00110094 CITY OF CUI-ERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING A D C9,` PERMo
I'I'N .
c "1�/f. I MILFORD DR ATLAS HEATING 00110094
OWNER'S NAME: AI'I'LICATIO ti li D T
BHUSHAN 155 SAN LAZARO AVE TTYTTi/2@0@
` (408) 739-051E
PHONE: SANITARY NO. CON'FROLNO.
a Q O ARCHI'ITCIIENGINEER: BUILDING PERMIT INFO
W❑ OL)G ELECT PLUMB MUCH
Hy LICENIHIs CONI'11AIME-1 UBCI.AEATION 106 Description
bercby allimt Wat 1 am ran dander Pnrvi n n%of Chapter 9 Recona Ging P
w wire Semina 7g)l)ot Dlvi,io iol'ihe Ro,inwsand Probsion,Ctdaandmw
y licansinlull lnrcx aryfc�IB
ou clsy//—�� REPLACE FURNACE
>mn a� Gmtmcnur
t�i 3 ��W ARCf{ITrcr'S DECLARAI'1 -
Ca m 1 Understand my flan%shall he toed u,public records
e,6 c,p p Lie n,ed Professional
%o OWNER BUILDER DECLARATION
w_w I hereby aRmt that 1 u exempt fmm the Comctoh License Law for the
C•[+Q li lkowing re-ton.15cndoa 7011.5 m
Buxi nA plods m Co1r:Any city o „.cry
rhr�a whim q ps 'n n t It p J lis p' y st rare
ij� Paan n - I. _th ppl a such if fl signed.tf 'm
bat he%licensed panaa,nbWaprvlannnrelie Conowbr'sLinataLow(u,tl11ef') Sq. Ft. Floor Area Valuation
(commencing with Section 7100)of Division J of the Business and Professions Cult)
or that he is exempt dmmrrd the hasi,f r the allcgal cscmpJon.Any violation
of Section 7031.5 by any applicant for a Penni,objects the appllemm m a anvil penalty
„tnor moreWanrvehandled dmlLms(S5(g). APN Number Occupancy we
❑Las owner of the property,or my wmplmyces with wages as their sole compematimi
will do the work,and the stream,i,at,,unsuited or ofl'crcd far ale ts,,,9044, a `1
Business and Profession.Oda The Contfueor's License Law'doe,not apply to an •-'` - 1`1 glllred Inspections
r or loosely Who build,nr improves thereon,and who dues such work himrtclf K
or through his own employees.provided(hut.such imprnvnncnu arc not intended or
offered!ror.,ale.If.however,the building or mtpro,nnent i,sold within one year of 301 — ROUGH PLUMBING
untplOi I.theowncrvhuilder will Imvc no,burdenal'provingthan he dial not build ar
tnpow,,fnrpurL%enf.ale.). 303 — ROUGH MECHANICAL
0La.ownernf the property.ameaciueively commung will)rcendmmmcm%tn 304 — ROUGH ELECTRICAL
gnus the does
o (See.TH4.Business and P,Iy of
CsdeO The Cnmmcbr's �
colouwhaw daa renapply m.nnawncrosand crty wbnnada,arn hecostracmt. 505 — FINAL F_L ECTRICAI.
and who contracts for such projects mith a Cmlmwmd,)licensed pursuant to the
CaI....la'cl,cLaw. 507 — FINAL PLUMBING
❑l.,it esen,pt under Sec. .B G I•C far this reason 508 — FINAL MECHANICAL �S/O
Owner Oar y�
WORKER'S COMPENSATION DECLARATION v
I hereby affirm under pewlty of lwrjuq one.1 he lidlowing da1ambome
❑ I have and will maintain a Cenilirt¢or Corwin In sell-insure lot Worker's
Compensation. as provided for by Section 3700 of the Labor Cale, for the
per5mam¢e of the work for which hi,pend,is i,u...1. 1 -
❑1 have and will mainmir Worker's Cmntpcmmlom Inorunce,as required by Seetion
3700 ardor LaMn Cole,for the performance Lir the work for which this panni,is
suet bf��l1Wnr� Lf Insinuate,olicrniep an/P�nlic urnpv�M�r��tyZ� '
mrt��rlrF/rf(p,Q
Policy
No.: WORKERS CIiR I IW'1'1(1N NSAHON I'ION FROMNSURANC WORKIilts'
COMPENSATION INSURANCE
Tld,stenion need not be annplcord If the peno.,is tonnm hundred dollars
($100)nr less.)
I edify that in the perfomnnce Lir the work sur which IN,permit is issue]•I
,hull not employ any parson in an,manner sa as to beton aobject 1n the Workers'
Compcmatinn laws or California,Dau,
Applieam
NOTICE 10 A'1'LICAN 1':11:alter%taking this Cenlf icane of fawn,pJun•You should
Z bccomemdjenm the Wbkds Compensation pro ,ions ofthe labor Ctde,you matt
Q O fmnhw'nb comply ugh such pct %am,m phis pumfn shell he dcc ted revoked.
z
H .N.
CONSIhcoc is I ION acou'[.ENDING adigAGENCY -
> 1 ork far a hib thin Ware t I a c..ed(See.
landing ugemcy Ion tic Mrfommncu
W Lea a work fm which this permit is iavuJ(Sec.J(y17.Civ.C.1
d Q
Leader',Nwem
Z IcnderiAJdmss
1..) C) 1 cc rify than I have read phis application and state that the above infonnmion i,
fss t_r correct.I agree h,comply with all city and county ordinances and state laws relating
C) V wbuilding cono....Iio.uand hcrehy amlmdecrcprocul.awcn or l hi,city to cater nPnn
the aa,ve.mennoned prolrrY for iospechan purpows.
rrryF esjod,recmmvr,indemnify and Whihurnd inaClryorCatalina,
rtucI ool and
V 'n liehilities,judgmets, coos and esti which may in any way ucerue abuinst said \� C25
city' an%equenceotW if AND WILL
CO
A 'LI ,T ' UGI US AND WILL COMPLY WITH ALL N NP(11N Issued by: Date
Sf C. r -./
Signam of p Vcnnt Leon Dab Re-roofs
IAZARDOUS MATERIALS DISCLOSURE
Wil mea aicmn or bible,building occurpm abw or handle hazardous material Type of Roof
as defined y f Cupertino Municipal Ctdc.Chapter 9.12,and the Health and Safety
Code See, 35120t)1 - •
❑Yes [I No All roofs shall be inspected prior to any roofing material being installed.
Will dwappremt in future hulldmg usurper'use olonent m Jcvia°Whiob II'a roof is installed without first obtaining an inspection, I agree to'remove
snit hvmdous air contaminants a.,defined by the Hay Area Air Quality Management
Disarm! all new materials for inspection. Applicant understands and will comply with
°Yas 0N all non-point source regulations.
1 have read the harerd s materials nymrcmcn%under Chapin 6,95 of the
California Health k Surety C Section,25505,25531 and 255]11 understand Wan
ii'nhe huilJing Awsnot cur dyh:rvcancnum,nhd in is my snlwmiM1ilinym uunity the _
k�,ldpsalto ftre9vim ,which matt he reef prim In issuan< Centl le ofupmlcy. Signature of Applicant Date
aamari wad s ata All roof coverings to be Class •B”or better,
OFFICE