01040061 CITY OF CUPERTINO
BUILDING DWISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
22303 REGNART RD R & H HEATING 01040061
OWN11WS NAME. APPLICATION SUR DATE
RND .TRNET S 770 CHESTNUT ST 04/13/2001
{ONB SANITARY NO. CON'IROI.NO.
a{ -Z ARC]IITEC'1'ICNGINRER: BUILDING PERMIT INFO
FOO_ • BLDG ELECT PLUMB MECH
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LICENSED CONTRAC'TOR'S DECLARATION Job Description
O z_G 1 hereby affiml Ihot l am licensed under positions of Chapter 9 momammcmg
�,l..w widlSu:Iinn]INNRm Division 3 of the Ruslness anti Professions Code,and my license
a'=Z is intallf-cemlc t.
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!)am
)amseCl.aa A/C ADD—ON.
O O Dnle L/_(-y —6(_ Conlrven,r
to ARC'HIIEC71 S DECLARA K,
t O se I mWcrshud DIY Plans shall he used as public accordl
aI
Ce z p O Licensed Professional
OW -NER e empFR UI!Ce Cannavin
w e, I hereby air,.IWI 1 ampl I'«m the RAI IO f'a License law Ina the 7
C ¢ fallow'my rc,o,on.(Section]11.115 o,B ac,and F' l'en'ia I,Code:Any city nouuunty
2 0 Which M1t1Yl«5 or Pemtlt 10 con[nuel,eller,improve,dcomfilb,nr Rpalr any atmcmte
u�67 fw Her nin,wanee.also«quires the applicant for such paamil to file a signed statement
that he is licensed puts...IlameproonnwnnheConnecto,,I.i-n-Liw(Claracr9 Sq. Ft. Floor Area Valuation
(commencing with Section]0101 of Division 3 ofilm Business and Prole,,max Code)
or Om he is Coc onthcrel'rorn anti the bs.is or the alleged exemption.Any violation r
of Section 7031.5 by any applicant for a peril subjects the applicant to a civil penalty
of Bat more malt five hand«d dill...($500). APN Number Occupancy Type
❑1,as owner of progeny,or my employees with wages as their sale comamostlon. RG r 02043
will do the sod,and the anucmre Is nal InmaJed or ober ed lar sale(Sec.7M4,
proiness and Professions Crile:The Contractors License Law dove not apply to an Required Inspections
oeircr of property Who)bunds or improves Ihercon,and who docs such work himself
or through his own employe,pmwded ma sash napaw,onola ale aal intended ,, 204 — UNDERFLOOR FRAME
offacd for sale IL bt wear,the building or unprovcmmint is sold within one year of
lapmoa..me awner.huuder will have tire burden(ir l,n ing that be did not band or 301 ROUGH PLUMBING
narrative for purq,w nl sale.). ry —
01.asrwneral hepn,,e,,amcortmilelyCoroactingwith licensed cnntotit) 303 — ROUGH MECHANICAL
,nstruct the aujecl(sec 7144,limiac.s ane Pmieasin.s Cnai The Cmtramar a 304 — ROUGH ELECTRICAL
Licemsc Law docs ao apply to artawns, ifpngeey who build,or'anpmvus dlercon.
and who contracts for such Projects with a contamur0l licensed pursuant to the 505 — FINAL ELECTRICAL
Ca..orCo"I.ientse Law,
❑I am exempt trader See. .B&p C lar his reosmr 507 — FINRL PLLIMBI19G
owner Date 508 — FINAL MECHANICAL
WORKER'S CO.NIPENSATION DECLARATION
51.4 — FINRL PUBLIC WORKS
l honl!m under penalty ofpeajury one of the following deciamtiomc
I have and will maintain a Comilicate of Consent to self-insure for Worker's
nntlementn, as pravand far by Section 3701 of the Labor Code, for the
m:rforinanee of the won k far whicll his pct mil Is issued.
8'11hmo and will nralrom Work,,Cn ticoenion Lowrance,us requited by Section
3700 of the IaMn Code,li,r me IcrL,m.....of the work for which this lame,Is
issnul.May W��orrkke�r's Cornlwaswion Insurance Carriieer and apolicy�number
a-,mQ:
Carrier:fj2loo=�_��policy No./v i_(_�11 LV_f/L
CI?Hf114CA1'IUN OIt LalaMl'Il(1. II1l1M ORKERS'
C(1MPHNSAI'ION INSURANCE
(This section need not rte completed if lie perrnit is In,Linc hundred Linin,,
RI W)or less.)
1 ecnify that in the perfnnrurs,of the work for which this permit is iuu.J,1
shell not cntpluy any,penun in any manner no as ,,become$object el the Worker."
Compctnatlon Lowe of Califtimia.Dam
Applicmn
NO IICE TO AI'1•LICAN'D 11.inner making Ihis Cenllicmc of E1111111611.1,yon should
come .bjaio
l to the Worker's Compensation provisns of the labords.
Co ,you mol
Q Q befonhwiel coatply with such provisions Lir this rennh¢hull be ducmed evoked,
FziCONSTRUCTION LENDING AGENCY
I I hereby aLd t Ina,there is a cnnamcuo.lending agency I...the rerun once
W It the work for which this hermit is issued(Sec.3007.Civ.C.)
L Q 'L.eaders Name
17. 7 IsnJcrs Address
U I«pity that l have read this application and sore that the above intonation is
W F.I corn t I agree to comply%ith all city and county triefirance,and.rt laws relating
Q W heobuilding sal dharsh,ue 1 I' fIh': tyl Iry,t
the W mentioned property f Proal purposes.
F Zo OY judgment,
t 1 pen I k r h I .,thesty i s ren gi au
V1 liabilities,on dg I: c nce(if e d peewhichmay n any way dews against said •� _
U z Cly (CANT UNDERSTANDS
mining(it hisp,COM
O
� APPLICANT UNDIiRS'rANUSA UWILI.COMPLY WITH ALL NON-POINT Issued b V ��' /TIS'/'��/l�C-�- / Date
SOURC 1.GULATIONS. Y'
A` / ACJ �f-1 —O
"sr .�tu2`�rn cIIAZARmemr � Dam Re-roofs
r Ilam iHDUUS MATERIALS r ,am SU rf
Will the aridupert ar war«bpal Co«ewpmt store ofmarque Health a Safety Type of Roof
an de.S..by etc Cupertino Municipal code.enamor 1),12.marine Health and Safety
Code$ccrinn 2551$u):'
E)Yea C31/ All roots shall be inspected prior to any roofing material being installed.
Will lbs applicant or future building aecuraat use 1,aimnem or devlcea which If a roof is installed without first obtaining an inspection, I agree to remove
crnit hveradou.an contantlwnts tie def ncd bribe Ilsy Arca Air Duality Manage tanin
A'a{nfall new materials for inspection. Applicant understands and will comply with
❑Yes all non-point source regulations.
1 have read the hazardous materials requirements under Chapter 695 of the _
Calif...iu Health A Safety code,Sections 25505,25533 and 25534.1 undomenol that
it the building docs not currently have a temnl,tout it is my responvindity In amity'tic
occupant of the requirement shich muss be met prior to issuance of a Certificme of
D ' `DI
LSignature of Applicant Date
w .III i,ed agml t Dat— All roof coverings to be Class "B" or better
OFFICE