(Sec. to a.Business and Pmfanob Codeg The Contractor's t. [, ,.. ,i
and who
law docs not apply m an owner with
a Ionto who solids se improves thereon, t
1' -,Cm whour's License kd such.Prolecn with a[ommaorts)licensed pursuant inthe . _.._ . . ___ ._ _ ..."-.. _.. .___. .__..._ ___._. _ _....... _�_
Commctols License Law. � � - �- " -� ����-����-� �� -
1.
01amexempt under See' .B&P C for this rentor I •t; L2.'_LI't is.1,
_ OwncI Date '
" '- WORKER'S COMPENSATION DECLARATION
�Ishereby affirm under penalty cf perjury one of the following declarations:
c� EI I have Ind will'maiatain in Cenificate of Conant"to xlbi
mum for Rforl the
Compcnsmia¢ m provided for by Section Jissu of N< Labor Code far the
F" penbrmanee of the work for which this permit is issued.
❑1 have and will maintain Workei s Compensation Insoranyti,as required by Section
_ IW the Labor Code.for the p"namonce of the Wolk Ior which this pemsit is
l' ill .My witu e"Com cation Insur6me carticr'and Policy number arc: -_
er. Policy No.: .x, rt?D\,1rtltv.vl:
rsi t' ...� 7�
CATION FEKEl11'TIO:Y'F --
r ' ' COMPaom lc¢d i(1h5_URANCE:y "' _..__..-..
• ENSATION IN _ _
(Thi,icainn recd not be' � p � c permit is for ane hundred dollen
($1000i ins.) t
I n fy than ih Serf,mance of the work Sar wh h th M 'i is issued;l l .,,[ , it
shall not employ any Server to any manner so as Yo become Subject to the Workers -
Compe . tion laws 1'C I f .Date
"ApSI ant - _ - .- _:-. _. _ _..-._" ._ .. -- '- _._ ..- .. t . . _. _".__ ._..
NOTICE TO APPLICANT II after making the Certificate of Exempuou you should `
0 become'subject o the Workers Compensation provisions of the Labor Code,you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a castration lending agency for he performance
ohM1' kf hich th' p 'Y.c lawcal(S c 3097 Civ.C.) "-
d .7 -lied s Nature
.... _ .. _._.. ..-. ... _ _._ _ ...... _"_. ..
;;)-zLed .Add . . I.. ..
I
acr[ify thaol have mad this application and sere that the above inform.tinI is
ks rF loncn:"Only to comply with all city and county,ordinances and state laws reining
tr 0 U to halldingmnionaion.and hereby authoriza iepresemmives ofihis city to enter upon
the above nmminned property fa7lnepection purposes. ."
�a A. IW<)*agreem J mtufy and keep harmtes,the C'ry of Cupertino against
F. sn liabilities.judgments,costs and expenses which may in any way accrue again.t said rt /
r,.7 y Cty [ sy ca fth granting of thisM1 t V
APPLICANT UNDERSTANDS AND WILL COMSLY WITH ALLNON-POIN Issued by: D e'
Stiv,' REGULA NS '' °'I y'
i APPlicaaVCti ru[mc Re-roots
gn s
` HAZ RDOUS MATERIALS DISCLOSURE
Will dr,OpInmin 6,ft buildigoccupant s handle,harallom tsutc'A Type of Roof
as defined by the Caper ,Mumci,al Court.Chapter 9.12.and the Health and Safety \ f'
Cale Sindurt 25532( 1 r• r s
0Y°' O".° All"roofsxshall-be ins ected.priorto.an roo5n materiaI being installed.. _... .__
Will[n ppl' 'it or future haildur,ocurprot use ecluiptutt or devices wh chl If a roof is installed without first obtaining an inspection; I agreeto.remove
a t becandous air contaminants as definind by the Bay Anni Air Quality Management
nt trio all new materials for inspection. Applicant understands and will comply with
0 yes t;, : all non-point source regulations.
_ 1 have read'the hunrdous maenals rcqutremvms uMrr Chammf ti 95 of he
C-n in Health A Safety Cuse:Sections25505.25533 and 25534.]understand thou
bd lldingll oat currently have n tenant,[hat It is my responsibility m notify the - -
t 'hpztn of the r<quiremann whici moat be met prior to issuance of a Cenific to of
,top `y Signature of Applicant Date _
owner Pr aamad=<e ngeot' .Date All roof coverings to be Class"B" or better`
OFFICE -
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