01030066crBUILDIN DIVISIOrvNOPERMIT
CONTRACTOR INFORMATION:
BUILDING ADURESS:
PERMIT NO,
21764 REGNART COURT
A A A FURNACE COMPANY
01030066
OWNER'S NAME:
APPLICATION SUB DATE
ART MUTO
1712 STONE AVE
03/1.3/2001
PHONE
SANITARY NO. CONI"ROL NO.
(408)293-4717
ARCHITECT/ENGINEER
-BUILDING
PERMI r INTO
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BLDG ELECT PLUMBECI
UJ J I_
LICENSED CGNIRAM OR'S DECLARATION
Job Description
1 herchy nrti initial am licenced under pnn'isiuns of Chupler 9lcnmmencing
,' Scaion 71XX0 of Division Jnl the Business and PmlcroionxCde. and myliccn¢
au lame nn1
CHANGE FURNACE 120,000
=
01 ARCAI'I'CCr'S DIiCI.ARA I N
I J rs Joy pl , hall he used a, obhe rc Js
Licensed Pf.- 'I
OWNER -BUILDER DECLARATION
I h by affirm that l ororm Ot frt i h Contractor, License for the
t
following .S crit 7031.5. V Cd y city county
ley pc ort a hrP demolish. repair any structure
pror to its issuance, alsorretuvcsthe applicant ]"'such pcminn We augncd statement
Sq. Ft. Floor Area
Valuation
that l,a ixKenn,rd parantlm In me pllwf�init. nrtnn ealltmetnr. Lieel,�e l.nw (cnantert,
mommencing with Section lfXxb of Division J of the lludness and Prinessions Code)
or that he is exempt dw cltom and the basis for she alleged exemption. Any violation
$1785
of Seel on 7031.5 by any applicant Iia a penoit snnjects the applicant n, a civil Penalty
APN Number
Occupancy Type
of no( more dwn five bmdrd dod„r% (S50(d.
I21. as owner on he yrop[rt,, or my employees who wages m. their ale ctnnpema0on,
3562404 7. 00
-
Required Inspections
will do the work, and IIts ... acom is not inteded or oflered ton sale (Sec. 71144.
Business and Pmtisdons Cde: 'rhe ConOactor's License Law does not apply m an
of pmpeny Who Wild,ar improves thereon. and who does .such work himself
XROUGH PLUMBING
11wner
or through his own employees. Provided that such improremmrc enanot intended ar
v 01 —
,,belied lin sale. M nowaver. me holding or hopmscmom is sold within one year or
^(q ^ — ROUGH MECHANICAL
impletion. the macr-builder will have the boNen of proving par he did not hold or
s b
intrinsicror parptae tdvile).
304 — ROUGH ELECTRICAL
❑1,a moerofthenro nraac:elusivelyeontmcan,with sen ... Ica ... IT.it,
505 — FINAL ELECTRICAL_
e:) The Conaclot ,
convict Chepmjeet ISet. 70W, 0iinash unit Pmfexeitms Cda
License Law does not apply to an owner of property who wild% or improve. lemon.
507 — FINAL PLUMBING
and who contracts for such projects wind a commcma(s) licenced purxnant to the
Carinrmrsl.lrenhe"'.
508 — FINAL MECHANICAL
Cl1 len exempt under Sec. . II & P C fill this mason
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Owner Duro
WORKER'S COMPENSATION DLCLARAI'ION
I hcrcby affirm under penalty of pernoy one nr the following dMantions:
❑ 1 have and will n aimmin a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section PW of the Labor Codefor the
pmfornumce ill the work for which this permit is issued
1 hale and will maintain Worker's Compcmvnian Insurance. as required by Section
I... the Ierm ce of me work for which this pemsh is
- 1X1 0l' the Labor Code, folotm
el. My Wnd,C. Coarl,�"''Cti/�/nJnlnmu:ume carieerr]xnII Is licY,y�num�Vnl'e'r�art:
Carricr:f ;
.
did, AIIUN<)It [P.1i,,'NIONI A155'(I
COMPEN NNON INSURANCE
(This scelion recd nal le compleled Brie permit is forone hundred dollars
D I INI)ar le".)
1 sentry that in the per[ ace of he work lit which this pump is issued, 1
shall ant employ any Person in any manner so as to become subject to the Workers
C .... i mini Lawsof Califnrn la. Date
Applicant
NOTICH TO APPLICANT: If, almr making this Cenilicate mf Exemption, you should
Mcome subject a, oho: Workers Cmnpemxtian Portio., of the Labor Cods, annual
tonhwith comply with hush provisimu" ur this peroar shall be deemed resided.
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CONSTRUCTION LENDING AGENCY
I herchy al inns that there is a construction lending agency for the serfnmmntt
of the work lin which It, permit is issued (Sec 9110, Cie C.)
,
1,oiler'. Name
,
Lender's Address
I certify act I base mad this rpplicalko and state that the -ho" inlimmation is
correct. 1 agree to comply with all city and county ordinances and state laws relming
to building comtmction, and hereby amhorim representatives of this city in enter upon
the ahose lotion led pu,pery ror n,prelion Pogaic
(We) agree it, save, indemnity and keep harmless the city or Cupertino against
liabilities, judgnmm., cost% and expenses which may in any wary xeric against
City in consequence of the granting of this Permit.
3—/J
APPLICANT UNDERSTANDS AND WILL COMPLY WI III ALL NON -POINT
Issued by: Date
y'
Stl CF. REGUL ONS. B -1
S
S', are tdnppbc:mvCin Date
Re -roofs
IIA%Alt DOUS MAI 'I TRIALS DISCL(ISUIU
W,R the apphcar ,, comm bailing iteration, ,lore in nandlc naaw,as material
Type of Roof
as defined by the CuWmm Municipal Cde, chapter 9.12, all the Health and Safety
Gyle, Section 25.5321x1!
ores 0 N
All roofs shall be inspected prior to any roofing material being installed.
use e,ai,msmordesks, which
If a roof is installed without first obtaining an inspection. I agree to remove
`WiBmcappbr:oaorfmttmWildiagtceupam
emit hvandous air coati name it, deimed by Ito Bay Alien Air Q,Jily Management
District?
all new materials for inspection. Applicant understands and will comply with
DYes 0 N
all non -point source regulations.
I have read the hhvnrdous Ioalerl:ds recount under Chapter 6,95 of the
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California Heahh & Smicty Code. Secants 25505.25533 and 25534. 1 understand that
it the building does not currently Lame a mom, that it is an, resrymsibil'ny m notify the
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realaait of me mquu hens which Ina.I he met prior m law:mcc of a Certificate of
pu icy. ����
Signature of Applicant Date
wn�/�)��%���1
All roof coverings to be Class `B" or better
g
O uuthuriad upent / Ilnte
OFFICE