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02120013 CITY OF CUPERTINO at9. MI' BmLnmc DlwsloN PERMIT CONTRACTOR -AU,INFORMATION- BUILDING ;e, a RUIgyplggapEsgOCKWOOD DR SUPREME AIR SYSTEMS PERM]FN92120013 OwPTTMEROBERT A AND JOAN L 520 MCGLINCEY LANE #15 APPLICA7'p2Sj"Tj2002 Ak HONE: (408) 879-0334 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 00 LICENSED CONTRACTOR'S DECLARATION Job Description szF I hereby affirm that I am licensed under provisions of Chapter 9(commencing p <i with Section 71xM0ofDivixinn Sof the Busiaessand Promarinus Cnde,deco license i9 FURNACE How in full fnmgand effect. 1, Z 01a Z Liccnsc Qjass �-— sl.V L 6 OyConitxWe/RATIO rif- ARCHITECTS UGCI.ARAcond, w kTs Oy U 1 undersmnd my plans sM1alLbe used as public records n 'Licensed Professional DEC 0 �00 •�7�/ g OWNER-BUILDER DECLARATION 1 botchy afarm Ibat I am exempt Gam the Connector's License I.e.for the $5000 A.a 00 fallowing reason.(Section 7031 5,Business and Professions Code:Any city of county 13 I' x which requires a permit m Construct,almn improve,demolish,or repair any structure Vl�f Fz„ prion its issuance,also requires the appiiczn for such remit file aligned statement 'y` xx< thatbe is lice used pursuant to the provisions of the Commctnt's License Law(Chapter 9 3,WEt4BldfiQAt2© ''gyog Valuation h ~a (commencing with Sectio 710))(31 Division 3 of she Business and Professhms Code)or 5— than he is exempt therefrom and Ne basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty OfpN N (]CCU araC net mom than five hundred dollars($500). 303 - ROUGH MECHANICAL p yType ❑ I,es owner of the property,or my employees with wages As their anlc compensation, will do the work,and the structure is not intended os offered for sale(Sec.7044.Business �pCC and Professions Code:The Contractors License Law does not apply to an owner or 505 — FINAL SDEC IOU$ properly won bud Ids or improves thereon,and who does such work himself or thmugh his IAL awn employees.provided that such improvements are not intended indicted for sam.If. 507 — FINAL PLUMBING however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not Mild or improve for purpme of 508 - FINAL MECHANICAL sale.). ❑ h as owner of the property,am exclusively connrie ng with licensed contractors to construct the project(Sec.7044,Business end Professions Cndep The Comic Li. cenxc Law does not apply to an owner of property who Milds or improves demon,and. who Comment for such p..jeers with n contruc offs)licensed pursuant o the Convector's License Law. ❑I am exempt under Sec. ,B&PC for this memo Owner Dam WORKER'S COMPENSATION DECLARATION 1 hereby M.under penalty or do,one of de following declarations: ❑ I have and will maintain a CenificmcofCnnsent winif insum for Worker's Compere station,as provided for by Section 3700 of the labor Code,for the performance of the work for which this permit is iss ed. ❑ 1. rat will aimJ tars Compensation Insurance,n y d by Section J71X1' r Qpr perfnrman¢of t{oWor nsmhic t ((asyy da d. yw„� My n roe pematinn sotoyd�uccasrieqr,.�T oofi Mt�s's 2, V a/ n '- •yA gM Policy Na: ✓✓ CERTIFICATE OFEXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not M mmplemd if IM permit is for nnc hundred dollars(5110) n Icxs.7 I coni fy that in the performance of the work for which this permit is issued.I shall not employ any perssm in any manner so As rat ccome suhjecno the WorkersCompensation laws of California.Da¢ Applicant NOTICE TO APPLICANT:If,after making this Cenifcam at Exemption,you should Mcome Subject to the Worker's Compensation provisions of the Labor Code,you must Q O forthwith comply with such provisions or this permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY (�. I Mrehy m5rm Nat them I,,Construction lending agency In,the performance of a the work for which this permdt is issued(Sec.3097,Civ.C.) 0 Lender's Name z Lender's Address U 0 1 certify that 1 have read this application and atam that de above iortior tion is LL F correct.1 agree to comply with all city and county Ordinances and state laws relating In O U building constriction,and hereby aumerim representatives of this city 10 enter urym the W shoe mentioned pmperty(or inspection purposes. t1 (we)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,Cosa and expenses which may in any way accmC against said City U Z in consequence of the grading of this permit. I/ l�J-,✓/ '—' APP (CANT UNDERSTANDS AND WILT.COMPLY WITH ALL NON-POINT Issued by: Date 5%CEREGULATIOf , .weft %/ —112-3 d� Re-roofs u of Applicant/Coun Date HAZAR MATERIALS DISCLOSURE Type of Roof Will Reapplicamorfmurchalddng upamstoreorhandlgha,a ousmaterial as defined by the Cupertino Municipal c,Chapter 9.12,and the Health and Safety CNA.Section 25532ta17❑rex 01All roofs shall be inspected prior to any roofing material being installed. Will the applicant nn"Iemte builJln upam use equdpdent or devices which If a roof is installed without first obtaining an inspection,I agree to remove Cmd M.mdoua it contaminants as def by the Bay Arca Air Quality Management all new materials for inspection. Distimil ❑YCA I have read the her nus mamrlale requirements under Chapter 6.95 of the Califon niallcahh&SufcsyC 'inns 25515.15533 and 8534.1 understand Nat if the Wilding does not currently how a tenant,met it is my R`s(Xnmdbilil to nn dy du ovcupam Of tb my ' sans which mus at pdonodss� Ccnh of Occupancy. gnature of Applicant Date - b Owner lir lnrhrcd agent roof coverings to be Class "B" or better !� Dam