02050074 cI eu o Nr.DPExON CONTRACTOR'
TING.. - .. 'r
PERMIT INFORMATION:
B •, '. - .. ...- _. ... _. ... ... ..._..� .. PERMIT NO. ._ -. _ . ...._._._ ....
19�iAD R&CASTLE DR -'- ALLIED 'AIRE.`SERVICE INC 02050074
S SAN 661 - -SINCLAIR -FRONTAGE
f HONE: - SANITARY NO. CONTROL NO.
{. (408) 934-8844
`0 0 ARCHITEC(ENGINEER: BUILDING PERMIT INFO
m BLDG ELECT PLUMB MECH
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- '. LICENSCD CONTRACTOR 5 DECLARATION jp D $�rypj
0 thlirebyeffrm thin lam bcensed unJer provisions of Chapter9 kommencing FNACE,• C./Q .O+(j r'(J�[J elj'j'tJlOn
with Section 7")of Division 3 of the Busmessand Professions Code,andmy license �-/ ^-^'+� rs
�' lam full transcend ep�ct L'�RD -TOF1�C "c JLcens I ' . seARCHITECT'S DECLARATION
-vy�O g f Y 1' d Innd my plc s hall he us d e. public records
1 6 0 0
Licar,ed Prot nal !
o OWNER BUIL DER DECLARATION „ i1
I hereby riff.th t.I m exempt fmm he Commnor's License Law for the .�. J
t Z< following Reason (Section 7031 5,Business end Professions Code Any city or county ) `. is .Is l
S D wh ch requires a permit to contract.alter.Improve,demolish r repair any structure Sq.
- 7 6
$ pn arae,alis requires the eppl cant for such Not m file a,igned smtemcm -• 1 + - -- -- -
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22
theth tillttnvxdpu....itotheproskoicus,ftheConwnortLux,malawchopt..9 "Pt Floor Area Valuation
(a m enei wnh Sechon•A100)of Division 3 of the Rusineu end Professions Code) •, 1 j'a t q' - y. tl
of thni h'e Is exempt therefrom and the basis for the alleged exemption.Any violation 43662:766§ :60, ' - -
,of Senion 7031.5 by enY npplicam forapermitntbject,the app--,roecivilpm -
sof am m.0 him Bse 6. d dollaa(s500). - - APN Number
" - - Occupancy Type--
Ol,as ownera(the proper..r my employees with wages as that...laceripamatimi, ••301 - ROUGH -PLUMBIN
will do the work.end 3he'suumme isnot intended or for sao' 054,
_ i .,...:_
• Businfas'end Professions Cade:The Contractor's License law docs not apply to an •- M CIIOIIS
owner of property Who builds or imp oves thereon and r,no does such work himself '3047 ROUGH ELE TRI CALF
. or through his own employees.Provided that such improvemen¢are not intended or -
"-o@red for We.11"h6w6cr.the Wilding or improveroem is sold within one year of -'- -505 FINALELECTRICAL, .
completion,the owner-builder will have the burden of proving that he did not build or `
improve forpup...fsale.). 507 - FINAL PLUMBING
508 FINAL MECHANICAL--
;;7 construct
as owner of the property,ram exclusively d Professions
ns Code:)
Contractor's m
License the project(Sec.7044,owner o and arty who
Code:)The Contractor's f'
_ Licenu I.aw does not apply to of owner of property wtlo builds seimproves thereon, -
,.Commihwca Livens L such prnjccts with.a commnorts7 licensed Pursuant to be
Conwn iia License Low.. _
O 1 um caae'mpt under Sec "'' B&P C for this Reason t
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WORKER'S COM DECLARATION
1 I hereby affirm under penalty.(perjury one of the following declarations:
❑'1 have and!will ie,Cmi cafe of Consent to self-insure for Worker's
Compensation, as provided for by Section 37W of the Labor'Code, for the
performance of work for which this permit is issued. . -
have and will Labor Case. ar th epi Compensation Insurance,as uquircd by section as" 16
' �W'of theinkeCode ( then Insurance carrier
work for number
this Permit is
issued,My W�orke�rs/�a pe tion Insurance currier and Policy numbeor arcG' - -
. Cent y�.� .�.Pobcy No -1t3s-o—set
r
CERTIFICATION OF BAEMPTION PROM WORICERS'•'�
COMPENSATION INSURANCE "
�CThis uetion Beed not be ventilated if the permit is for one hundred dollars
`h h amity that in the Performancemnn the work for a ch thisPermitto t e issued,l
shell en employ any person in any manner u es to become subject to the Workers - -- --
-
CompenseiionlawsofQali(bmie.Data
" ' -
AppliwE -
NcometoOAPotheWorker'&Compensation
o oan,e,,tion,youshould
Most . .
beirome h Gori to the Worker's Compensation permit she f be
Labor Coda you mars
onhwuh rom I with suchprovisions'or this arida shell be tlttmed¢yoked.
'o
W, work
CONSTRUCTION
heI(NDfNGAGENCY
ylrath.11honiac6nswcn do y
(or h-e rtosmane
fit,.wu k f hiclustermlt t suWSec 3097,Cit.C)Nome
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Lender Add s
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1r.nee 1.1Ih use read thisityaapplicationdstate that the above n trusrelan is /i/
kT+'E.I co en 1 gree io cp ply with all city and ry Ninenc ad mine laws relining JI3'
R,Wilding era,efl.m.a hereby authonu representatives of this city m enter upon
theabove-mentioned propcny.far inspection purpous.
6i (We)egrcemcove,indemnify.nd kelp harmless the City of Cupertino against
"Vi liabilities,judgments,msti and as me,which may in any way....against said
V:4 Ctry in conuquence of the gamin of Nis permit. '
APPLICANT UNDERSf YLL COMP WITH ALL'NO--POI Issued b r - Date
SOURCE REGULATION C,S � Y
Signature of ApplicannContoic - Dae Re-roofs - -
,,HAZARDOUS dATERIALS DISCLOSURE
Will the amficnint be future W Wing occupant store or handl haxardoas mateAal Type Of ROOF - -
as defined by,the Cupen no Men c pal Code Chapter 9 12,stat the HaIN end Sida y
Cade Sect on 2 - % 1
Owit, .t t I^B'F-_ All roofs shall be inspected p`noi to any roofing material be ng Installed.
- 55321.)^a Will the applicant or far..building«caper on equipment or devices which If a roof is installed-without first obtaining an'inspecnon;I agree to remove
- I cm i hasurdous air conmmmants es defined by the Bay Am Air Quality Management
District
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all'new materials for inspection. Applicant understands and will comply with
!. all non-point source regulations. .
`i,.-✓ Lha - cod the Naxallous rlmtm.Is requirements under Chapter 6.95 of the "
California Health&Safety Code;Sections 25505 25533 and 25534 1 endersared that
if the building does not currently have p tenet than is my responsibility to notify the
oa paid f the re u r tents which must be t p or t.issuance of a C n' tet'f
pa`y Signature of Applicant Date
Owner orno;ix d a m Data roof coverings to be Class B"or better
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