03010056 CITY OF CUPERTINO .�s+� 'ar �° ••
ItU11.131NC DIVISION PTRMIT CONTRACTOR INFORMAT•.,y =ISO#N
BUILDING ADDRESS: A PERFECT CLIMATE PERMIT NO.
7526 NEWCASTLE DR 03010056
OWNER'S NAME: 10570 S DEANZA BLVD APPLICATION SUB DATE.
ANDY LY 01/09/2003
41 nONL3: 408 861-9545 SANITARY NO. CONTROL NO.
ARCIIITErVENGINEIIR: BUILDING PERMIT INFO
BLDG ELECIPLUMB MECII
HE LICENSED CONTRd under
DECLARATION Job Description
HEU C 1 M1ereM1y al Brm that 1 am licensed under pmvisinm of Chapter H(commencing p
�Zj6 with Sc lien Of Division 3 ofte Businm and Professions CtNe,and my license is
<�„ mmue ClasseerceeL REPLACE FURNACE ������'®
�� License Class Lic.M
F y t- Doc TS DECLARATION ARCHITECTS DECLAR ATION JAN ]. 0 2003
1 understand my plans shall he used as Public records
�O6Dr
F LL LL� Licensed Porm.,sinna
Ho'Ho'JJ OWNER-BUILDER DE Ce RAI CommeN {�'
I bcrchy afford that 1 am exempt from the Cunuacmr'x License Law for the ,����®'IA'/�
i 6 Q O following reason.see ion 7031.5.Business and Professions Code:Any city or county 1��G
k g� which mquirce a permit ro cnnsuuel.alter,improve,demnlisb,or repair any structure
Yi< pdnrm its i.envnce.All rcyuims the applicant Losuch permit to file a signed statement
cx that he islicenedpursuanttotheprevisions(iftheContractor'sLicenseLaw(Chapter9 Sq. Ft. Floor Area $3 YO Cation
4 (commencing with Section 7110)of Division 3 of the Business and Profeasions Codc)or
..
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjecu the applic sect to a civil penalty of
net more than five hundred doll..($500). be Occupancy Type
❑ I.as owner of the pmpeny,or my employees with wages as their able compensation,
will do the work.end Ne Sween:is not intended or offered for sale(Sec.7044,Business — $g �(
and Professions Cod
Chile:The Contractors Lions,Law diva not apply to an owner of 3 03 - ROUGH SDCQIIOnS
property who builds or improves thereon,and who does such work himselfor through his
own employees,provided tat uch improvements as not intended orotic for adc.If, 304 — ROUGH ELECTRICAL
however,the building or improvement is sold within one year of completion,due owner-
builder will have the hidden ofprovingBeat he did not Wild or improve for purpose of 505 - FINAL ELECTRICAL
sale.)' 507 - FINAL PLUMBING
;ccnse
as owner of the property,am exclusively contracting with licensed contractors m 508 - FINAL MECHANICAL
m.the project(Sec.](144,Business and Professions Code:)The Convenor's Li-
'on
i- .
Law dues not apply to an owner of property who builds or improves thenen,and
contracts for such projects with a contractor(O licensed pursuantto the Contractor's
nse Law.
am exempt under ,B&PCfo the aserWORR'SCOMPENSATIO :CLAN NI hereby eR Oder penilry of perjury one of the following declarations:
haw and will maintain a Certificate of Consenuo self-inaure for Workers Comperen,as provided for by Section 3700 of the Labor Code,for the Performance of the
work for which this permit is issued.
rl 1 have and will maintain Workers Compensation Insurance,m required by Section
3700 of the Labor Cole,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy num her are:
Currier: I Policy No.:
CERTIFICATE OF EXEMirr10N FROM WORKERS'
COMPENSATION INSURANCE
(This section need nm be completed if the peurnif is for one hundred dollars(S 100)
,it lees.)
I ccnify that in the performance of the work for which this Permit is issued,I shall not
employ any Person in any manner so as to become subject to the Woskcri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenifiemc of Exemption,you should
become subject to the Worker's Compensation previsions of the Labor Code,you must
r
OO
(—r forthwithm
comply with such provisions or this permit shall be counted!mused.
'Z " CONSfRUCI'ION LENDI NO AGENCY
k for loy which
Nat there issued(Seconstruction lenCc, agency[Or Performance of
Cao the work for which this permit is issued(Sec.JIH],Civ.CJ
a Q Lender's Name
ddress
V QZ Correct. Address V
1 unify chat 1 have read this application and sum thin the above information is
L4 U builds.I agree a comply With all city and county ordinances and safe laws relating e
Quj moscngtttioned mxnd herebyauthervic wedcor prpoexmefives of Niscity menmrupon the
r nl above-(We) ncee Cosa yfor
emnify apurposes. /
C. (Wc)agrectesave,indexpeyes which may
in any the
City
rue Cupertino
against
aid nm
UZ in
equnce of thecosssantlof this expenses which mayinanywayaccmc agatnn aid City I /
C.) Z A PLIC consequence of the granting of this permit. t(/
APPLICANT UNDERSTAND AND WILL COMPLY WITHAI.1.NO Po NT Issued by: Date
SOURCE REG , IONS. n
Re-roofs
Sigature ofA nGmucmr aam
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will "ieam or future building oecupantslom or handle Wardous material
as dcfiLd ac`by 2ss3zmm no Municipal Code.Chapter 9.12,and the llcalth and Safety
Clan.bCupmitt E All roofs shall be inspected prior to any roofing material being installed,
Will the applicant Or
future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit In= I air comtionhu nts as defined by the Bay Area Air Qualify Management all new materials for inspection.
s heI
❑Yes
1 have mad the requirements under Chapmr6.95 of the Califor-
tiesHealth&Snfery CsvJe.Secuem525N15,25533 and 25534.1 understand that Base pudding
dans not curtemly hasx mPank that it is yrespomihility m notify the occupant of
reyuircmcn.which set l�mct prior ssusnccnfeCcnifca¢A��g
gnature of Applicant Date
oo armbo atda 1 All roof coverings to be Class "B" or better