01110020 OF
CI BUI DLG DIIV�'ISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20293 NORTHCOVE SQ ALTON AIR CONDITIONING & HTG 01110020
OWNER'S NAME: APPLICATION SyB DATE
HIGGINS JOE J 45300 INDUSTRIAL DR 44 11,05/2001
(510) 490-5655
HONE: SANITARY NO. CONTROL NO.
t
GOO ARCHITF.CTIENGINEER: BUILDING PERMIT INFO
w❑ BLDG ELECT PLUMB MECH
—1 r
y
LICENSED CONTRACTOR'S DECLARATION b Job Desc�rrl tion
Inntbyaf)of that lam of
licensed under End pronsof Chapter9(romn¢cense REPLACE FURNACEO& A/Cp & WATER HEATER.
:yCl.°j with$eni0n]WO)of Division 3af lnc Businessmd Profession Code.and my license;yES i," ' no' prm C_ (60000 FURNACE, 2 TON A/C &
:0 u Lieen a los Lic.M
:°a Dmt '� cnntrarmr 40 GALLON WATER HEATER. )
I a O rn p. p RCHITECT'S DECLAR ThN
,g �vnderst�ta my ons shall he used as public ds
—
i Licensed Professional
'x o a ON'NERBUILDF:ft DECLARATION
w_ I hereby aP:m that 1 an exempt from the Connector's License law for the
lZ Cz< followingremora Leeman]o3L5, t,alter. and ve,deimn.a Code:Any city orcounty
which requires a permit to construct,alar,improve,demolish or rcpvr any strtinure
applicant
for such pacmn to Til .signed summeat.
2p
63Po ..poor to its iuuance,also requires IM applicem for such pemdt to Til=e g
that he ishansed pmrsnim mtlrcP =law(cnap«r9 v,s, Sq:Ft loor•A ea•� fp . $49`dAlation
or that a ii cscm satienl]Bpand the bats or the
a bigede omni bol esAn ons Code) ��tJ.V•t)\.1 t. �, �k.1 '
or Nm be is 31.5 b zany applicant
and the basis for Ne alleged evemant to Any violation
—of Section]031.3 by any dred doll fora permit subjects the applicant to a civil Penalty -
nrnntmnretnanfvenanardammrs(asw)._ . 31tp1bor0 Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation, '
Bilinll the Work,end the structure C nortor'sintended License
Lfor snot(Sec.)Ria,- 3 04 - ROUGH ERFFC1uTrUICn�ctions-
Rosiness and work,
no th strut tune is Contractor's nor offered law docs not appl(Sec. man `
owner of Brnperiy Who bauds or improves thereon,and who ares such work himself 501 - FINAL ELECTRICAL ENERGY
or through his own employees p iced lh t h P m 1 t tended or
f�Frcdfon�tewrerwbl the buildingimprovement sola m car nr 505 - FINAL ELECTRICAL � - ---'
completion,for the oose of soled) 'IIA theburdenprovingfthat hdid lb Id or
P Pm
as ED 1. owner of the P periy exclusively contracting with licensed cntracl rs to _
construct th project(Sec.7t Business d Professions Code:)ThContractor's
License Law does a.,apply m an ownica of P p=ray who Wilds or improves mc«an
..and bo contracts mr.such.pro3ecta ith.a c usm,H)licensed Emissions to Ino-
C nue t re License L
❑1 an exempt under Sec. - B&P C for this reason
Owner 'Dute
WORKER'S COMPENSATION DECLARATION ..
!- thereby arfrrn under penally of perjury one 0111=following declemtiom:
} 7 1 have and will maintain'.Cenificam of Consent 1.self-start far Workcrs
st` ompensmion, as provided for by Section 37M of the Labor Cade, for the
- perfonrunctbf the work for which this Permit is issued.
1 oe and will maintain Workers Compensation Insurance,as required by Section
I
the labor Code,for the Performance of the work for which this Permit is
.tuud.My Wmr ,Compenut 1 ura c camerud Policyoumbermrc .. .--_... �. _.___..�.�.........._._.
_
caro a' I a PoliyNn C3J11U�S �.a -
t t RTIFICATIO OF EXEMPTION FROM ORKERSI
t vt
COMPENSATION INSURANCE_
r(This sectio n need raw be comPlnd if the Permit is for one hundred dollars ' ' f ,t 1 U
(EI00)or lcss.7
I certify that in ane rformancefor
-..- ..._ "... .._..._. .. __ .-,.... ,_..�. .. ..—,...__..
pc of lht s k f r which lis. ct t x issued;'
Com not employ L ono of
m any mannn,zo as io become stabled w the Worker%
Apple cnsatlnn Lews of California.CDate
cant
NOTICE TO APPL a Work If,over makingtionthisrCenin s o o e Labor io de,youhmo t
Wcomci coobjmply it such provisions
or his Permit
me Luber Code,you must
Q O fnnhwith comply with such pmvisionx or cots Pcmtit shell W deemed rcvokd. '.
yes .. _. _. .. ...
CONSTRUCTION LENDING AGENCY
e`'I t=ab 'dfimi Nat three is a commuctma lending agency for 0e perfomnnce I `
s.. of the work'for which this Permit is issued(Sec.3091,Civ.CJ -
W' lender's Name -- . .o-_:...o.._�..._........_.. ._.._.. ..:.e: . . ._ - .. .. ... ... ._. .... ._ _. . . _... __ __. ._
Z Isnaer's Adders:
-'C) Icenif,min l have read this application and sink marine ohm=information is
cinrecl.1 agree to tom I .and county.ordinances and slate laws mlatin
6 Pard heeb city B _....__..._._..r
Q:V toabovc-condoned prpert M1eabyspectionupmsenulivca of this to cis«r upon
Lthe above-mentioned pmpeny for inspection p nom le -
► y (Wt)dgmetssave,indemnifyand keepharmless the Cityof Cupertinoagainst - -
N liabilities,judgments,costa and expenses which may in any way accrue against add aa lei
V Z City in.ANT U race of the a 5ZNOD'lois p OKI Y _
APPLI,ANT,U{;' ERSTA SANDN'ILLCOMPLYWRH'ALLNOnPoiNT"' -Issued by:
" sotmf�luJ. )t n . . `:. �, �� 'G y.
sign _ a Ndm/C rap lb : o Re-roofs '- --- - '
HAZARDOUS MATERIALS DISCLOSURE
the pPlihmofuture Wilding occpantston,ormadleharabl material T�ypeofRoof
'
as def d bythe Cupertino Municipal Cod Chapter 9.12.and the Health and Safety
cda;g t 2ss3zl.)t I❑Yes , " ,r.ahYat• tt'r I-.i• ,.., -' -All
roofs
r.ssh-'IalF).ib7e...i.nis eci tedrt.. noIr.t•o"any.roofing material.being g installed..
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to'Pemove
imit herearthous air motandiroma d,rib"by the Bay Are.Air Quidty Management
Dian;Rall new materials for inspection. Applicant understands and will comply with
❑1'es 'oNp. 1. all non-point source regulations.,
1 - l
have readibe M1 arama«
nus rids« « enus
qu munder Chaptec 6.95 of the
California Heehh&Safmy Code:Sections 35505,25533 and 2553A.1 undersand that
if one building does ria emmardy have.ten.m;that it is my respgneibility to notify the
rccopa I of the«quer ems which must be met prior to issuance of a Cenificme of
- •l � �j Signature of Applicant - _ Date_
Owigd4r audioneedagent- _ \ ate All roof coverings to be Class"B" or better
,,r......n....... ... ' - OFFICE