04110125 CITY OF CUPERTINO .�+ aa•+,• . s
Buainrvc Drvlsiory PERMIT aC`O1N.RA, "`bR INF'ORMATIUN ... -
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DINGADDRESS: CAL—AIR INC IFRM11NO0411O125
400ER'S NAME: PERMIT ISSUE DATE
CBRELLIES 1555 S 7TH
ONE: SANITARY NO. CONTROL NO.
(408) 283-2300
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH.
- CONTRACTOR• D RATION _
uoo LICENSED - Job Description
F `A horeb affirm that I ser Lim under p sof Chapmr 9(commencing p _
^¢ wire has )of Divlaion3afdh Budges Prefwions Cade.and my llceme4
<
in full a ° Q$. REPLACE ROOFTOP UNIT.
]�Lu, Lican Lm.N - ..
tit Dam iL �_Con A
ARCaid bo u e DEC N
3� �denunJ my Pico aha11 W umW as puh c meards -
uo� Licowed Professional - Q
OWNER-BUILDER adDECLARATION \ _
1 WrtnY aBIroI that 1 1. exempt from the Colons Co :Anse Law(or me r
o o following muoa ermil i IID Ltr Business and Improve,
demolish.
Cade:Any oily m csunq• l - -
E:00
•$ which requires•permh re construct.sag improve,deermit t.nr a pair and swcmrt — ' ._ - -
�� prormits imwnc purse pursthe uant
requires,[be applicant of ft far wohractue Liars:Law a signed(Chapter
gggg <
(that hecommencing with
Sectio 700MofDivionsn oftheBusiness
uwmfsUcenseUonsCac m9 Sq.Ft.Floor Area -Valuation
$ C (commencing with Satiium n0 the boards f r the
the B ed rear ld de.Myons CMO w
��11 $ Jut he Is attempt therefrom sM dm huh far de aluyr4 cumpli°n.MY vio1W on of
Session 7031.5 by any applicant fm a permit wbjeou the applicant m a civil penalty of arO 0 _ . J OCCU anC e
not mom Oe fve hundred dollen(SS(In). p y-Tyrp
❑1,umvnmofthepmpmy.wmywploymwithwaguaftUwucmnpemdon, _
wiadothe vMand tosmrctucIsnet mlendwaroffered formic(Sec.70".Businus Required Inspections
and Pro(es tse,Cade:The Conusemr'License Law does wt apply u w owner or .. 9 p .., ..
properly who Wilds m improves thereon,and who wassuch work himself or through his
own employau,providW Natsuch improvements are not intended or offered for sale If.
however,Ne building or Improvement is veld within ane year of completed.tie owner- '
builder will hate the burden of proving that he did not Wild or impasse for purpose of -
am.).
❑1,u owner of the property,am exclusively conuactng with licensed conuwmrs an
conslmn the Paden(Sec.70th,Bushes and Proletarians Code:)Tba Commerce.U. -
cert law dao not apply m an owner of property who Wilds or improves them=.and.
who cancans for such projects with a aontracmr(O licensed pursuant m me Conuaclors
Liam Law. .
❑I am esempt under Sec. .B&PCformisom. -
r Dam
WORKER'S COMPENSATION DECLARATION
1 hereby a(fmn under penalty of perjury ane of the following declaradmam
I hiveand will milnuin a Certificate of Consent to self-Insure for WaskermCompen-
soon,as provided for by Section 3700 of the Labor Code,(rd the performance of the — -
Efor which this permit is issued. ..
I
and will maintain Workermpem
's Codon Insurance,u required by Somali
of the Labor Code,for Ne performance of the work fm which this permit is bound.. .
My Wor�lon, Compenw. lnwnnce'a ercod Pal' n�umhheer art:
Cuic! l�-i.poli °.; t.,fl.A
CERTIFI ATE OF P-XEM OM WORKERS
COMPENSATION INSURANCE
nIds seWam need notbacmnpicmd Kt the permit Is(monk hundred dellen(SIW)
or kms.)
1 certify that in dw"rear lane of the wart res which this permit Is iniad.l shalt am
employ any peen in coy mwrerw a as Wcomawbject to the Worked Compensation
Laws of California DamApplicant
NOTICE
NOTICE TO APPLICANT:If,after making this Certi0cate of Esempden,you maultl
become subject m the Worker's Compensation provisions of the Labra Code,you most '
.J,7,' forthwith comply with such provisions or this permit mall be dcema l rooked.
Z H CONSTRUCTION LENDING AGENCY — —
E+ Ihercby aRrm Nn momtsacanstmctnn tinting agemy fnr ren performencc of
a 7 the work for which this permit Is issued(Su.3097,Civ.C.) -
aQ Lender's Name
z Lender's Address
V Q I certify Out I have read this application cod sum that the above informstun is
LLE correct.I agree to comply with all city and county aNina 3 and slam 12"relating m
C)rVWilding construction,and hereby authorize representatives of this ity to order upon dm
[I] shave-mentioned property for hupecton purpme.
(We)agree an save,indemnify add kap harmless she City of Cupertino against
i.w r�A IIWiIIJes,Judgmenu.caw and expenses whl
mayor cotuc y way aaagainst icor City
C) in eomcquarm of me gratin of mos pe
;defired
ICA N DS A ILL COMPLY WITH AL NON-PO NT Issued by: Date iii
R
Re-roofsif
rt erApp°`Hd z°A o°u ATERIA S DISC ASURE pm Type of Roof
WIII Orc applicator tutu Wier;=.pact stmem addle hazardous mamral
by the Cupertino Municipal Code.Chapter 9.11.cod the Haalm cod Safety
Section 25533(07 �''u_ All roofs shall be inspected prior to any roofing material being installed.
❑Yes ✓Will the applicant Lar future building accupam use equipment or devices whichIf a roof is installed without first obtaining an inspection,I agree to remove
hazardous air contaminants as defined by the Bay Area Air Quality Managcmonl all new materials for inspection.
Disuin7 =, /
❑Yes uj51v�
I have mW me hvndew mamralsmquimencnts under Chapmr6.95 of the Califon
nullwha&Safely Code dorm 3.15533 wd25534.1 underslwd thatifthe Wilding
does rat cube a e w it is my rcaponsINIILY m notify th oaupwt off the
acquimmc do, ,.u .. OL Signature ofApplicant Date
Own amamcdagent m All roof coverings to be Class nBn or better