02020017 ctBUILDINUDN
PERTNO
GOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMrT NO.
10084 LIBERTY OAK LA GARY ' S FURNACE SERVICE sspp 02020017
OWNER'S NAME:
ETERESA GRIFFIN 360 CARMELITA DR AbPy2ic`jT?6 062
PHONE: (650) 967-8171 SANITARY NO. CONTROL NO.
G p ZZ ARCHITEC(ENGINEER: BULDWG PERMIT INFO
kCkC ;Fj BLDG ELECT PLUMB MECH
.ts-.i a N rJ
Z O y Z LICENSED CONTRACT'OR'S DECLARATION J b DDeSCfI tlOn
OZ IherebyaRrmmmlamlicensedunderprovisionsofChapter9(commencing FURNACE CHANGE jc 7pes P
r.L t wit1b Sbf on]000)of Division 3 of the B bas std Professions Code.and my license
a f IS in full15 endeffect. 2W1 �[/ 2
Li..0` L' J
y to ? ContraWy S
li 3 u � CHITECT'S DEC CAk N
S�0 I understand my plans shall be used as point ords
ni S p O Licensed Proximnal
fes
aF 5f� OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contimator's License Law for the
z following re n.(Section]031.5,Business and Professions CallAny city or county, $1450
a
I F O which requites a permit to construct.the l palter,plic improve,demolish, fi repair any structureand
uy�j3$ priormit issuarcp also«quirts me applyant for such pemdtm flkasiBttW suument. ,,()�, _ -. _. ..._
shay Egos licensed ponundul he Prrovisions ame cartel License lawChapters) _ � j933t, Agp[60laf- 1 A y,iir.- 1 Valuation
(cmiimencin8with Section]09pj of Division 3 of the fiuliness and PTryfissions Cade) �,li:Vr i i ,x•_..('.dOf.3• 1¢ i%{:3',g;=a L�.1'�. 5
or moi he li es'embs`therefram and the basis for me alleged eiempgu .Any violation
-of Section-7031.5 by nay applient for a permit iambics the epplamr,ro o civil Penalty '
of not mere this from hundred dollar,($5n()). 3 01AP 11PjF5H PLUMB I N >o) Occupancy'Iype
❑I,mmasnerofinepropeny.ser my employers with wages as their sole compensation, 303 ROUGH MEC HANI AL
`wIII do me work;and'the sLmrc is not Intended or offered-for'sale(See'7W- -"" - - - ------ - - - ---- - -- ----
Bosmessa d'Pmfeesmns Code%Convenor s License law does not apply to an 304 ROUGH EI1&Q1iRJ ions I.` "..a,of property Who btaIds or improves thereon,and who does such work himself 505 - FINAL ELECTRICAL
or through his own employees.provided that such improvements are not intended or
oco completion,
r sthe wee e e r will have
or improvement n sold within not year or 5 0.7 - F I NAL -PLUMB I NG
improve on p owns bu Id ill have the burden of proving that he did not build or 508 - FINAL MECHANICAL
improve for purpose of sale.).
t_Sl fowner fine Property. p.Business
and mpsangwmlem he Comctsm i'L
men se Low the does
project(Sec ]to a owners and Professions Cade)The Contin neon. r
7
License Low does nm apply man owner of Ispropertylamp who builds or improves thereon,
..,r._ _.and_actors kensresta[La such.prolat with a comtmcur(s).liccnud Pursuam.to,me. _ ..._. __...._.._. ._.. .—_...
°' �� Conuacmfs License Law. _ _.__—.. .._._..-._.________..__.__.___
❑lam esemPt undir Sec.'f' `lY. (, o - ';B&PCforthisuaun
•tai _ ,...-. .•....� „ - ., ,Q�
are
Owe,. "'WORKER'S COMPENSATION DECLARATION _ rlr�rr.IN�.u�LED
q
Ih by ffirm J Tran Isy,ofp B y n' fthef II gJ ckrmionsFEB �,'S 2002
❑ I ha a end II• mita Cy-Sec of Chem tt self bser for Worker's
performance
as provided for bys Permit
7]00 of the lobo Code,'for the
performance of the wad for which his permit is issued. .
❑1 hirsoind will i* ilmiln Workers Compeiaa lPn Innupn[q ax ttgaired by Seetlon BUILDING
3700'of the labor Code,forthe,perfohnnal'of me'work'for which this farm;[is
yolamil My Worker'slCompen atlon hasumniceentier and P 1 cy be rc
" . Canis`I U t 47e t d j t iiTo,I cy N,:
ft CFRTIFTCATION OF EXEMPTION FROM WOR pRg �, u+'i`f�
'" 'COM PENSATION INSURANCE- >ti Ssftl 1 I
...... ..... ..__...,...., .�..__._ ' __..
Aii ('ITu ucu.a need nm be comp eicdlfthepermitisforonehundreddollers
(Slao)or less J,
"- (corn y t at in t performance of the rkf which'hi permit i's issued,I _ _ _ �- . ..ILL. '_:\ ir5 `7 •KI r. _ —
'ih 11 not employ any person m m er xm to mpsnpjgPs m @e Workers, `
Cmnpensa' sof lifamia. ata _liedo
too
:NTfrICL TO .I ANT If mak ti this 'n t f heExemption,es should
z m .ubjet theWkPC p r np haofm Labor r Je you must
z O ItiMw to co -will
such Provisions or stilt p<veis shall be tleemed rcvnked.
i7"""Fb"it"!rCONSI'RUCIION LENDING AGENCY "'s •`herctiy ihauherei5amnswnion lending a8cnfiy for the perlbrinance ;t11:.: -. '�- -,- \• 1 -__
�'.^ of die work for which this permit ii issued(Sec.309],Civ.C.) -
96 lkbders Nom:,_,in.:,,,,.i:,.:.,-„ - _,.....,,.... .___1 .;_,....-a,..:' __.... _._...----..... __ .._. _.._..._...._. ..._-.._..------...._._. ..._..- - -._... .-'---
�.,z Le de Adgres: -
V 0Icenfy that I have madthis appl t mic aidsthat the aboveinfmmation is
FT+'-ri commit 11 agree,to comply with all city and county,ordinance andstorelow,relating
_02:V to building eonsuucilwand hereby euthonx rcpres<nmuves of thio city to enter upon
'W meabove-mentioned property for inspection purposes.,
G s (W'e)Sgree to rove;indemnify and keep harmlesi the
City. Cupertino against
V1 Haddlifica.judgment,com,and ,pamcs which may in any ay accrue,against said
U z Cisy mconsry dhol gr nungo th permu _
APP ICANTUNDERSTANDSAYo WILL COMPLY WrHA ALL NPOINT V (/
to sbl RCP R c( T!r Ns 1 y Z-6 p�-7 Issued by: Dale
i _
g t A of cam ct , ate Re roofs
HAZARDOUS MATERIALS DISCLOSURE i -
�,) 11 the pplicam o1 f m bu Id'ng ace p t store rh ndl hoz d s matenal ,Type Of ROOF _
as Jef d byahe Cupcn no M n c P�1 Cad ChoPtcr 9 12 and Ne Headh and Safi ty t p;"' ,1 '-" ""`""'""v u •--- -..�......_.._.._., .
Code Semm�2553Na) lr t >•. 1 't try t - oo
�\ q- ,-+,. 1 l fx'�,i T�J"Ltd f: }4�Ih" k
_ ❑Yes ,} I .o Nm ,t', „_. ` All roofs shall be Inspected-prior-tp,any,r(iofing-matel;ial being installed,,_,
-r ,wutneappr�antm r t rcbuildi gac p t'�xe:q Pme�tordevl�a,which If a roof is installed without first obtainingan=ins ection; I a ree,to-remove
em t hazy d ar
r cone its m deMeJ by the Rny Alen Atr Qwdty hlawgemem P g
all'non- ...1,source re�ula[lons : rstands and comply with
P Applicant _
a new materials or inspection. A
(cant Understands
p a
Calf aHealm& r .k -
` - I ha ad dh<h rJ s rnaten Is Tey rc cots and r Chapter fi 93 of the ,
acu 7 fine et oro 5505 33573 and 255Ja 1 demand that )�
pan raga rcmtent wNch" t sant th nt s my rc pons b I Sy to not fyme
If met Itl ng Joes iwsc rte tly ha
,pun be ten poor m usuance'of a CeNficau of
�^ og Signat r of Applicant Date
°a Drou
ten ed agent Dmp, ' - All roof coverings to be Class `B"or better