03020031 CI'T'Y OF CUPERTINO "° � ^• ��.« ) * 'r'.
BUILDING DIVISION PERMIT CONTRACTORINFORMATION
BUILDING ADDRESS: A PERFECT CLIMATE PERM]F No,
848 KIM ST
OWNER'S NAME. 10570 S DEANZA BLVD APPLICATIONSUB DATE
OTO GEORGE Y AND EMIKO G 02/10/2003
ONE: (408) 861-9545 SANITARY NO. CONTROL NO.
ARCIII]ECTIENGINEER: BUILDING PERMIT INFO
BLDG f:LECT PLUMB MECII
❑
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w� 1 M1crcbY aR
LICENSED
am CONTRACTORS DECLARATION
<� Provisions of Chapter v commencing Job Description
G� with Section 71Mgt)or Division 3.d Or,Busmess and Professions Cole,and my license is ��
y infu114,rtcanJeff.. HVAC ���®
✓�? Liccn,¢CI�' Lie
FNFpDa¢ ' Cnnvacmr
�o w� 'S LCLAIANg��
I understand my plan,shall W u d as pant Rc records
MAR 1 8 2003
rn O� Licensed Pro@ssional
BUILDER DECLARATION BUILDING
<
w P 1 hereby affirm that that I a exempt mm
m cacmfrom e Coctor'a License law fm the
m i❑O following staved(Scniun]11315,Business send Pmfesainna Cndc:Any city nr county
x m which requires a Permit to consumer,alter,improve,demolish,or repair any structure
=< isua
Her I,iu snce,olso became the applicant lot such Penntuo Glc a signen
ed statement
r
that he is license) ursuan to the provisions of Contractors License law(Cha(Chapter S R. Floor Area
,4Z❑ p p P y• $3111$llOn
n;r (cot hemoni;exempth Section ll and the
basisnn3 of the Businessandon.Any
vi GWc)of
y Nal io u exempt therefrom and the bazis for the alleged exemption.Any violation of
Section 7031.5 five
any applicantdlta for 1permit xunjec¢the applicant m a civil penalty of
not more Nan r nanama dmlara(a5gq. or Occupancy Type
I,as owner of the property,or my employees with wages az their sole compevxtion.
will do the work,and the structure is not intended or offered for aide(Ser.1040,Business 0 t — ROU
pp����((Jd
and Professions Code;The ContractorLa
Contractor's License w docs not apply to an owner of 303 — ROUGH t.HLGns
property who builds or improves thereon,and who does such work himselfor through his
own employees.provided that such improvements are not intended or offered for sale.If, 304 — ROUGH ELECTRICAL
however,me building or improvement is sold within one year of completion,the owner.
but lder will have the burden of prowing Oat he did not Wild or improve for purpose of 505 — FINAL ELECTRICAL
Salt')' 507 — FINAL PLUMBING
❑ Las owner of protect
Properly,,B einem and confessions with licenses contranoo t. 508 — FINAL ME CHAN I CAL
reins Li the es no, (Sec.]tort Business and Professions Codc:)The Contractor's Lit
who contracts
law does not apply c en owner of property who builds or improve Conara.and
whonse Law. for such pmjecu with aconvacmr(s)licensed Purxuammthe Comracmr's
License Law.
❑lam exempt under Sec. ,B&PC fnnhis reason
Owner Dale
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of me following declarations:
1 have and will maintain is Certificate of Consent o self-insum for Workers Compete
aa,ion.as provided for by Section 3700 of the labor Cade,for the prom mance of the
r forwhichdox,ormitisismcd,
w I have and will maintain Workers Compensation Insurance,az required by Section
I of the Labor Code,for the performance of the work for which this permit is issued,
My orke,r's/Iur
Com,ricea,ion Insurance carrier and Policy nAm
Carrier I�1li+CP.I1}l YU Policy No. I-!
CERTIFICATE OFEXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed If the Permit Is Ionone hundred dollars($100)
m less.)
1 creify that in the Performance of the work for Which this permit is issued,1 shall not
employ any Penin in any manner so as to become subject to the Workers Com,aeration
Laws of California,Date
Applicant
NOTICE TO APPLICANT:If,after making Nis Cenilieate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you mus,
Q O forthwith comply with such Provisions or this permit shall he deemed revoked.
z N CONSTRUCT ION LENDING AGENCY
[-+ I hereby aorto Our there is a construction lending agency lot the Performance of
Ix the work for which this Permit is issued(Sec.3097,Co,C)
41 Lenders Name
z Undcrs Address
V Q 1 certify Nat 1 have read this aPllic.li.e and sum that he above information is
(- correct.I agree to comply with all city and county ordinances and state laws relating to
Q C) building Construction,and hereby amhonm rcpecocrodives of Nis city to enter uponme
above-mcedpc
ioned Pmrty me inspection purposes.
H 4L (We)agree to save,indemnify and keep harmless the city of CuPenino against
N liabilities,ju cnu.custsand rises which may in any way accede against said City
!) Z inconseyu c oflbegramin of Orr pemri,.
.. NDERST DS/MD WIL C P WITH A NON-POINT
SOURCE GUIssued by: D
So 'If Pliwn nmrvem
Re-roofs
AZAR USMATERIALSDISCLOSUn I Type Of ROOF
illy ePpliC. wre building Co occupc,Chant r ore 9,12.handle Health andas Safety
al
as defired Sec io the Cupenin Pal CWe.Chapter 9.12,and the Health and Safety
Code.s]don 2s53zan All roofs shall be inspected prior to any roofing material being installed.
C]Yet u
Will the applicant or future i ing occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
Ditosit mi/ us air ennlaminanl,`us,tlClincd nY me Bay Area nor Quality Management
ict' all new materials for inspection.
t.�\f.1 ri
❑Ycs
I have it chaeafdousmmerialsmquiremenuunderChapur695ofineCalifor-
riallcalthAS ct Cot,Scnioe25N15,2553 d2553o.1 undcrsunJ muirthe Milding
mss nm cvrrt t have a¢ L m it is res reiM1ility m nndly riot tncupanl of the
equinmems ichmust tp tomo van cess mamnr eaP Signature of Applicant
Date
Owner or nnna< agent D,e All roof coverings to be Class "B"or better