Loading...
00080048COMPENSATION INSURANCE (This wnionneed ont W completed dthc permit is fororchunAed ddinm($100) or less.) I cenify that in On pedo.. of the wmk for which this permit is issrd.I shall not employ any person in Any manner to as to become wbjwuo the Workers' Compen- wion laws of Califomie. Dam Applicmt NOTICE TO APPLICANT: If, afar making this Certificate of Exemption, you should Wmme subject to dm workers compensation provisions a the labor Code. you must Forthwith comply with such provisions m this permit stall W deemed invoked. CONSTRUCTION LENDING AGENCY I hereby aRtm that then is a wnsuucd.n lending agency for the perfumunce of the, work for which this permit is iseued US.. 3097, Os. C.) Lenders Name [� j Uncer's Address {yI Rectify da,1 have round Out application And.um that the JWsA information is 6, octect. I agree to comply with all city and county oedimnees And state laws mating m s7 z building construction. And hereby authorize reprommusives of this city to enmr upon Re, U aWv'..AmiuuM property for inspection purposes, (We) agnse to A. idemnify and kwp humless On City of Cupertino against l) Iubilmes,judgmenn,v. end expenses which tory in any way ..A.&. said City ;s., W in consoo Re a Ibe granting of this permit. [— 0- APPLICANT uNDERSTANOS AND WILL COMPLY WITH At.[, NON -POINT tjO U Z SOURCIi�Pj'UI. i NS. /s ?�0u sigmtun.f A,li,antl omracmr — t H RDOUS MATERIALS DISCLOSURE Will de applicmt or forum building ccapmt Acme or Wdie Numerous toatuW as def sed by the Cupertino Munr ipsl Code, Chapter 9.12, And the HW N And Safety Codc, Section M532N)7 ❑Yes Will the applicant or faun building occupant use equipment or devices which condo haatdour air contaminants as deNmd by the Bay Ara An Quality Maougemem DonswO E3 Yes L— o 1 have read No hawdms materials reyuirtmcnts seder Chyxer 6.95 of Ne fomu Heald & Safely Code, Sections 25505, 35533 and 25534.1 uncensored that If the Re -roofs Type of Roof All roofs shall be inspected prior to any roofing material being installed. If a roof is Installed without first obtaining an inspection I agree to remove all new materials for inspection. Applicant understands and will comply with all non point source regulations. Signature of Applicant OFFICE All roof Date to be Class "B" or better CITY OF CUPEMIINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: rcu"l O O 0 BUILDINGADDRFSS: 621 LONNA LA ALLIED AIRE SERVICE s3'tl]E,kYN(0 1 _SUBMITTALDATt ' ANNE M 661 SINCLAIR FRONTAGE OWNER'S NAME: R.08/07FTEIM PHONC (4.08)934-8844 ARCHITEC'IIENGINEGR IiULDING PERMIT INFO U 'du ,i, Qn t- D 7 z o y MI LICENSED CONTRACT'OR'S DECLARATION hereby affirm Nat l am licensed under provisions of Chapter 9 (co ming lob Description _w with5ation7000)ofMvision3ofdw Busimesmdpro(onion Code,asdmyliunwis I tome A"�'7O U3� FURNACE C/0 — 80000 BTU, ADD A/C 3 TC veN De¢ Cooloac x a ARCHITECT'S Dlci_ARATrbbi I W mcmds 5.C S understand my pians ,hAl used as public Licensed professional OWNER DECLARATION a a c ^_ r -BUILDER I from Ne Contractors License taw for the / t z I hereby apron Nat un exempt Ale i ff o folkuin,.. (SaUm 703 1.5, Business ard profusions Cude: Any city or rounry au 's z wMch nsquuca a permit to construct, attest, improve, demolish, or rapsir any summons Sq. Ft. Floor Area nation prim to its inmnce, aim requites the applicant for such permit m file aligned autemem Out he is licensed punumt to IN provisions of ibe Conreemore Liana U. (Chapin 9 2 APN Number Occupancy Pones Y Type (c.rRing with Section 7000).! Division 3 ofthe Business end professions Code) re that he is es<mpt thetvfrom and the Wais for the alkged exemption. Any violation a Section 7031.5 by any applicwt for • permit subjects the applicant to A civil penalty of Ant mons Nen five hundred doll. ($500). Las ewnu of the r n y employees wi wages a popcy,mmeml thwa utWvwlemm maden, a Ulred Inspections `r 4 P will work. AM An crouddo for oak (Sec. A4, Business clot Inmidruse, and pmN he C.nere U to whion. Cale: the Contnetre s License Law docs not apply w lf owner a 204 — UNDERFLOOR FRAME propcny who buildsmimproves lberton, sed who does such words himself ordwegh err, his own emph yars. provided Our such impnwANAmA are Mt intended m (Rand for 301 — ROUGH PLUMBING We. If, however. the, Wading m improvement is mid within one yearofconspleum, On owner -builder will have she WoreenaprovingOmWdid AmWild or improve for pur- 303 — ROUGH MECHANICAL pm<as.le.). ❑ L ...,of the pr.party, am e.charvely contracting IN licensed contractors to 304 — ROUGH ELECTRICAL construct the project (sec. 7W, Business And professions Code:) The Contractors U. ,A.I-awdoes 505 — FINAL ELECTRICAL mt.ppI, m An owner of pmpany wn. Wild, ne improve.x meson, and who mn=ts fm such projacts with A 1WI ,mc(O Inentd Pursuant In tW Conuacmrs 507 — FINAL PLUMBING License Law. DI—c-mptmder Sec. .B&PCNeOixreason 506 — FINAL MECHANICAL ownm Date 514 — FINAL PUBLIC WORKS WORKER'S COMPENSATION DECLARATION Ihcnby dorm under penalty 0f perjury one of the following dwlentiom: ❑ )have andwill maintainaCenifcam ofComentm self.insua for Woher'a Compem Am-u provided fm by Swdon 3700 of dee Labor Code fm IW pertomurce of the Wkf«which Nia PesachuinuW. 1 have and will maintain Waters COmR.WIm Inweem<. u rtquved by Swoon J7fpof the labor Code, f0 eprohmen ace of the work fm which Nia permit is imued. My Wor '.Co pE .0 so arecuwtflend Policy nmrmhrawo'i. i_.��/ Comer /mitis.. J►• hay No.: COMPENSATION INSURANCE (This wnionneed ont W completed dthc permit is fororchunAed ddinm($100) or less.) I cenify that in On pedo.. of the wmk for which this permit is issrd.I shall not employ any person in Any manner to as to become wbjwuo the Workers' Compen- wion laws of Califomie. Dam Applicmt NOTICE TO APPLICANT: If, afar making this Certificate of Exemption, you should Wmme subject to dm workers compensation provisions a the labor Code. you must Forthwith comply with such provisions m this permit stall W deemed invoked. CONSTRUCTION LENDING AGENCY I hereby aRtm that then is a wnsuucd.n lending agency for the perfumunce of the, work for which this permit is iseued US.. 3097, Os. C.) Lenders Name [� j Uncer's Address {yI Rectify da,1 have round Out application And.um that the JWsA information is 6, octect. I agree to comply with all city and county oedimnees And state laws mating m s7 z building construction. And hereby authorize reprommusives of this city to enmr upon Re, U aWv'..AmiuuM property for inspection purposes, (We) agnse to A. idemnify and kwp humless On City of Cupertino against l) Iubilmes,judgmenn,v. end expenses which tory in any way ..A.&. said City ;s., W in consoo Re a Ibe granting of this permit. [— 0- APPLICANT uNDERSTANOS AND WILL COMPLY WITH At.[, NON -POINT tjO U Z SOURCIi�Pj'UI. i NS. /s ?�0u sigmtun.f A,li,antl omracmr — t H RDOUS MATERIALS DISCLOSURE Will de applicmt or forum building ccapmt Acme or Wdie Numerous toatuW as def sed by the Cupertino Munr ipsl Code, Chapter 9.12, And the HW N And Safety Codc, Section M532N)7 ❑Yes Will the applicant or faun building occupant use equipment or devices which condo haatdour air contaminants as deNmd by the Bay Ara An Quality Maougemem DonswO E3 Yes L— o 1 have read No hawdms materials reyuirtmcnts seder Chyxer 6.95 of Ne fomu Heald & Safely Code, Sections 25505, 35533 and 25534.1 uncensored that If the Re -roofs Type of Roof All roofs shall be inspected prior to any roofing material being installed. If a roof is Installed without first obtaining an inspection I agree to remove all new materials for inspection. Applicant understands and will comply with all non point source regulations. Signature of Applicant OFFICE All roof Date to be Class "B" or better