00100078 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
Bl11LDINO ADDRESS: I'I7tb11'f NO.
43 NOEL AV A A A FURNACE COMP NY 00] 012078
OWNER'S NAME: APPLICATION SUB pro
SE H I_ AND ITRIAM 1712 STONE AVE 1.0/10/2000
PHONE; SANITARY NO. ('ON'I ROL No
(408) 293-4717
]. ARCH)'1'r:Cl'/ENGINEER:
BUILDING PERMIT INFO
E00 BLDG IiLECT PLUMB MliCll
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LICENSED CONrencroR'S DECLARATION Job Description
o��e 1 armlB
or an„amt id I.am licensed ander pmvidon.orenapter 9 amen
omrmg
F=Cw with Semian 7ddbaf Division lof the Business and ml•, d nd my license
kin rttu o-,nean y.�� -1�� "�� AC UNIT
J te d< Licenw:❑tws LIc,b
R 9 i U Dole _/d_ o Comr:ml�ur .
F n LLO G 7—
ARCHITECT DEC O
_ 4 I unMnsand my plans shall be used as public reu,Ns
a x p p Licensed Pn resdanul
p I1WNER-II13ILDIiR DECLARATION
w= 1 hereby affim,thin 1 at eentpt train the Cn locator's License Low for the
I following master.(Section 7031 5.Business mal Pn is W ons Cudc:Any city or county
E S p
which residues a penat t construct. hero impori derail Al. ie an, wcture
prior to t also y s the applicantf h permit tofilea signed:mtement
math licensed nu: tt t p n. tin c l t 'xl - 1 (chapters Sq. Ft. Floor Area Valuation
aootmcnmttgwith Seeaoo7000)rotDici.i..n3ofthe nt ttd
aPutc,vo,.Cadel $0
nr
Ill.,he Is exempt themfmm and the bads'for the oll,rd exemption Any violins," '
of Section 7031.5 by air applicant for v permit subject,the applicant too civil penalty,
of am more than fists handled dollars(S500), A PN Number Occupancy Type
❑1.as owner of property.or my employee,with%ages its their.olc compensation, '70E,0. 00
will do the work,and de structure is mot Ins ul or orcered for sole flee.7(94. Required Inspections
Bashes,and ProfcsslinI,Cad, the Cn..I...s License Law docs inn apply u,nu q I
uirv,r pmpeny Who hnimso,improves thamnn.and who does such work himself ROUGH MECHANICAL
through his own employees.provided that such imp rovemcros mean,intended a, 303 —
offered for sale,If,ho%eva,the building or impmvcment is sold within one scar of
completion,the owne,-builJcr will have the burden of roving that be did not build nt 304 — ROUGH ELECTRICR
improve h,r parpase of sale.)' - 505 — FINAL ELECTRICAL_
01.as owner Of the prulrtrty.amexclusively contractingwith Icensedcontactors to 508 — FINAL_ MECHANICAL_
construct the project(Sea 70-W.Business and Professions Cash.)The Contractor's -
License law doesoat apply h,an nwnm of pmpcny who builJs or improves thereon.
Co who amnracn far wait pmjmt,with a mntactnrt))licensed pursuant m the
Col; less Liccnsslaw.
❑ ,un cxcntpt under Sec. li h P C Illy thin levan
Owner Date
WORKER'S CUS1PIlNSAT1ON DECLARATION
• I hereby affirm under penalty of perjury one of the following dcclamtions: Z O
❑ 1 hwill n ave Ind v Cedilla"', at Consent to scif-n,um for Worker's C1n1/
Compensation. us provided for by Section 3700 of the Labor Cock, for the
Nib)nnures,of the work far which this permit is issued.
❑1 hove and will maintain Worker's Compenmtion Insurance,as required by Section
3700 of he Labor Gee, or the I,cIfun,vvee of the walk far which this permit is
issued.My Worker's CCuoll ensu lo)o Inns/yrnnec carri I'nliiccc yrs h'
S r L "(/'obey Na.: _ 3✓ 'tt��y
Ca er. L
ERT14CAOE EKIONN FROM WORKERS'
COMPENSATIN INSURANCE
flIts lection need not be completed Irmo Irrmit is forona bombed dollun
IS 10"t nr less.)
I cenify 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 Workers
compcnration Laws of Catiomia.Date
Applicant
Not ICE 10 APPLICANT!It,Mir,soaking thh CunlBetm of E.ctupdon,You should
heenmc uilibeuci Worker,Cmupe va inn provisions of the LaM1or Code.you most
C Q forthwith comply with such provisions(itthis pcm,it shall he decimal revoked.
z
E'O In CONSTRUCT ION LENDING AGENCY
ai > 1 hereby affirm mat mere is a eon.amcnnn lauding agency for the performance
nl'the work III,which this Permit is issued(Sal.3097.Civ.C.) -
O6 Lender's Name
= .T Evaded Address
V C I cenify that I have read this application and some that the above infommtinn is
IL t y correct.I.gree ,I comply with all city and county ordimmacx and same laws misting
0 O mbNdit"'o..Bnnlnn......IIII mal,oduse mprc.cmOlives or this city,..anernpnu
r� the above-mentioned pmpeny for inspection purposes.
L y 1W'gegrcem.wve.innd keep Inch
inthe City I Oute.aidCulismins,against T '
N liabilities.judgments run and expert i which may in any say acerve ugaina said C\ I CY/h/
C.) z City mconsequenceCANT UNDERSTANDS
of the NS grantingof this permit. /D�/O dp
APPLICANT UNIlERSTANDSAND WILE.COMPLY WITH ALL NON-POINT Issued by: Date I
(lU '.REGUL TIU O ��y)
:'g aIn_'dAp"'I Conengor Onm Re-roofs
IIA9lsRDOUS 1ATERIALS DISCLUSURF.
WHIM applicent or future Building occupant sone or handle haamdws mmcdal Type of Roof
as defined by the Cupertino Municipal Code.Chapter 9,12,and the Health and Safety
Cade,Secflr 2553200!
EIYa, CNo All roots shall he inspected prior to any roofing material being installed.
Will the applicant is,fumm building weepare use rgaiprncnt or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
it hazardous air commninants as defined by the Bay Area Air Quality Management
District] all new materials for inspection. Applicant understands and will comply with
❑Yes ❑No all non-point source regulations.
I have read the hazaNaus materials rcquircial under Chapter 6.95 of the
Califnmiu Health&Safety Gide,Sections 25505.25533 and 25534.1 understand that
if the building does not currently have a tenant,that it is my raNsan nility m notify the
Occupant of the requirements which must he met prior m issuance of a Cmailicum of
OccupancyDate
Signature of Applicant
All roof coverings to be Class"B'r or better
OFFICE