02060181 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTOR-INFORMATION:
BUILDING ADDRESS. PERMIT NO.
7881 LEONG CT ALTON AIR CONDITIONING & H G 02060181
OWNER'S NAME: APPLICATION SUB DATE
FLAVELL GEOFFREY L AND LIMAY H45300 INDUSTRIAL DR #4 06/26/2002
PHONE: SANITARY NO. CONTROL NO.
(510) 490-5655
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
ea
to BLDG ELECT PLUMB MECH
a I-7
Z' LICENSED CONTRACTOR'S DECLARATION
y- 1 thereby ffrtn that 1 am licensed under f Chapter 9(commencing Job Description
O Z- Y a provisions° p
with Section]000)ofDivision]or'he Business end Profess^nsCMdmy licensee
REPLACE FURNACE/ADD 2 A/C.
�a<y� is in full force on tt 1 199
s < License Cass Lic.M
3 m are Contreco'
ARC ECT'S DECLARAT O
F''S O I undarsmad my tons shall be used as public recor
Wo. C Licensed Prolessonal
w n a OWNER-BUILDER DECLARATION
u, 1 hereby affmn that 1 am exempt from the Contractors License Law for the
$4700
< following reason.(Section 7031.5,Business and Pmfesions Code:Any city or county
F O which acquires a permit m construct,alter,improve,demolish,or repair any structure,
to —prior.to its its uance,cals.«quire.,the applicant for such Mean m filcasignWzmtememc.
thahgif licerml pursulnndthe pmyssdom of the Com«dor's License Law(Chapter r ftF/1, p �s j�,d rf.� Valuation
.1Z,ncing.wrth Sectian70M)of Division 3 of the Business and PryryfS5mss' ns Code) lON"Tll 4:+t'iY 1�r+Y'`°J �.�t:�.7 Lti�.'
or,liar he Is exempttheiefrom and the basis for the allig'cN etemytiph.Any violation l
-of Section 0031-.5 by any applicant fare Permit sub*u the applicant to.civil penulty
yM� P
ofmm
t ore Nan five hundred ml,In.(S50)). 303AE!N1'C1 Tl. lY'1 MECHANI Alj` -, i ''`' Occupancy Type
e
01.as owner ofthe property,or my employees with wages as their sole compensation, 104 _ ROUGH ELECTRI AT,
-will'do-the work;'and'the structure is not intended or offered'for sale(Sec.7Bu-
Business and Prbfcssions Core:The Contractors License law does not apply to an 505 - FINAL ELRq1I11831 erections-1,I _
owner of ugh his al,ow emploho iees.p i provided
t thereon,and who does such t int himself
or 5 0 8 - FINAL MECI�I CAL
or through his own employees.provided mat such improvements is am not intended y cd or _ 1 _
;Rend ion.the.If,lid-build the Wilding o7im en irprnt is that
within one Wild
or ��S n` '""—---""'-"'
oprove for purpose
of
will have the burdenor provingthat hediJ norhill or
improve for Parpom of sale.).
❑I:m owneroRhe property,am exclusively g wi
comuctinth lieenttd comrenon toqq-��OO-- -- -- --. — - - �- � -- -
-_ construct the project(See.70aJ.Business and Profession Codi The Contranor'a JUS 1' •V i1 s^
License Low does not apply to on owner of property who builds or improves thereon, [ 2
` ..anJ,who contracts.for,such Projects.with.a commetm(s).licenmd.pursuant.,oNe. ._ ..-...__.__..,...- ._.___-_,.....__...- ._. _____......__.
_
Contractors License
°Imxmpt undersc ' . ' PCfohs son ) BU,L
Dm DG
' '.WORKER'S COMPENSATION DECLARATION
I herebyalfirm arde,1 peralt,of Pj ry one M the following d cimations:
❑ 1 have'and will' a uan a Ceaificida of Consent to elf-hasnare for Worker's
Compey t n aa.-provided for by Section 37W of the Lather Code, for the
performs c or the work for which this permit is issuM. .
I�7ve and will maintain Worker's Comienauion Insurance,as required by Section
'1 f the Lobo,Code;foi the performance of the work for which this Permit is
issued.My Wohcls Compensation Insurance carrier and Policy number are.
(3a9 2`.' ;.r.T�llfi.� •, `i•f?.',*; t•_• i t r [ , t
L, f! CERTIFICATION OE E}tEMPfION FROM WORKERS's'; P �l..'Y A 1'n \i_ P t F.1 - rat:�l sh:
COMPENSATION INSURANCE °^""r " ' '
n"(Tdssacaa,;i'bEed not be coreleted if the
p permit is for orrc hundred dollars '•'•:
(SIIX)1 or less.) •
I'sent ,that i person
Performance f the k f which this Perrone Warks is issued 1 t a-1 -
,hall a t employ any per.o m any manner so as to become subject to the Workcn u
Compenua,ind lows of Calil'nrnia:Dred n'
NOTICE
NbfICETO APP LIC ANI
O rtmpenkmg th¢CemfijExeo you should
Zbccometo WorkersCompensation provisions
ofeeLabor d,yo,umost
foh hcomply with.such provisions his permit shat]b dconed revokedx`
'
CONSTRUCTION LENDING AGENCY
a,� 1 h by'Ifirm th t tl e in,mct o I d ng agency f ,h perfnrman ti 1 A ..
L>a.Q LeLead,,',,
°d °Ad lac wh ch et int . sstied(S '309] Cf¢C1
6s: ... . _. _._.._. _ -. ._ ... ._...
I,- � I Gerd y,nm l have read this application and su r det the nnmi
,hove obounis
r fi_Ea correct.1 agree to complywith all city and,county ordinances and state laws relating
-D V to building construction.and hereby authorize«presenmtives of ihii city to sorer upon
�s W the alive-memioned property for inspection purposes
(We)agree msave.'indanni fy and keep harmless the Ctiyof Cupenino_ugai no
.y liabilities,judgments costs and expenseswhich may in any ay a against said
C,7y City nconsequence" 'ctrth'g Starting Pe t
APPI(CANT Rtr YDS AND WILL COMPLY,WITH ALL YbN-POL`1T'r
.Sou := GL. .• t: ^�.Z Issued by: Date
_ Srgnlryfr/�f ADPhcanVComrvcmr. - Dae
t/ HAZARDOUS MATERIALS DISCLOSURE Re-roofs
.: Will the tiri,ficaiu or„future ambling occaphm store or handl harml material ,_Type Of ROOF-_..
is defined by theC MurnIM cpal�+Me Chapter 912 and hHealth and Safety ____.>q._.- --
.
Cole Section 25532 / _ ., :P ` � - tl .4 r{:l. i ''Y ift'.'Ej A1{L;_I°f. [• r ;, ,
°Y [gA4o ;;` srs, .:-' - _ _All roofs shall be inspected prior to.any_roofing material being installed. . w_
Will theacomm fm of n g occupant ret umequ p t devices which If a roof is installed without first obtaining an ins ectron; I agree to'remove
m t h wNo r min nu s J d by theBay Areas Quality Menagem t g P g
of°'^° all new materials for inspection. Applicant understands and will comply with
❑Yrs _ .. _. .- -. - .. .
., ” all non-point source-regulations.
I h rcnd'do has d ta.maeri�lh quirements and r Chapter 6.95.of the
Californ a Health es S Iery Code Section.25505,25533 and 25534.1 understand that
obuilding .. .. . .. ._ .. _ .
�t�8cu sloesnotamn,ly haveote tthaiu'myresponsibility tdnni notify
D u r men, hich must he are,prior m iAm a of a Certificate of
rcy
toter
Signature of Applicant _ _ Date
Gun'kgor a a arped:g n, Date Al] roof coverings to be Class "B" or better
;a.>.�:I :.........:.... .. .... . . _:.. ....-'-`- '_- ..OFFICE .. _ ._. ,..