00060158 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMA'FION:
HUk.nINGAiJOasy8 MACADAM -LANE CONDITIONED AIR PERM,11 No.000Fi01.58
Owfe:R'SNA1�URAJ PAULOUIS 164E GIL-MAN AVE APPucATIOM 213/2000
NE: (408) 374-6311
SnvlrARv ND. covrkoL No.
O z Z ARClll'FEC(ENGINEER: BUILDING PERMI'P INFO
{u O O ELIK IiLECT PLUMB MFCII
a 1"_- I= LI LI
1<wt
LICENSED CONTRACTOR'S DECLARAnON Job Description
00 0 Ilerebyattionflat lall]licensed aI........ im,xr,fC,lmpler9tunnuneming 86, 000 .BTU A/C CHANGE OUT
with Seen ma 7009 of Division 3 DI lee Ru,inellmol Precision,Code.wool,license
=�—� is m loll muccandel
z a License Class Liv.p
°a U Dam Comment, - -
w 3 LL 7 ARCHI"I'IiCI"S DECI.AkN IN
undcrpcunl my plwns shall Inc n,ed ns puhlic,u.nrds o
C -
sW
p` Licensed rmresatnnw
a a that I a -nU1LDEk DECLARATION'
I hereby all inn that am e3.Rosin trona the lessorsCContractor's License law for the
f lli'li ng rc a ,,all h"mr ua't.,fines,and l'ml'c nuclh Ceder war an e ..my
O sett J 1 M1 ria I t I p Isar, sop . J Ilsh I''r ry a 'm e
aim Dna rt t Isom to m inions r mmpermitLie :6 Lrenem
mmn I n sed..mean thcp provisions one t Commi rsL a 1a (Chapters nsode) Sy. Ft. Floor Arca ValgS$iF�1�8
(co mm fie is eing with Smionomanofhebasis JDIthe Business exandiefAnonsCalc)
or the he is exempt therefrom and the basis for.hr.JlcgcJ cxcn,ptioa Any violation
of Section 70315 In,any it"licunl tont permit subject,the npPlleam m a civil penalty N
of mm some than Eve hamered dollars lSS10) A PNYIY3gh39. 00 Occupancy Type
01,as owner of the property.or my anpluyecs w ith wages as their sole enmpereatinn.
will do the work,and the svuewe is not intended ur offered for sale(Sec.ov14.
RusfilePmlcx.
.and . s Code:The Co awc or's License LawJots not apply ,,an 303 — ROUt!1f4uiM1 1dV4PN!rAL
nI Vmpcity who builds ler I......levies full, i i I whin
Its docs, ch work hi milt
crnc,a,h lis own emlheyces.prwidcd mat such improvements are net imended ler 304 — ROUGH ELECTRICAL
offered for sale.If,tmwever,lee building or impmvemem is sold within one yew of
completion.the smncrbuilder will hmethe burden MpeNngthat hedid no,build or 505" — FINAL ELECTRICAL
improve for purpose of sated.
OLn, eflheprorrry.a 'sh-sclycneametingwith werwdee.,lrcoersm 508 — FINAL MECHANICAL
con sns el ase project fan.71143.owner
wn erof and ens who
Glop The CDmmreon. .
Linnen co Jasnot apply man ownerof a cornvssbo buildeseor d purstai Ihto he
and who commas for such projects with a cnneenortsl licensed pursuant m the
Contmcunr'.License Law.
❑Bunt cse.np,under Sea .R.F PClnr thin reason
Owner Doc /
WORKEe'SCall,ol erju, oreolCIARAI'ION
d 1 nereny trhrm n.,aer p.�rnalty erpednry ere none n.unwn,g pedararem,: ^3
J I have and sell . aimain a Celine.,of C......at to sell-insm'e lin worker',
Contpenmtion, m provided far by Section 3700 of the [.,her Code, fill he �,
performann of the work for which this permit is issued.
0 I heve and will nminlain worker's Cumptust inn helarni as required by Section
3701 of file Labor Code,for the whoa eco DI'tire work for whlun this..emit Is
sued.My Worker's Compensation Insurance eanier and PoI'uy nrmher arc:
Currier: Policy No.:
CCR'I'11ICATION OFESEMP'NON FROM WORKERS'
COMPENSATION INSURANCE
('Phis canon recd not be coundeed if the permit is for one hundred Jeff...
play or les,.)
I unify that in the perlurmnna of the work far which his permit is issued.I
shall nm employ any Penna In.my mwmer so as to became sal to.he Workers' -
Cn.npc ,ale n Laws of Cnlio nia.Outs
Applicant
NOTICE TO AI'1'LICAM':If.al ler.king,his CvniR<am of Exnnption.you should
necomm sobjen nn,nc W'nrkcr s Cnmfcnwtion pnrvision,of me Lnbur Cn1c,yen nest
0 0 fnrhwhn comply with such provisiom or this per.nia shall M AennN revoked.
CONS'IRUC'I[ON LENDING AGENCY
' I hereby off nn that mere is u cunslmmion lending agency ler the penumunm
of the work for which this permit is issued(Site 3097,Ci,C.)
L Q Lender's Name
0 Z Le kr's Address,
L) 0 1 sentry that l move read this applicminu and state that the above m om,n.ion is
fi [.. corer.1 agree m c ul,ly with all c,,y and county nNiumnes and sale law,editing
0 U an building comtmi and hereby authonre epesenetives of this city to enter upon
the ovoc-mentioned aureole Int inspection purposes. -
yy (We)agree m smo.lndemn lfy aod keep hm.nln.the City of Cupertino against
W Ilahilities.judgment,costs and expenses which.nay Ia any wry taste,egaln.a,aid
U Z APPLIvANTUNDERSTANDS A D WIthiLL
permit
APPLICANTULATIOAND WILL COMPLY WITH ALL NON"PoINT Issued by: Date
SOURCE:REGULATIONS.
Slgnw...cof ArPbc:..110mnut Iyme Re-roofs
HAZARDOUS MATERIAI,S DISCLOSURI;
Wilt the applicant in fume building..,in sone ler handle havwdoes lowered Type of Roof
a,defined by the Cupeninn Municipal Code.Chapter 9.12.and the Health and Safety
Code.Seen 1255)2(.)^
Ove. 0N All roofs shall be inspected prior to any roofing material being installed.
eWill the epithet to,Future building ncavpantuse equip.nemnrdevices which If a roof is installed without first obtaining an inspection, I agree to remove
m. ha
Mous air connotations us dell by the it,Area Air earthy Management
gala? all new materials for inspection. Applicant understands and will comply with
O Ye, 0N all non-point source regulations.
1 have fwd the hmardo.,.macdal, ,dmmew,amdc. Chapel 695 lel .he
Carter.Health Fr safety Code Sections 25505.25533 and 25534.1 understand that
Rue building dons not currently have a herrn,,that it is my m%ponsibinty to nmifY the
occupant of the requirements which must he met prior to issuance of a Cenilicoe of
Ottope", Date
Signature of Applicant
Owner orwool d.edagent Date All roof coverings to be Class "B" or better