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BUILDING DIVISION PERNIIT'
FCOI TRA TQR INFQRMATJOV ��
BmL.TiNc�IMTS WY #3
CAL—AIR INC
P( U 8177
OWNER'S NAME:
PERA4[ISUE DATE
ARC SIGHT
1555 S 7TH ST
05/27/2008
ONE:
SANITARY NO. CONTROL NO.
(408)283-2300
ARCHnEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job D05CT7pUOn
Ihmmiry grim that I n7010)ofDiAmamlicamwdunder pmvivom orChapter ,Code.9l(my he..
T0111I) of Dividan 3 ofdee Bulm<• seed Profeuiom Cade, seeds my liceue u
withil
INSTL NEW SANYO FURNACE SPLIT SYS, INSTL FAN COIL
in full farce aM effett
Ime.
License Class La. Is
comic
Dade Con
DEC
DECLARATION
As
I undersonJ my Plana shall he used u Public records
AIR
Licensed Professional
OWNER -BUILDER DECLARATION
I .(Tiro than I from the Corston law for Je
,herebyneem I.S.exempt
2011. and Ca e: Any
following mare.. Code:
An m county
which permit 1 ,. Am .. der li ,.I
a permit re enmaemm, glee impmva, demolish, or repair any anamm
its
primmits licensed ...ttalm o ftres thcaisimesnt fw if don Counsepermit ta Eanom LawCeaumcm
maim:. Bxwith
Sq. F[. Floor Area
Valuation
Section B.AncesslMnrtlaw(e
$13900
).fDNioma.Ithe ahmr9
(commcncingwiNSedion00110)af0ivuion3nfNeBusineuandProfessinmCode)or
Nat he Is exempt thonefrmn and the buil for the alleged eumptime Any violation of
Section 7031.5
35720041�Number
Occupancy Type
fro hundreeddllars(S50%nSubmatheappleanmroacilpmlrya
❑ I. u awmer of Je proponsy, m mY eroPlaym with wage u then sole mmpewlon,
Required Inspections
will do the work and Je strucmm is notinended moRemd foualo(Sm. 2044, Business
and Prof eaamm Cade: The Grammes License Law does rot apply m an awmr or
q P
property, who builds ar impmwes Nermn, and who dates such wart himself u Nmvgh his
own employees, p Wdcd that such improvements am not imendad aroRemd forsale. IL
hawever. the building or improxemant u sold within one you of mmpledw. the owmr-
Wilder wi0 have the burden of proving Wt le did amt build or improve far WTose of
sale.).
❑ 1. as camen of the pmpany am Cxchawaly contracting with Hamad mnlrm ars un
consumer, aloe prefect (Sec. 7W. BmineV tad PNfe siom Cade:) The DonlMon's U.
.
ecme Law dm not apply m an owner of property who builds or improws theme. and
who conuacts for such projects wide a contractor(s) licensed paramount un the Conummes
'
License law.
❑ I am exempt under See ,B@PC fm Nis mann
caner Dae
WORKER'S COMPENSATION DECLARATION
I hermy allure under penalty of perjury are of the following declamivas:
❑ I haw and will maintain aCcnifmnteof Camenuo sclGinsum fm Worteh Compere
Minn. a provided for by Section 3]00 of the labor Code, for the performance of the
far which dein pannit is isucd.
'
I baM a1M will malnmin WaAR's ComN=don Inst a. u a uimd by Scdon
3'!110 of the Inbar Code, for dee Performance of the wart for which this farm, is issued.
'
My We a Compensation Inscren ornior and Policy num
Carrion: Policy Not
CERTIFICATED EKEMPnON FROM WORKERS
COMPENSATION INSURANCE
Ma s acctim nerd mt b e com pleed time permit Is fwr om mad ed dopers ($100)
or Its3.)
1 certify dont in the perfrson. of the work fm which this permit u cued, l shall not
employ any person in any manner so u b become subject to the Wormers' Compensation
Laws of California. Dean
Appliorm
NOTICE TO APPLICANT: IL after matlng this CcniOme of Exemplum, yon .abmlo
become Subic" to the Workeri Compcwtion provisions of the labor Code, you most
comply with such provisions or this Kmim shall be demand momcd.
CONS RUCT ON LENDING AGENCY
1 hereby An. that them is x mmsvucfam leading agency Sur do cofma. of
the wort fm whim sew Permit is mond (Sec. 3091, Civ, C.)
Landers Name
Lander'. Add.
1 sonify, Nu 1 have read this application and some this Ute.bow infoamamn is
Comm [agree m comply with all city and county ominanc" and sale laws rtlaing to
Wilding conswmon, and hereby inodamire aepruenutives ar this city an nota upon the
al me-mmaloned property for Inspection purposes
(We) agree to ave, indemnify and step harmless the City of Cupertino agAmt
liabilities, Judgments. tofu and expenses which may in my way attma against aid Cry
me ome 1.APPLICANof alae amingor Nis permit
AND AND WILL COMPLY WITH ALL NON -POI NS
Issued by: Date
SOURCEREGUN
Re -roofs
signmwrt or Appli a to< Data
allows A Alf DlsaosullE
Type of Roof
Will the applicant or future hot occupantsmmorhandlchmardommamrial
m
So dalmned by the Cupentsunmpal Code. Chapter 9.12, ad the Health and Safety
Cale, Section 25513(x)?
OYm
All roofs shall be inspected prior to any roofing material being installed.
wall the. li anon ser rwmrt builain a m ant am ser which
IR P Wuipr
If a roof is installed without first obtainingan inspection, I agree to remove
Pe g
cosh d
m air contaminant u defined by the Bay Arta Air Quality Managcmcnt
Qu MSM.
all new materials for inspection.
District?
Dis ict?
❑Yon No
I have read Jac hvaadam materials requirements under chapter 6.95 wide Califon -
SIA Hcal"Safety Count. Sava"25505.25533 and 25534.1 uamdvaand Jur if the building
door not c he ane a It Is my responsibility m ratify the encu t f the
nhia
regnimm °
` ` nm¢cvlvLCMlcMul°--�'e)''-°
Signature of Applicant Date
All roof coverings to be Class '%q." or better
Owner or autlits&d agent Dae