03040031 CITY OF CUPERTINO "°u 7,7, P.h, _E;
BUILDING DIVISION PERMITCONT ` CTOIt TNF'URIV,IATIQ1
BUILDING ADDRESS: CAL—AIR INC PERMIT"°03040031
R•s"AME: 1555 S 7TH ST #K PRE"T""IfIn7/2003
WZ
PHONE: (408) 283-2300 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
J86 LICENSED CONTRACTOR'S DECLARATION I O O O O
ly F i hereby,form that 1 am ficemW under Provisions of Chapter 9(commencing Job Description
a� with Section 7")of Division 3 night,Business and Professions Codgmd my license Is
in roll fonx ted eReca HVAC UPGRADE COMPUTER ROOMLimasmRNA
Dan Canu
Class snar ff—a®�9'A LED
REPLACES EXPIRED PERMIT
As shall use DECLARATION 402040102
',� l undcssund my Plans shall be uteri a PUM1Iic record, AUG O J 2003
I:W;o� Licensed professional
OWNER-BUILDER DECLARATION
I hereby aRrm that 1 am exempt from the Conurmors License Law for the ^ p�/'�
OO
following reuon.(Section 7031.5,Business and PmfessiouCode:Any city orcounty BUILDING
$ which requires a permit to construct,alter,improve.demolish.m repair any structure
prior mi%issuance.also requires IM applicant for such permit to rile a signed auument
FF GthathcislicensedpursomttoMeProvisionsofdeConuscmrilicenseLaw(Chapter9 Sq. Ft.Floor Area Valuation
Y (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
3$
at he Is exempt themrrom and the basis for the alleged eumPOon,Any NolsOon of
Section 7031.5 by any applicant for a Permit ubjems the appliunno a civil penalty of APN Number $]L�cOtfijfdlfi;ry Type
not mom Nen fns hundred dollars(5500).
o
I,uowner oflhe Proprny,mmy dmPlayees wire wgeau the'v ante compensagon.
will do the wads and the structure 4 mon intended or offered(or age(Ste.70N,Busircas
and Pmfesslons Code:The Con5actbrs Limese law does not apply In an owner or Required Inspections
propenywho bulldsor Improver Memon,andwho dou,uchwmk himself orthrough his
own employees.Provided that uctiimpmsermnu tee not intended oroncred for sale.If. 101 — FOUNDATION
however,me building or improvement is mid within ore you of completion.the owner.
builder wig low the burden of proving that he did ret build or improve for purpose of 102 — PIERS
L 103 — UFER
L as owner of the property,em exclusively contracting with licensed contractors in
co some,the project(Sec.70ed,Business and Professions Code:)The Cortrantors LI. 104 — REBAR
cave law does not apply to an owner of property who Wilds or improves thereon.and, 105 — ANCHOR BOLTS -
who contracts for such projects with a cenwnar(s)Ilreved Format to the Convector,
Lleen,elaw. 106 - SEWER & WATER '
❑Tames ,undersea. Be J.%7i, on 202 - UNDERFLOOR PLUMBING
s 203 - UNDERFLOOR MECHANICAL
WORKER'S COMPENSATION DEC ON
Ihtreby emrm under pevlty of perjury one of the fa0awing eecluations: 204 — UNDERFLOOR FRAME
❑I hew and will maintain a CardOate of Consent to anlf-insure forwoM1ermCompen. 205 — UNDERFLOOR INSULATION
ration,an Provided for by Section 37th of the labor Code,fm the performance of the 301 — ROUGH PLUMBING
work for which this permit is issued. 302 — TUB & OR SHOWER
❑1 naw mod will mommin Worker,Compensation hvuanmas, required by Section
3700 of the labor Code.for the performance of ma work for which this Morita issued. 303 - ROUGH MECHANICAL
MyworkeescommnationlosunnmconlmandNticynumberam: 304 — ROUGH ELECTRICAL
Carrier: Policy No.: 305 - FRAME
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 306 - HOLDOWNS
Crhts section had notnt,complcwd if the permit is for one hundred dollars;(Sign) 307 - INSULATION
or tom.) 308 - SHEETROCK
I terrify that in the scrionromm of tha work for which this permit ts issued.I mall not
employ any pmann in my mahrcran u to bamme subjaUn the Workess'Comperoetion 309 — EXTERIOR LATH
Law,of California.Data 310 - INTERIOR LATH
Applicant
NOTICE TO APPLICANT':If.afar making this Certificate of Exemption,you should311 — SCRATCH COAT
become,ubjen to the Workers Compensation provision,of me Labor Code,you mute
z mMwim comply with,ren provisions or this permit mall x desmed reveled. 313 - ROOF NAIL
z - CONSTRUCTION LENDING AGENCY 501 — FINAL ELECTRICAL ENERGY
Thereby affvon that men:is a construction lending agmoY for the Performance or 502 - FINAL PLUMBING ENERGY
0.
the wmkfor which mlapermitaissmd(Scc.3097.Civ.CJ
Lenders Name 503 — FINAL MECHANICAL ENERGY
i[1 Q
jz Lender,Addrees 504 - FINAL BUILDING ENERGY
Up IcudfyMon lhaw madmHapplication and sum Mat the&howInformation is 505 - FINAL ELECTRICAL
D, F correct.I agree to comply with all city and county ordinances and state lawn rehting to
O V building conswction,and hereby authodanmpresentativesofthis city mewruponMe GAS TEST
U shove-mendomd property for inspection purposes O 7 F I
C es ju agree m sew.indemnify and keep may
in ss me City of Cupertino,gains,
rfA liabili,les,7udgmenu,cosuand eapevawhich mryinanyway accruegainslsaidCiry 5 A C IC,
V APPLIonsC ucvcof the UNDERSTAN of this D WILL COMPLY WITH ALL NON POINT Issued by:5 Date 7
500 EGULATIONS. C .a _
arum of ApplicurgContruter 7 Ame Re-roofs 514 L4INAL PUBLIC WORKS
HAZARDOUS MATERIALS DISCLOSU Type of Roof
Will the applicant or future building omupant,tom or handle haurdous material
4.6,
t,OvdbytheCupeninoMunicipalCode,Chapter9.12,andmeHeslghandSfety
a.Suedon 25532()7 - All roofs shall be inspected prior to any roofing material being installed.
❑Yu Ar"o
Will the applicant or future building occupant ue equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Im.mu, it contaminants as defined by me Bay Area Air Quality Management all new materials for inspection.
Disuia7
❑Yes XNu
1 have read the huardous materiels rcqummt,nts under Chapmr6.95 of the Califon
nit,Health h5 oy Code,Sections 25505,25533 am125534.1 understand muifthe building
dans not n,ly haw a moan t' msponsihiltty at notary the ex pact of the
req ire wnkn moil be Iasnanm or.Ccnirtea o«ao Signature of Applicant Date
Owncror sulhorizcd eget am All roof coverings to be Class"B"or better