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PERUNO
CITYBUILDING
CONTRACTOR INFORMATION:
PERMIT
BUILDINGADDRESS.
141544 RAMPART AV
VALLEY HEATING & COOI,
P RMI'TNO
NV 00120090
OWNER'S NAME:
APPLICATION SUB HOT 1;
MAROTTA GRANT W AND ILLENE
J 1171, 1u 4 I'H ST
12/15/=000
ZONE:
SANT VARY NO. CONTROL NO.
J
(408)294-6290
ARCHITIiCFTNGINEER:
BUILDING IIERMIIINFO
BLDG ELECT PLUMB MECH
1=1 IJ I_I I_I
LICENSED CONT'RACTOR'S DECLARATION
Job Description
I Ill affirm mal 1 ani licen.ed under ......arms of Chapter (misnaming
with Scotian 7000) of Division 3 of the business and Prolessmn. Curie, Wnty license
I,,. fall bmree andgrctat.
FURNACE_ REPLACEMENT
IAnc _/�( U Cantmao
ARCHI1 EC'I", UEC'All"
1 understand my planuhallbe used as public records
Liccmsed Prnfcvsinnll
UECLARAHON
oOIVNER-BUILDER
I Ill offinn that 1 am five brant Palm the Contractor's License law for the
following reason. (Section 7031.5, Business and Professions Code: Any try,), county
which reglirca a pcm,il to construct, aper, intpnwc, demolish, or repair any structure
priorm its issuance, alsorewires the applicant for such permit to lila n signed statement
Sq. Ft. Floor Area
Valuationl
that henlicensed position tuthe mar mndafineeonhmetorsLiamse Law (Chapter9
(commencing with Section 7000) of Division 3 of the Havoc, and Pick ion. Cade)
-
or that he is exempt Ihamfrom and me hada limbo alleged eacmpllnn. Any vinlmlan
of Scmiou 7031.5 by any oppli... I for u Verial subjects life opplicem to a cI'll pcn.hy
,if not mopfIiia, hundred dollars 15500),
APN Number
Occupancy Type
�T
00
711, as owncr(it the property. or lny employes, with wages as lair dole mogcmmlan, 36925006.
will do he work, and the structure is not unleaded lir altered lin sale (Sec. 70114.
The Commemr's License law docs m
-
Required Inspections
Business and pofosiom Codc nm apply an
Ili property Who build.(it mprovesthereon. and who does such work himself
or
301 — ROUGH PLUMBING
Ill...ngh his own cmpluyecn.incited that nueh hnpm.c,li tux not imondedlir
offered for sale. If. however tine building,, improvement is ,,to within line yen, of
303 — ROUGH MECHANICAL_
completion. the owncr-bullder will have the burden of proving that he did not build or
mprove for purpose ofsalof
Z04' — ROUGH ELECTRICAL
❑Lusow file prpert,rani,elmholycontravening xithlicensed carmal
505 — FINAL ELECTRICAL
mnial the project (Sec. 70W, Business nod Professions Code:)'Ihe C9nlmnr's
License Low doesm,lapplymat—ou,ofpmpeny who milds or improve,a Baratta,
507 — FINAL PLUMBING
and wan uirracta Ga ...If ,,,,jet,, with n unntaean(,) licensed pursuant l9 the
Council
S08 — FINAL Iv1F_CHANTCM
❑ I ant exempt ander s«. . B & It c for oda reason
Dwner one
WORKER'S CUMI'f:KSAI'ION DECLARATION
I hereby affirm under penalty of perjury line of the following declarations'.
I have and will maintain a Certificate of Consent mxborrt for Walker
JWMt f the Labor Cal I the
' alµ i -: provided f M1il Section La
r
pcH f 0 d for whichtills'poillil is issuesi.
❑1have d Ill maintainN k Compensation Insurance. 4 Iby talion
\Apr Ili the Labor Clude. for the parrionmence of the work for which this pe T is
p
wed, My W,rks's ClallIVII-11011l sfratucarrier a,d lol'cy litainherart,
Carrier: Policy No.:
C17RIIFICAT]ON OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
'
Clhis section need not be completed it the permit is for one hundred dollars
6100) or lass)
I eenify that in the Icr m meae of the .,,,it fur which IIIc permit is issued. I
shall nm employ any person in any manner a, as to hecmne subject to lie Workers'
C, mpeusmina Lows of calil'ool u. Uma
Appllcun
NOI'ICI!TO AI'1'LICAN I': 11; afmr nuking this Certificate of liscnfplin4 You should
Mmnc.ubjccl h, the Worker'. Compensation pros sof the Loan Cof you must
forthwith amply whin amt provision,. lir this pannit shall he dea l revoked.
CONSTRUCTION LENDING AGENCY
I hereby wiffm dair there is a consul lending agency for the performance
of the wnrk fur which this pannit is I,,.ad (Sea 3097, Cie C.)
Landers Name
1_cndcr's Address
I ,roily,hm I hnvc,,ad thisapplicminn mrd some Iwo the above ialbrmalin I is
,00c,t, I agree w muff with .11 city and aunty ordinances and dune laws relating
o building canslretion, and hereby emhl repreunutives of this city u, indicators
the aMrve-meafomd property for in.peNun pmpwas.
IWeltgrcc to save, Indent fy and kccp hxnnlns(lie City ol'Cupertlnn against
'
liubilitics. judgments, a 1, and c,lcnms which may in any way .,me agah"t said
City in amreyue of me goring of this penult.�
APPLICANT UNDERSTANDS AND WILh COMPLY WITH ALL NON -POINT
L)
Issued by: (� _ Date /
RXGULTION
SOURCE; REGULATIONS.
Re -roofs
Signature o[Appliammucl maverm Date
I IALARDOUS MATERIALS DISCLOSURE
Willow nrp wl f to mom mudding neenpafn dime n, Ill lie ba lmlon, maltsial
Type of Roof
as defif¢vl by the Cupertino Municipal Cade, Chapter 9.12. and (lie Health and Safety
Cale, Section 255320l'f
'°
❑Ye.. t
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or deviav which
If a roof is installed without first obtaining an inspection, I agree to remove
emit Iuaardous air contaminants as defined by the Bay Area Air Quality Management
Wde,7all
new materials for inspection. Applicant understands and will comply with
°Yes t
all non -point source regula 'ons.
1 have read the initis us materials fequiretnares under Chapter 6.95 of the
Cnlilinnis Ileal ill .@ S:dmy Chale. Sections 25505, 25533 and 25 534. I understand that
if the building docs not cunendy hnvc a I'll f. IM1m his my ra,u no ul it, a, runty the
occupant of the requirements which must he mat prior o issuance of it Certificate of
Oc aney'
Si * rare of Applicant Date
�i3ate
All roof coverings to be Class `B" or better
umorimd agent
OFFICE