00090174 CITY OF CUPERTINO
Huu.ulNG,DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMITNO.
OWNER'S NAME:. APPLICATION SUR DAL H
1,0184 01 PORTAI AV A PERFECT CLIMATE_ 000907.74
soHONE: SANITARY NO. CONTROL NO,
al-IES 4799 LYRIE LN 09/27/2000
c z ANCHITIiCr/IiNff
It011,10IN(I I'EItMII'INFO
O HLIX Iv,iat
?I-EC1' PLUMB MECH
Fay 4082269990 1_1 i�l II 1_i
y•EtoLICENSED CONTRAC'TOR'S DAII
I?CI.ARON r Job Description
z
sit1 hereby ap°mat 1 am licensed ander,pradaives of Crammnti
Chapter 9(comeng
°mitpa wlm Scottun7001puf Divi ...,3offe Bn6me.un^d YruAsti uns Code,andnty license
is inI IIIrKc and dire l�Y�
z ¢ I.;ccn,c Clm!�s
C'-- Cnmm�clur
¢7 3 a G AR
CHI'1'EM'S ION
t`O] lmtdermnn emyplo.,.wall beu.ed a,,cmTil records ADD A/C — FU RNRCE
si't
e.d° hianxJ Pndcexional
(hWNER exxtro i r n the NAr,tor //
ON
e 1 hereby allirm tIhit,W 1 am exempt I'mm the Grnwetor'..Liwnsc latw lin the
�V, fnllowingrc a.(s«tion 7031..5.Business and Professions Code:Any city orcranty Sall
4 x�0 witch :' p ' lin ........ II -, 1 lith ystreet re
c a mprion I Matinee.also y the pPl cant] h pe rt file signed son ncnl
m,th Licensed p :m n In provisions nn contractors l L (Clatpter9 Sq. Ft. Floor Area ujtiol
(corrincoving with lel 71xtIU ol Di'jonti.1.11 tire balittrIs and plollIoLno Code)
or that he is exempt Ihemfmm and the rest,for the alleged ammpuon.Any molal nn
of Section 7031.5 by any npplicunt fora Pcrmil subjan the nppheanl m a Cis II penally
of nor dam Iran five nnndmd damn(sml)). A PN Number Occupancy"type
01.m owner of flee pnapm ry,or...r cmPloycu,wllh wugcx Ise ehcir wee...npeetuualt,
will do the work,and the streclum;s not intended or olicmn for sale(Sec.71W1.
Ba,inel,and rrofa,ehtn,Code:'Ihe Comracmr,I.iccnse I.aw does nal apply In an Required Inspections
caner of property Who bonds or Improve,thew,)°,and who noes Inch work ni nostril
or through his awn employee,provided that such improvements am not intended or 3 J.628054. 00
offcud In vole,11;In r,the mild inap.. went Is sold within nnc yea of
mtpletion•the ax ner-boilder will have(lie bode°(it poising than be din nm build or
I`opm.ermparaacnf.ale.), r 301 — ROUGH PLUMBING
01.as ownernnbe property.ame,clu.;vc)y cmnraevng with sensed coteractan 1U ROUGH MECHANICAL
1mnnstct the project(See 7614.business and Professions Coda) Obe Contractors 303 —
.vanw Law doe,not apply w nn owner of property wen milds or inip ove,Iecraon. _
and who contract, for inch pmj.t,with a comracmd,)licensed paumnt to me 304 — ROUGH ELECTRICAL
CAL
maa
Cateforsl.Ic °Law' 505 — FINAL ELECTRICAL_
01 ono exempt under Sec. .E&it C far tit's,K;non
Owner D:Ila 507 — FINAL PLUMBING
WORKER'S COMPENSATION DECLARATION 508 — FINAL_ MECHANICAL
1 hcrchyy III..°under peirdly lit"'i..y one o1'lire fdlowlng dedmmions:
have non w,It maintain a Ccnifieam nI Comcnl m self-insure fir Wnrkcr's
Compcnvation, on provided for by Section 3781 of leu I,thor Coole, for the
performance of the work for which this permit is,Swed.
01 have and will maintain Worker's ConiWasaion Insurance.as rejairerl by Section
37(x1 of the Lonor Calc,for the performance of the work far which This permit is
,sued,Myy�..Wforkc�r',Cuny,cnsatlon Laurance currier and policy number nrc:
Carrier_]]}[,1f(KWI[ON
_.XEMI WORKERS*I'ENI'IhICAi'OM EN ATIONINS FROM WORKERS'
COMPENSATION INSURANCE
(This¢cion need not be completed it the permit is for one hundred dollars
lE I(NI)or Iced
1 certify that in the performance of the work lot which this pemail is issued.1
xhull not mrj)oy any person in any intoner It,os to become wits,to the Worken'
Cnmpcnwdon Loss of C.Id.,nis.Dale
Apphaam
NOI ICE TO APPUCAN'p If.imp rad,ng m;,Ccrlilirnm of Excmphon,you should
becomc,ubjre Ia the Worker,Comlen.wdon provision,oI the Lana r Cade,You enoyl
Q O fonewith comply with such pnw;t;on,into,pemtit shall be cha ned revoked,
y CONSI RUCTION LENDING AGENCY
> 1 hereby anima that there is a ennamction Icnd;ng agency for the performance
Wof the work for which this persu
mit is issued be,NII Civ.C.1
L ❑ Under',Name
Q Z Lender's Addicts •
1 certify that I have mail this application and into that the arise information is
Lz. tr correct.1 agree it)comply with all city and ecurty ordinances and gala haw,relating
Q U Iohole ing o0mLea lion,and hembyauthonte representatives rf this city reenter upon
the tbmnmmtil;oncd property its inspection purpose..
rL (W'e)agme testis,,indOnany and keep barrel..sflte Cr,of Cute..Inn a,rino
(n liabilities,judgments,antes and expenses which may in any way amore against.said
U Z City in consequmuc id II¢grunting of Ilii perm;v
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
sot,KgL .CUT. TIf3NS. L"foo
/�
s�gna nr ppbcanocnmra„nr Re-roofs
HAZARDOUS MATERIALS DISCI.OSURH
Willd,apphcnnl,n fame railing oveupthn lira or handle hamrdoatmmenal Type of Roof
as defined by the Cu1x•nino Municipal Code.Chapter 9.12,and the Health and Safety
Cute,S,,I,i 2}532([)'1
0 Yes ON. All roofs shall be inspected prior to any roofing material being installed.
Will the a"hean ,,Ram nu;ldlngoccupan.,a aydpenon,0r devi,e, wino If a roof is installed without first obtaining an inspection, I agree to remove
emit hmonloun air comaminuno as Jef neJ by the Hoy Ama Air Quality hlanagemenl
rnun,,, all new materials for inspection. Applicant understands and will comply with
0}'e, 0N all non-point source regulations.
I have Kan the eaaardoo,ummrlalt eeyunemcnm ander Chapter 6.95 of the
C,lifomit Health&Safety Code.Sections 25585.25533 and 25534.1 understand that
if der build ng does no conenl ly hmu a tenant,Ila,it is my responsibility tv notify the
acupvm od the reyuimincnb which mwt Ise ens Prior le i...",'a al u Ccrliliemn of
Signature of Applicant Date
O-1r�mla,ritedagent {� All roof coverings to be Class "B"or better