01030122 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING.ADDRESS: PERMI lNO.
21682 LINDY LA VALLEY HEATING & COOLING 01.030122
OWNIA S NAMIi; APPLICATION SUB DATE:
NETHIINGHE SUNIL S AND ANUJA 1.171 N 4 TH ST 03/21/2001. .
PHONE: SANITARY No. CONTROL NO,
(4.08)294-6290
❑te7, ARCIIIF17CI'I17N(;INI!IiR: BUILDINGPERMITINFO
Ow 0OC BLDG liixcr PL UNIH MECH
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'L tr N 7 riot lot,I CUNrRACnY1M5 ommodRfION Job DCSCI'IpllOn
p Z_G 1 hereby ulRnn Ilial I ran livensed nnkr pmvisiom nl'CM1upmr 9(commencing
with Will onleend)of Divisionl ofthc ltuxinct,and l'mfcssionsCWa and myliccnsu
Lice,
VIII I'orcc unA cfidu1/, �1 j (( '/n
o W a DitenKC L D a �� _ FURNACE REPLACEMENT
W 3 al w U nam_ /--- commnor T
ARGIII I'ECT'S DECLARATIU
H LL i I 1 moll my plan,sbill be used u,public reca d.
ia p, Licensed Rnlesxional
(lar I am exempt It m(lie RATION
o v, 1 hereby arum,,lien 11. exempt Iran,he Connor's License law for thele
F T following rennn.(Section]BJ L5,Business and Pmkssions G,Je:Any city or cnunry Z
O such mquimx x pennil to construct,alar,improve,demolish,or repairany structure
as
a3� Ed rolls i...ance.ulu,aequire.alhpplian,basal permi4
no nleaaigned nenuem
that he is hecosed pursuvn fame m,,l office Gmtncu,rf License lawn illy Sy. Ft. Floor Area aluation
(commencing with Section 701 of Division J of the Bu.incs and Pmfessiane Ca1O
or Ind Ill osmrpl thomfronr mW the lass..for the alleged ewmption.Any viclalinn
of Section 7131.5 by any apPlican lira a senior.subjects the applicant to a civil lanulry
of nal it bell r.e hmmred dinars S50 ). APN Number. Occupancy Type
0 L;s owncnd(lie pngary,or my ungquyns with wages ax dol,ourp,nsulnn. 356,2417137 6191
will do the work,and the slowdre is not intended or oll.sed for sale(Sec.7041
Business and Profession%Gvlc:The Contractor's License Law docs nor apply a an Required Inspections
or propedy Who huulds nr hal Thereon,and who does such work hlmsell
owner irnugh illicit enrploym,,provided lien se.,Impmvemenit are not included or 204 — UNDERFLOOR FRAME
offered rot sale.If,however,the building or improvement is sold within one year of
ail ledan.theawner.buude,willhavemeburdenofprovingmathedidnalbuildor 301. — ROUGH PLUMBING -
Improve for portals of xuLJ.
303 — ROUGH MECHRNICAL
❑Lux owner,(theproject
p(Sec.7. 4.mdinessa d prating with licensed a Coracron n
nine,the oe,tit flee.nus.Bax and mustily ho hold,ori ...Cc,dime 'a 304 — ROUGH ELECTRICAL
and who
Law drat mat apply ler o owner td a cony who halms se improves thereon,
area wren.antm.ts rte such pn,jat wird a enntmemro Imen¢a pursuant m me 505 — FINAL ELECTRICAL
Cumnmwdx L.i'mi"Law.
0lon,cxenp,unt,'Sce. Bx�perorlri...asan 507 — FINAL PLUMBING
Owner Date 508 — FINAL MECHANICAL
WORKER'S CONIPKNSAT1ONDFCLARATION 514 — FINAL PUBLIC WORKS
I hereby affirm ander pematy of Ill one of the following dedaradnns:
❑ I laws,and will nainmin a C"ofieue rel'Cusent ,,%dl'-insnrc for Worker's
Comrpensuun 1. as provided li,r by Sectio 3700 of ,he LaMrt Code. in, the
performance of,he work for which this permit is bond.
01 h t,e mod will mainmin Wurker'%Cnmpsl..n Inwrnrtc,as regmred by Section
371X1 of me Labor Gabe,lin the performance ol'thc work for which mil permit is
issues,My N'nrlom,Compenation Insurance carter and Policy number arc:
Carter. - Policy No.:
CLRTIIECATION pit EXHliff rloN FROM WORKERS'
COMPHNSA9'1ON INSURANCE
This section need nal be cmnplebed if the permit is for one hundred dollars
($Igll orIll
I certify that in the pamormance of he work for which his Penn is issued.I
,hall not anpiny any person in any manner so ox to become subject to the Workers'
Cnmp,'naation Law,nl'Calihmniu.Due
Applicant
Not'ICL!TO APPLICANT;If,alter making this Certificate of Exemption,you should
beaus subject hr the Worker'%Compensation Provisions of the Labor Code,you must
O 5mhwim comply with ouch provisions nr this pcuniI shall be d.emad rcvokcd.
z
F ^ CONSTRUCTION LCNULNG AGENCY
C �: 1 herchy animr that mere in a con tmnmn lending agency for the performance .
Lrjof the work lar whin,thismit Peris issued(See.3097,Cls.C.)
a C Under',Name
5 z leader':Address
V 0 1 eeody Ilial I base read mit application and ,are flin,he above infonoaion is
IzF., <al I agree m n
cnrply with ail city and county oNin irl and wale ining
U.,rel
O V to building construction ind hereby orhorlse representatives of this city menter upon
r� ,he ahmemaninneA Prpery Iia irgautinn nip...d.
tom., a (We)agree to love,indemnify and keep harmless me Cory of Cuperino against
y liabilities,judgments,coats and expenses which may in any way accme against said
fJ 4 City In eon.cqum,'col the grating of thus Non;', Z
APPLICANTI I NDEISTA^.S�AND WE LL COMPLY WIT H$ALL NON-POI M' Issued by: Y Due �^ l� d /
r SOUP ��or r:J /
signs mrnpplteanrG�n,tmenr ante Re-roofs '
HAZARDOUS h1AT1iRIA1S DISCLOSURE
P511 the appnicont or farm.lmilding occupant sur.or handle hae:wom,material Type of Roof
s Jolined by me C Isriino Municipal Cude,Cl 9.12.and the Ilealth and Safety
Glc.Section 23532(a0'r .
G Yea 13No All roofs shall be inspected prior to any roofing material being installed.
Will(lie l,plict to,filleteholding noeupan(use egniprentto,devle ods 11'a roof is installed without first ohtaining an inspection, 1 agree to remove
emir lnzardom aur cnnmmined,to.define)Ill 13,Arca Air Quality Mumgcnem
District' all new materials for inspection. Applicant understands and will comply with
GYes 0Na all non-point source regulations.
1 have read the hazardous materials requirements under Chapter 6.95 of the
Cubbor is flcalm A Safely Code,Sections 25505,25533 and 25534.1 understand Char
If the huildtngdocsnn,cu menly ties,atenad,Thal h is ny respusilanity lout fyme
occasion of the requiremM tor m
requirements which mus, are,priissuance of a Cenilicate of
coca
Signature of Applicant Date
stat arized agcar Lt+Lt./ Did All roof coverings to be Class "B" or better
OFFICE