02110136 CI'T'Y OF CUPEWFINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:..
rGL1l&4)03F.SrOAKVILLE AV A PERFECT CLIMATE PERMTr Nf02110136
ov'NBdBANAMAN JOYCE 10570 S DEANZA BLVD APPLICAnajNTL/112,yr 2002
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ZONE: 408 861-9545 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
0 0 0 0
HOZ LICENSED CONN RACTOR'S DFCLARA'FION
Job Description
K 1 hereby ailuro mm 1 am licensed Bunder Previsions of Chapter 9 my ficencros p
NEW FURNACE
�¢ with Section 7lMXq of Division me Bu.'�anJ PndcssinnxCWc.nnu mYli¢na is
in gulls, 9hde Li.X is FINALE®
CIA Date .�{. CnnVactn��.p�.�
I -ARCHITECTS DE(:I.AIF-gTlO MAY 2 1 2003
9 < 1 urcs
actund my plans shall he used as public tccords
O
ce 3� J,iccnsd Prolessional
OWNER-BUILDER DECLARATION FLING
s'�`<5 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
w n 0 following reason(Section 7031.5.Business and Professions Cole:Any city or county ��—YYY���
'>e m which requires a permit m construct,alter,improve,demolish.Or repair any structure
w"q pnoriod,iunancc.also rcyvires the applicam UrsuchpMnu,u,lileasigncdamtement
that he is licensed pursuant to the provisions of the Contractor's License Law lC dcl9 3)q_CF131)b2Ar@0D Valuation
ax (commencing with Section 7000)of Division 3 of the 11 awincss and Professions Coder
ed — Nat be is exempt therefrom and the basis for thc alleged caemption.Any violation of
Section 7031.5 by any applicam for a permit subjects the applicam to a civil penalty of N-N Occupancy Type
net mem than five hundred dollars 0500). 303 - ROUGH MECHATICAL
I,as owner of the property,or my employees with wages n mcir sole compensation,
will do the work,and be structure is not inte Wed or offered for sale(Sec.7144,Business gg��yyDD
and Pref.mot CWte no Convectors License Law dors net apply m mi owact Of 505 - FINAL LS eons
property who builds or improves Bremen,and whodoessuch work himself ur through his
wn employees,provided that such improvements are not intended molrered for sale.If. 507 — FINAL PLUMBING
however.the building or improvement is sold within one year ofcompieion,ON owner, 508 — FINAL. MECHANICAL
builder will have the burden of proving that he did not build or improw for purpose of
sale)
❑ 1,as owner of the propeny,am exclusively contracting with licensed contractors tu
construct the project(Sec 704q Business and Professions Code:)The Contractor's Li
cense law does not apply to an owner of property who Wilds or improves drmon.and
who contracts for such pmjec4 with a convaaor(s)licensed pursuant so the Conmucams
License L.W.
❑I am exempt under Sea ,B&P C for this reason
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby a fimt under penalty of perjury one Of the following declarations:
1 have and will maintain a Cenifcatu of Consent o self MOM,for Worker's Cnmpen-
73700
r m,as provided for by Section 37R)Of the labor Cove for be pertermance of the
rk for which Nis permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
of dm lJrer Code,for me performance of me work for which this permit is issued.
y`oekc�`rIsC�orO?nsatienl surance tamer and Policy num bee areIOU Palic No.: IIID
CERTIFICATE OF EX EM P11ON FROM WORKERS'
COMPENSATION INSURANCE
frhis aetni m need not be completed if tbe permit is limns,hundred dollars(311X0
nr I...)
I certify that in the performance Of the work for which this Permit is issued.I shall not
employ any person in any manner sn us to become subject to the Workeri Compensation
Laws of Cali fornix.Date
Applicant
NOTICE.TO APPLICANT:11,aver making this Ce nilicmc of Exemption,you shot ld
become subject to the Worker's Compensation ter m
provisions or the LaCode,you ust
OO forthwith comply with such provisions or this peoritihall be deemed mvokcl.
z CONSTRUCTION LENDING AGENCY
[-. 4 I hereby intron met there is a construction lending agency f or the performance of
p' ,7 the work for which this perm it is lasucd ore.3097.CIv.C.)
(11 Q Lender's Name
fL Under's Address
U O I ceNfy dual I have read this application and sum that me areas,information is
F correct.1 agree to comply with all city and county ordinances and stale laws relating m
0 building,instruction.and hereby amhorim representatives Of mis city to corer upmthe
abnvememioned property Ior inspection purposes.
(Ws,)agree to save,indemnify and keep harmless the City of Cupertino against
F' N liabilitiesjudgment,costs and expenses which may in any way accrue against said City
U Z in Consequence(I he granting of this permit.
APPLICANT U ER ANDS AND WILL COMPLY WITD ALL NON-POINT Issued by: Date
SOURCE REGU. TI
. Re-roofs
Sign co n du Uont ucom
HA GOD'M RIALS DISCI.OSUQE Type of Roof
Will ON applicant future build Occupant some or handle haisruous mamnal
as defined by the Cupcnins Munici Code.Chapter 9.12,and the Health and Safety
code 5cecet 2s53$a)^ All roofs shall be inspected prior to any roofing material being installed.
❑Pas
Will we applicant luiuh ming Occupant use equipment Or devices which II a roof is installed without first obtaining an inspection, I agree to remove
emit namdum,air Counts i is Jcrned by the Buy Area Air Quality Management all new materials for inspection.
Disvict?
❑Yes
Inove read me hawardeus materials mquiremenm umber Chapmr 6.95 of the Califar
oulluelt SulcryGxk,Scctium25Nt5.2553JanJ 255373.1 untkmwnJ thmifmc M1olding
doeentry ha a tenant,ma it is my resrymsibiliry ,,noGly w acupam OI me
require cur
-stn, mlpnorleismenceefaCenri I, la ane. ignature of Applicant Date
owner t aumenrc ent te All roof coverings to be Class "B" or better