01060023 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10340 PLUM TREE LA A & H HEATING 01060023
OWNER'S NAME: APPLICATION SUB DATE
LEMPEL, MORDKHAI 770 CHESTNUT ST 06/05/2001
PHONE: SANITARY NO. CONTROL N0.
(408) 279-0722
0.070 ARCHITECTIENGINEER: BUILDING PERMIT INFO
z u— BLDG ELECT PLUMB MFCH
y i LICENSE CONTRACTOR'S DECLARATION Job Description
I Imrehy alfrm that
1 am licensed undermost s'mns of Chaprer 9(commencing
to E-- with Section 7000).f Divisian 3 af,he Business and Parfiessiom Code,and my license
:"w< in lull forte and dfen �1
kioNecl5> U 2 uo.n '�i�/ ( L( 7 A/C ADD-ON
:0 y Data �c—i—`9( C ordcmr —� V/10
�
i3 ARCHITECT'S DICTA 220 VOLT CIRCUIT.
u S 1 understand my plans shall ve used as public mainds Q
i�
Licensed Professional
OWNER BUILDER DECLARATION
K So So 1 hereby affirm that 1 am exempt from,he Contractors Limn.m Law for,he
F z
ou >• following reason.(Section 7031.5.Business and Professions Code:Any city or county
wh hqPans construct. 1, p demolish, mPYt care
L 3 aa .pro t I , < I. q ,n pp1want l such a n Firsigned
,g Jstatement -
mot he is I cem.ed p ant to the kovisions of the Contractors L L (Chapter 9 Sq. Ft. Floor Area, Valuation
Team , tlS t 90001 fD t fah Bs < and Profession,Code) ',)
or that hes a,cuip, hiref,rim and the bass for he al qed amormi nAny violation 6700
of Section 7033 S by any applicant far a permit subjects the app]team to a civil penalty'
efnm mum than fixe handredeo11furs($500). APN Number - Occupancy Type
01,as owner of the property,or my employees with wages as their sole compensation,
will do the work'and the structure is not intended or offered for sale(Sec.1(W,
Business and Professions Code:The Contractors License Law Jens no,apply to an Required Inspections
owner of properly Vivian builds or improves themon,and aha does Such work himself
homi ementimeplsarehinintended
yearor 203 -. -UNDERFLOOR MECHANICAL
completion,
for sale.If,however.the building or improvement ig rola within one Wild of 3 03 - ROUGH MECHAN I CAL''
ompinion.,hc ownerMhilder will have Clic Horden or proving that he did no,Wild or
improc for purpom of sale.)' 503 -.._FINAL MECHANICAL- ENERGY. ..
ol.asm,ncleftImpropenymnexelu,ivelycontncdngwhhfhcenmdeontmnont? 508 - FINAL MECHANICAL
onswct the Project(SCC.71314,Business and Professions Code:)Tim Contractor's
License Law does not apply to an owner of property who builds or improves thereon.
and who contracts for such.projects,w ith a,nntracmns)licensed puraaam.to the
_ Contractor's License Law. 1
°l am exempt under Sm. - H&P C far this reason Ic -
Owner
Data
- WORKER'S COMPENSATION DECLARATION
1 hereby of na under penalty of perjury one of the following declarations:
AF 0 1 have end will maintain a Cordillera,aI Consent m%elf-inwo,fur Worker's
,Ni_ Cnmpetnaaum at Provided for by Section 3700 of the Labor Code. for the
performance of the work for which this permit is issued.
01 have and will maintain Worker's Compe drain Insurance,as minimal by Section
3700 of,he Labor Code:for the Performance of,he work for which,his permit is
issued, y Worker's Compensation Insurance carrier and Policy number pre: ^/
conte '/_
Policy No. if 9/D ZO� .... - t• ,,; rat• . ..
.t '
CERTIFICATION OF EXESIPTION FROM WORKERS"
. „ COMPENSATION INSURANCE"".This section need no,be completed if the permit is for one hundred dollar 1
IEIIXI)or lcssJ ,
1 serif,rant in the Performance ar me weak lin which Or,permit is I,,.ad.1
shull not apploy any pcnon in any mm.mar W as to hrxmne.whim m the Workers
Cmu,ammion Laws of California.Date.
NOTICE TO APPLICANT:ll:after making Otis Camfleare of Exemption,you should
Wcoe subject w the Workers Compensation pmv,,ons of(he Labor Code,ymu must
Q Omforthwith comply with such provisions.,,his permit shall W deemed asse .
F = ' CONSTRUCTION LENDING AGENCY _
C ' I hereby arum that mem is a construction lending agency for the performance
-O of,he work for which this Permit is issued IS a 3097. iv.C.) ,.
Leacher,Name_ .. C... _.. .. ..
o
45 Lender's Add.,,
' h
.z h
U O 1 crnify that I have mad this application and%rate that the above information is
In [ter correct.I agree to comply aim all city and county ordinances and state laws relating
O U m building mastication.and hereby horize representatives of mit city to enter upon
>„ tr7 ,he abovamentinned,property for inspection Purposes.
y (%'a)agree to save:indemnify and keep hamtless the City of Cupcnino against
0,h liabilities,judgments,toss and expenses which may in any way accrue against said
Uz ci in APs cratit.
I'I:IGAN7yuNDERST
ANDS vomctanadtAND of WILL COMPLY WITH ALL NON.POINT '
~ SREGULATION, .f �. 5_UI Issue y: Date C{/�
tg�f Appucan`co omfor Data Re-roofs
" HAZARDOUS MATERIALS DISCLOSURE' '�
.'. warm2appheantm,ramreWddn,gtceapanr,nxeaaM1analena:amresmaterial ..Type of oaf
s defned by the Consume,sitimaipal Code.Chapter 9.13,and the Health and Safety s
Code,Section 235J2(ap i. ly
°Ye,' ❑Nm, ;," _._ . . .All Colts shall.be inspected prior to any roofing material being installed. ...
Will the applicant orfuture Wilding weapon use equipment or devices which If a roof is instAed-without first obtaining an inspection, I'agree to remove
ami,huzzrdo.,air impoundments as defined by the Bay Area Air Quality Management
Di„Tier. all new materials for inspection., Applicant.understands and will comply with
0Ye% ' °No all non-point source regulations;
-
1 have mad,he harvrdous materials requirements under Chapter 6.95 of the
California Health&Safety Code.Sections 25505.25533 and 25534.1 understand that } ,. .. .
if one building dors no,comendy have a tenant,that i,is my mspansinility to notify the
d
`pant
of Che rryuiremems whicM1 moa he met prier m Issuance of a CeniGcae of
"pant'3' _ Signature of Applicant Date
nal ambos=eaasent Dae. All roof coverings to be Class "B” or better
OFFICE
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10340 PLUM TREE LA A & H HEATING 01060023
OWNER'S NAME: APPLICATION SUB DATE
LEMPEL, MORDKHAI 770 CHESTNUT ST 06/05/2001
PHONE: SANITARY NO. CONTROL N0.
(408) 279-0722
0.070 ARCHITECTIENGINEER: BUILDING PERMIT INFO
z u— BLDG ELECT PLUMB MFCH
y i LICENSE CONTRACTOR'S DECLARATION Job Description
I Imrehy alfrm that
1 am licensed undermost s'mns of Chaprer 9(commencing
to E-- with Section 7000).f Divisian 3 af,he Business and Parfiessiom Code,and my license
:"w< in lull forte and dfen �1
kioNecl5> U 2 uo.n '�i�/ ( L( 7 A/C ADD-ON
:0 y Data �c—i—`9( C ordcmr —� V/10
�
i3 ARCHITECT'S DICTA 220 VOLT CIRCUIT.
u S 1 understand my plans shall ve used as public mainds Q
i�
Licensed Professional
OWNER BUILDER DECLARATION
K So So 1 hereby affirm that 1 am exempt from,he Contractors Limn.m Law for,he
F z
ou >• following reason.(Section 7031.5.Business and Professions Code:Any city or county
wh hqPans construct. 1, p demolish, mPYt care
L 3 aa .pro t I , < I. q ,n pp1want l such a n Firsigned
,g Jstatement -
mot he is I cem.ed p ant to the kovisions of the Contractors L L (Chapter 9 Sq. Ft. Floor Area, Valuation
Team , tlS t 90001 fD t fah Bs < and Profession,Code) ',)
or that hes a,cuip, hiref,rim and the bass for he al qed amormi nAny violation 6700
of Section 7033 S by any applicant far a permit subjects the app]team to a civil penalty'
efnm mum than fixe handredeo11furs($500). APN Number - Occupancy Type
01,as owner of the property,or my employees with wages as their sole compensation,
will do the work'and the structure is not intended or offered for sale(Sec.1(W,
Business and Professions Code:The Contractors License Law Jens no,apply to an Required Inspections
owner of properly Vivian builds or improves themon,and aha does Such work himself
homi ementimeplsarehinintended
yearor 203 -. -UNDERFLOOR MECHANICAL
completion,
for sale.If,however.the building or improvement ig rola within one Wild of 3 03 - ROUGH MECHAN I CAL''
ompinion.,hc ownerMhilder will have Clic Horden or proving that he did no,Wild or
improc for purpom of sale.)' 503 -.._FINAL MECHANICAL- ENERGY. ..
ol.asm,ncleftImpropenymnexelu,ivelycontncdngwhhfhcenmdeontmnont? 508 - FINAL MECHANICAL
onswct the Project(SCC.71314,Business and Professions Code:)Tim Contractor's
License Law does not apply to an owner of property who builds or improves thereon.
and who contracts for such.projects,w ith a,nntracmns)licensed puraaam.to the
_ Contractor's License Law. 1
°l am exempt under Sm. - H&P C far this reason Ic -
Owner
Data
- WORKER'S COMPENSATION DECLARATION
1 hereby of na under penalty of perjury one of the following declarations:
AF 0 1 have end will maintain a Cordillera,aI Consent m%elf-inwo,fur Worker's
,Ni_ Cnmpetnaaum at Provided for by Section 3700 of the Labor Code. for the
performance of the work for which this permit is issued.
01 have and will maintain Worker's Compe drain Insurance,as minimal by Section
3700 of,he Labor Code:for the Performance of,he work for which,his permit is
issued, y Worker's Compensation Insurance carrier and Policy number pre: ^/
conte '/_
Policy No. if 9/D ZO� .... - t• ,,; rat• . ..
.t '
CERTIFICATION OF EXESIPTION FROM WORKERS"
. „ COMPENSATION INSURANCE"".This section need no,be completed if the permit is for one hundred dollar 1
IEIIXI)or lcssJ ,
1 serif,rant in the Performance ar me weak lin which Or,permit is I,,.ad.1
shull not apploy any pcnon in any mm.mar W as to hrxmne.whim m the Workers
Cmu,ammion Laws of California.Date.
NOTICE TO APPLICANT:ll:after making Otis Camfleare of Exemption,you should
Wcoe subject w the Workers Compensation pmv,,ons of(he Labor Code,ymu must
Q Omforthwith comply with such provisions.,,his permit shall W deemed asse .
F = ' CONSTRUCTION LENDING AGENCY _
C ' I hereby arum that mem is a construction lending agency for the performance
-O of,he work for which this Permit is issued IS a 3097. iv.C.) ,.
Leacher,Name_ .. C... _.. .. ..
o
45 Lender's Add.,,
' h
.z h
U O 1 crnify that I have mad this application and%rate that the above information is
In [ter correct.I agree to comply aim all city and county ordinances and state laws relating
O U m building mastication.and hereby horize representatives of mit city to enter upon
>„ tr7 ,he abovamentinned,property for inspection Purposes.
y (%'a)agree to save:indemnify and keep hamtless the City of Cupcnino against
0,h liabilities,judgments,toss and expenses which may in any way accrue against said
Uz ci in APs cratit.
I'I:IGAN7yuNDERST
ANDS vomctanadtAND of WILL COMPLY WITH ALL NON.POINT '
~ SREGULATION, .f �. 5_UI Issue y: Date C{/�
tg�f Appucan`co omfor Data Re-roofs
" HAZARDOUS MATERIALS DISCLOSURE' '�
.'. warm2appheantm,ramreWddn,gtceapanr,nxeaaM1analena:amresmaterial ..Type of oaf
s defned by the Consume,sitimaipal Code.Chapter 9.13,and the Health and Safety s
Code,Section 235J2(ap i. ly
°Ye,' ❑Nm, ;," _._ . . .All Colts shall.be inspected prior to any roofing material being installed. ...
Will the applicant orfuture Wilding weapon use equipment or devices which If a roof is instAed-without first obtaining an inspection, I'agree to remove
ami,huzzrdo.,air impoundments as defined by the Bay Area Air Quality Management
Di„Tier. all new materials for inspection., Applicant.understands and will comply with
0Ye% ' °No all non-point source regulations;
-
1 have mad,he harvrdous materials requirements under Chapter 6.95 of the
California Health&Safety Code.Sections 25505.25533 and 25534.1 understand that } ,. .. .
if one building dors no,comendy have a tenant,that i,is my mspansinility to notify the
d
`pant
of Che rryuiremems whicM1 moa he met prier m Issuance of a CeniGcae of
"pant'3' _ Signature of Applicant Date
nal ambos=eaasent Dae. All roof coverings to be Class "B” or better
OFFICE