08090195 CITY O�FI CUPE42TIN0
BUhLDI�uG D WISION PERMIT .€COI'!I'xRACTCTR INI''C?ILM.ATIf/N
BUI 1 qA DRESS: PERMNO.
�y'� IT PARK VILLA CL VALLEY HEATING COOLING 08090195
OWNER'S NAME: PERMITLSUEDATE
11g, 1171 N 4 TH ST 09/29/2008
NE: SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
REPLC FURNACE & ADD A/C O O O O
a o LICENSED CONTRACTOR'S DECLARATION
CmF 1 bmby a nne dust I w Ilenand ends,provisions of Chapter 9(commencing Job Description
t Zty with Section 7000)of Division 3 ofte Busilrss and Pramanimu Code,and my licensee
in full force and cRc
32Z tisane Clss fY.•
-Fp Dau Canlracur /
e uuuy��� AR HIIECTSDECI.sRA ON
I
? < understand my plea shall k used u Wblk,cords
g6
O t; Licensed Prefesvoul -
OWNER-BUILDER DECLARATION
ji f I hereby M.that I am exempt from dm CanuacmYs license Law In,the
y a O following muom(Section 7013.Busicss and Professions Cale:Any city a county
,s$9 which r q.i.a Pettit m conamet.alar,improve,demolish,Or refour,any slmctum
u52 prior to its bounce,also requires the applicant for such permit m fileasignedautemmt
ESD that heulicensed pumunitot1mpmviaouoftheCmuscter'.U.Law(Chain.9 Sq.Ft. Floor Area Valuation
' (commencing with Section 1000)of Division 3 of the Businessand Prefessiou Code)or
y $ find he u exempt therefrom and the buil for the a1kgul exemption.My violallon of
Sccuun 1031.5 by arty applicant fora potent subjects the applicant u a civil penalty of APN Number Occupancy Type
not mom than five hundred dollata(S500L P Y YP
❑I,u owner of the mammy,rr my wplowu with wages o the4 m. 0". uNun,
wiB do lenimmhe wouL and the swctums not kLMadoraffenadw do s ter,a(Sec.10x4.Business
aro Rty who W Cods:The sus tncmr'a ndwho Law does not apply m rt owner Of _ Required Inspections
OwnertywW Wild orimprovrs themonandwha mora intended
himselfortNough his
ownemployes,lding or than such lit is semenuartnot intendedmoRemd for Owns,,
however.the Wilding or improvement Ie sold within one year of completion,the Owns,
Wilder will haw the Wrdcn of moving that k did not Wild or improve for purpose of
sok.).
❑1.u owner of the property,am exclusively contracting with licensed contractors b
construct the project(Sec.1064.Business and Profieeslou Cade:)The Conuaeuri Li.
ecus law des not apply to m owner of property who Wilds or improve thereon,and
who contracts for such projects with a contractor(s)licensed powwnt to the Contractor's
Lkeue Law.
❑I am comp,under Sec ,B&PC for dds mason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury ane of the following declmumu:
I have and will maintain a Comficate of Consent to self-imme for Woe s jr Compen.
union,as provided for by Section 3100 of tW labor Code,for fire perfmmauc of the
work for which this pmmh is issued.
I Wtai
w and will mainn WorterS Compensation Iuarma.u required by Section
1 flW lsxtr Cook.for Ne performancesl the wori,fwwhich this permit is used. '
My Workers Pensanmn nsu,ance carrier and Policy mumer am
Cartier. Policy No.:
CERTI CTE OF EXEMPTION FRO WORKERS'
COMPENSATION INSURANCE
filius section need not W eomple rd first permit is two=hund,eddellars(SIUO)
or less)
1 certify that in the performance of IW work for which thio permit u issued.l shell mol
employ any'.in any mmnerm tau me subject title Wormers' ompensadon
Laws of Califomii Date
Applicant
10
NOTICE TO APPLICANT.W.a r m W ng this Ceniacau of Esc¢ don,you aboulJ
Wants subject he the Worker's ComPemktion previsions of de Labor Code,you must
,,- z fmmaroh comply with such provisions or this Permit Nall k de and revoked,
z O CONsrpuc ION LENDING AGENCY
P �� for which
Nem is a emtructinn kMingagercy I.,ft pufum era
Ix permit is issued(See.3091,Civ.C.)
[21 Q Isndefs Name
7 z Lenders Address
V Q I emify that I ban mad this application aM sue that tic aWw informatin,If
I2, FCarlb:L I agora u Comply with all city and county mntlnarees aroe sulaws mlaung to
V
.Q Wilding consternation.and hereby aushorire representatives of this city of now upon de
aaWw-mmuoned property for iupeeidn purposes
(We)agree to caw,indemnify and leap harntkss the City of Cupertino against
ty,Z liabilities Judgments,ensu and of this
may in my wyamuc agilNl said City
f,J z A rDis�ct?
T UNDER
r tho TAN of thus permlt.
T UNDERSTAN AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
TIor, Re-roofsHAZARDOUS MATERIALS DI OSU0.E are Type of Roofl tic appliant w future Wilding mce,pantsuro of handle haurdou material
y fie Cupertino Municipal Code.Chapter 9.12,and de Health and Wety sss3z(g1 All roofs shall be inspected prior to any roofing material being installed.
un �oIf a roof is installed without first obtainin an ins ection,I agree to remove
the applicant or Tum Wilding actvpam use equipment sir devices whichg Pnm air conumin'n Oncd by dtP Bay Area Air Quality MarMChuCnl all new materials for inspection.
❑Yrs ❑No
I have mad the hmaoeus teauriab requirements under Chapter 6.95 of the Califor.
lira Health&SafelyCode,Section 25505,25533 and 25534.1 undsrsund thus ifde Wilding
does net euncntly have a mnant.nut my mspamihility u notify the mcupmt of the
t Dam All roof coverings to be Class'A!'or better