00090160O
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CITY OF CUPERTINO
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CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDINC. ADDRESS:
PERNIT NO.
331—A LOCKW00 DR
JAMES HEATING AND R
C SERVICE00090160
OWNER'S NAME:
APPI.ICATION SUIT DATI1
AND SANDY
-852 COOLIDGE AVE
09/25/2000
PHONE:
SANITARY NO. CONTROL NO.
4087366693
r ARCIII ❑iC'i'l1iN(ilNEliR:
BUILDING PER 011" INFO
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BLDG r:1.liCf 19,UM1111 MliCli
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LICENSED CON 'IRACI OR S DECI,ARAI'ION
Job Description
1 hereby adn" n that I am licensed under prvvlxions of Chapter 9lcolnmencing
o with Section 900NAnf Dowam.1of the Boiness and Prnfcsir, Curb, and my license
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kinmurnrceandidle. . a0 �.�
U License 1 : 2(;L Idea,
FURNACE
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Dxie _�yfJ!9 _ Contractor
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v. /� ARCH ECT S DECLARAI DON
Iy "an4t Jens sl III ed n. puhl'y,fre+A.!
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p L naduPnhfcssinnal
hilt eCont1'ION
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that I�MPti Ir is limns taw lie me
I hereby that 1 am ncmp from the C
reason.affiralSect inc and ssions C;Ne:Any city or coctnre
a which nmir,.(Scnian]IDI.5.
air......deahli repair 1ery structure
o which gwsu a permit m cnm%t e6 ulcer, air deem
met,
for such
for snobperms mfileasigned sm¢mem
pure itsissuance.also m it i file
theapo....
Sq. Ft. Floor Are[1
Vii UIIOII
— II
Iodine rho
itpSectio ellhep
jun beencing
fGoisirl
Ede)
withand professions Chile)
(commencing with Steam ]tNN el the HusmLsl. and
J Inthealleged
$1400
iod. An, ,i
a a has!, a cacmaion. Any violation
thin is cxcmpt rhercfrom and the basin
or Shut
Ihrap:mhir subicers the lmpllmmeha civil Iwnalry
of nation5111 it W, , the
io by anydred
APN Number
Occupancy Type
olt
n
of ort mote man Eve hundred drtaw (sStN).
❑ h as owner of the property. or my cmployces with wages as their sole co riga nsmion.
7, 13003 3. 00
Required Inspections
will do the work, and the structure is not intended lir offered for talo (See. T}W.
Business and Prefasslmhs Celle: The Contractor '% License Law does not apply u, an
mcaner nrprvperty WToboildsor improves mereon, and who dol work himandf
X04 — UNDERFLOOR FRAME
thrnngh his own tmployees. Proan vulcd that such imprnanmants are not Intended car
offered lot sale. If. however. She building lir imp at a nam is .sold within line year of
�.
301 — ROUGH PLUMBING
nahidninn, the rrwill have the wrer-hdildcburden of proving that he did not build lir
impnrvckalue'1C.1dre)
303 - ROUGH MECHANICAL
ol.a,rwnerntIadIFpemy,car ewsivclynlmmetingw,Ill rcemedc:,.nowtorxte
30p — ROUGH. ELECTRICAL_
conamer the project (Sec. 70,14. Business and Prefesiom Codca'1'he Courtrai
License Law does hall aptly it) an ovacr of prolfert) %III) buld,; or impe"I dualism,
505 — FINAL ELECTRICAL
and who contracts for such projo iv cath a contortionist licensed pumhmm In the
Commerce, Llmme law.
5017 — FINAL PLUMBING
❑ I u a exempt under Set. If le P C lin this record
508 — FINAL MECHANICAL
owam D:Ite
WORKER'S COMPENSATION DECLARATION -
514- — FINAL PUBLIC WORKS
I hereby ul'Iimh under penalty of perjury one if the f Mowing declarntionp,
❑ I have and will 1laint'ain a Certificate of Clinical uh self -insure Int N'nrker's
Compensation, as provided for by Section 3704) of the Labor Coda, for the
,performance of She work farwhich this permit is issued.
❑ 1 have and rill maintain W'orker's Cmmpemmion Intact as required by Section
3700 of the L.abm' Chat, for the cafach n ce of the work Int which this recruit in
Swed. My Winker', G.mpach,r iod Insumnee currier and Policy hander ore:
Oil
C... m: Policy No.:
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSAI ION INSURANCE
(This section need not M completed if the permit is for one hundred dollars
IBI ix)) lir lac) .
I .artily than in the pmfommoa. lir tno work far which chi. r Is innueI I
shall Nin emp h y person In any hechny�.0 e� tajrhe Workeri
Cnmpcnna,it Calihh 2P
Applicant
NUIICE' APPLIES N'a,ahenna rs CeniB<me of Exemption. you >houlJ
L beerme ah'to to I'd W,IIo r", Cmnpdo .tan pn),,,I I, If lie Labor Crdn you may
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O Forthwith comply with such Imar inns of dis,n'rmil shall he demand revoked.
[n CONS' I'kddcd ON LEN DING AGENCY
? I hereby affirm that them is a construction lending agency for the performance
of die work int whirl, chis pct tat Is awed (nee. 1007. Civ. CJ
.
Q I.endcr's Name
z Lcndcr'n Aches
I cenify Shot l base ach is application and a mm rhauhe aMwe information is
annal, I agree u..ou.ply with ,If city nal conn,,INinnhar, and stat, law., rclming
U ah building consmhaion, and heachy nationals representatives of this caym enter aper
.
rhe abovommnioned prnpcny for Impztioo paramos.
agree tosave. indcvily anti ecp lanns lathe City of Capcuito against
1 (coq m
h liahil'nics, judgments, curers anJ cxpcnses which may in any way accrue againer miJ
z Chy'n aonxcyucnm al mu gnmiilhg of rbix Pcrnii,
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AMGUIDERST AND WILL COMPLY WITH ALL )N�PONT
Issued by Date
$Fl
Re -roof.
names rr Applieant7cw m r re
ovl bar, (ISURIi
iI..I OUS buildingoverhaullirhandle hauNuusmaterial
NiII thee
,mm, Fatumbuildingir.
,
Type of
Charmer 9.
w dei Sed by the Cupcninn Municipal Gate. Chupmr 9.12, nnA the Health and Safely
Calf
Ghdc, Section 255321u1:'
❑Yes 0 N
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future budding recnpant use egnipmedt or devices which
If a roof is installed without first obtaining an inspection. I agree to remove
near halt; on, ,it cunmmirano,us defined by the nay Arca Air Quality Management
Didlim+ _
all new materials for inspection. Applicant understands and will comply with
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all non -point source regulations.
,
I have read She hae.Won, materials requirmnents under Chapter 695 it the
California health k Safely(:,d., Sccnrns 2550 y55131nW25534, 11 demand that
._
if the huilJing does nm cuouty have .tenant, aha it is in, roamnibility to mudythe
m of me mquirememx which must be met pain, to lothe a of Ceailicme of
G
°ache
L✓ry
nature of Applicant Date
�rsa, �lL!
Di.—
- All roof coverings to be Class "B" Or better
neemaa1Fnriule
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