01010098 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10551 N PORTAL AV ATLAS HEATING 01010098
OWNER'S NAME: APPLICATION Sell DAPS
STAVANG CURTIS W AND T17RESA G 155 SAN LAZARD Ak.E 01/23/2001
PHONE: SANITARY NCOM'ROL NO.
(408) 739-0516 4
O c Z ARCHI'1'ECr/ENGINEER: BUILDING 1.17RMII INFO
w 0 BIAIX ELECT PLUMB MECH
at
FSC IJ L=7 Ll I—t
O y'L
LICENSED CONI RAC DECLARATION Job Description
hcrchy uffmn m;n law licensed ud under prat i,inn,of Chapala. (commencing
F::u x'ithSminn 7000)of anal ProfexF1'Im �ny linn,c
=y ,� i,illnaurarcaaaltal`"`%, W ,!fir REPLACE FURNACE AND INSTRLL A/C
s 6 Liccnm Class Lic.N
O Date_�i�—f1S� enmmetnr
W n a N A HITECT'S DEf.LARA'I'10
{_ce ; 1 prole sio why Plann,hnll M usul u,puM1lic rceonis
�a
00 O C Licensed professional
°'Key Oar I a-BUIhULR UIa,C1.ARAT1(1N
1 naso affirm ohm 1 am elatn,t from the Conioar,Cs :Arse Law for Inc
^I whichfollowin6aires a. ermitncomstrIfu,inm,untive,demolish,
C\Wc:Anyally someone,`t G wm<n res issuance,
n Gana re con s tine applialter.cant
improve,h perinut t fi repair any aructure /
Prot t. also arq ' .tl ,glia hf such n ll g d,lonanuad
(caadhe is les,entslpna p m p n. red c f ',1«Prole IchCter9 Sq. Ft. Floor Area ration
(commencing ,Seca 7IXlan thDivisiont fah l , JI IAD -Codd / � $1
f[flaSec heIs7031.5
by anyliant or. parmifor ubject theged pplcpfoo Anyv Penalty
of Section a thin
5 by any nted doll for v ltennit subjects the applicant m a civil penult,
at nm more roam hve nulmmd dollars oslxn. APN Numberc�IpptcY Type
01,a,none'ofthe Im Ity.wro'en'do'cer,with a,a,t,h their ole v.....I car"lioti, 31630099. 00
will do the work.and the amcture is not intended or offered for,ale(Sec.7(M4,
Bmine.,and Profession.Code:The Cantmcmr's License Law doe,not apply m alt Required Inspections
owner of prolvoy Who builds tar iialpeces therven, und who does such work hinn%aff 204 — UNDERFLOOR FRAME
or through his own employees,provided That such improvements we not intended or
offered for sure.IL however.,he building or i;npn v'e nen,is vmd wirlon,ate year m 301 — ROUGH PLUMBING
nnpleun...ata;."n"Ibudder will have the burden of proving that he did not build or
improve mr,a�n.eaf.ale.). 303 — ROUGH MECHANICAL
O L as owner of the prop[rty.amevelusively. contracting with sensed contractor.to 304 — ROUGH ELECTRICAL
Lmv.I the p,,,jea(Seo.7044.nusioens call Prefe,win I,Cole)The C...amnnr',
icense Law does not apply to an owner of property xhe Imim,or ampoeve,thereon. 505 — FINAL ELECTRICAL
and who comma,for such profecu with a aomraetnas)licensed Imrxuait to he
Cntrocml•..License Law. 507 — FINAL PLUMBING
El l ame.ampt umlcr 4c. .B&Penin d,iw r<t,nn 508 — FINAL MECHANICAL
Owner DatWORKER SCOMP S
NAI'ION DI!CLARdrON 514 — FINAL PUBLIC WORKS
I hcrchy of i...I under penalty of perjury Ino of Ola following decbmniuns:
Cl I have and will common a Ccnificme of Conlin m,all-alone to Wokvr's
Cmlgmmntion, as provided ),r by Section 170) of the Labor Code, for the
performance of flue work for which his permit i,issued
❑I have and will maintain Worker',Compensation Insurance,as required by Section
3700 of the Labor Code,lin the perfomwave It It work bar which this,coil i,
i„uetl,Sly Worker's Compensation Insurance c rricrund Policy number we:
Can;all:-*If, rlcS—__Party No fN�i7 3 yla.
KATION OP BKI:M III[ON FROM WORKERS'
COMPENSAI ION INSURANCE
fib,secLion need nm ba completed it ha permit i,ton are hundred dollar,
(V01)of Ies+J
I ecody ilia[In the pcdonnance of the work for which this permit is issued.I
shall not employ any person in any manner so as a,become subject,the Wurkcri
Compeavadan Lows of Cul'dbrnin.rate
nppll<ead
NO]ICH T(1 APPLICANT:If,uf,r making this Cwton'te of Lcmp,inn,you should
be ,.hj,cl to the Walker',Compensation provisions of the Labor Calm You must
Q O fonhwim corn,),isith warn pmvlsian,or this peroul shall be deemed revoked.
FIzI C(INSTRUCr1ON LENDING AGENCY
ai 7 I mo by atliml that there ix u en ntrawnon lending uguncy t...live p,if onmmc<
of the work for which this Isomil is issued(Set.3097.Cl,C.)
0.. p Lander',Name
7z I-ndd,Address
tJ O 1 eerily that I etas:Iet i fin,.'Pfear inn unit Lama tint the above imLnnafact i,
4ss per. comae,.1 agree,comply with all city and county erdioence,vad state law.relating
O C.7 ,building enmtmelion.and harchv earn,fie aprc,cnwf,,,of,hi,city n,enter upon
W the unnvo-n,cntirnted p,,,,,Iy for me nion parpace,.
'N 0. (We)agree,s,oc.intMnmify and keep hanNev,the City of Cupaolne almost
V1 Iiubilitic,jmdgnrent,,cost,:nW c,,,oa,which may in any way Beane t mint said
U z Cityin CANNUND of thegrantingof thi •Dans I
APPLICANT UNIIIiRS'rAN1lr AN[ .L COMPLY W1TN ryhl NONIr� Issued by: Date
SyRFyl N,1 A / /
Sldirsene.nf A,liie.IltaCmm�ae,nr Uwe Re-roofs
HAY,%RDC) MAI HRIAIS DISCLOSURE
Will the appl'inuanr In Nodding ocu,pam store or hwdlc Wvaofaw Inatenal Type of Roof
u defined by mu Cupertino, nicipal Code,Chapter 9.12,and the HeJth and Safety
Crate.Section 255321u1'f
❑Yes 0 N All roofs shall be inspected prior to any roofing material being installed.
Will the:mpli,annmcame build ingnacastor.,aegnip,tend ordevice,which If a roof is installed without first obtaining an inspection, I agree to remove
craft ltaeanlous air contaminants as defined b,the Bay Arca Air quality Management
Disnm;� all new materials for inspection. Applicant understands and will comply with
O Ye, El No all non-point source regulations. -
1 have read the norodnu.v materials requiremnn,under Chapter 6.95 of he
California
Health k Safety Code.Seat n 1,25505.25531 and 25534.I und,stand tun
it,be building doe,not currently have it Imand,that it is my resrymxibility to manly me
accuPznt of the rcgYltem[nr,which mush be act prior to"weew,of o ceriticatc of
Occupancy.
Signature of Applicant Date
Dwmnallhnnandaad,)gent Data All roof coverings to be Class "B"or better
OFFICE