02040109r
CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
'CONTRACTOR,INFORMATION
BUILDINGADDRESS:
PERMITNO.
A PERFECT CLIMATE
02040109
OWNER'S NAME
APPLICATION SUB DATE
JOHN RARLAN
10570 S DEANZA BLVD
04/19/2002
PHONE
SANITARY NO. CONTROL NO.
(408) 861-9545
ARCHITEC"VENGINEER:BUILDING
PERMIT INFO
rBLI'DG ELECT PLUMB MEC'H
C_I L.' J I I
LICENSED CONTRAROR'S DECLARATION
Ihertby0) of lhnlam licensed t...tamviaionsofm paah,p(rom,lh,,my
with on7000)ofDivision3oflheBusinasendPnfessiOnsCotle.endmylkenw
Job Description '
IS In
unlull fOR ��AA
REPLACE FURNACE '& ADD A/C
.
Llcenu CI Liy
— _
Commr�
ARCHITECTS DEC RATIO
I undemeM my plum {hall be cud as public records
Professional
OWNER -BUILDER DECLARATION
1 hereby aRrm that I am exempt tram the Convector's U"mo, law far the
following maeun. (Section 7031:7, Bmineu and Profassiom Code: Any city or county
which requirespmro
a nit to natmn, alter, imprman
e, demolish, or repair y structure
,7 8 O O
-priarm its ifwanca, alw re quirts Neepplicaq farsiuh aimed,w file a si'sed{utement
that be:irli+iusedpyisvonlijdhW olv'sbnsofdleContranMsLicenseLaw(CbW,,9
-- - — --Valuation -----
5 y
t-f��`-�-;3106.3t7� �,�\f': l�jij`l`
----
(commeprin1 with. bationjDp0)af DiW{ion Sof the BusigssaM Profnsiom Cade)
or thefts is exempt rhhefmm and the scale far the ancient cuumptnn. Any violation
'OfSeddon7031.5byany applicant for rpeemh subjects, the applies, to a clvi-perulry-
;ofmmakitheifiwhuncheddollars(5500).
pp NN73''
301—N UH
;'ea.rTNO Occupancy Type
❑Lv{owner of the pmpeny,gmya loyeu with wagescaNeino1. camppeenwtion.
,wlj-dolfie wo
-r and the itmcture n no, fiiereed'or a@red"for kalee'(Sec:'7Z..
.owner
K PLUMBI
-
G
CAT
304 - ROUGH E 1I9Mt10nsT
mfessiom Code no Conme,to s Linme Law does nor apply to an
of a Who Wilds
property or hmpmvca thereon. and who does such wok himself
or Nmou ed1mr own employees. pmamee that such Impmvemenu,w not imendpd N,
!a(lamtl i ale. If, howeaea the Wading Improvement told within one of
.....5.05....-._-EINAL._ELE�TRI CAL _..
t n Wild
dstrov.for rheownorWader will have Ne When of proving that he did nor Wttla
507 - FINAL PLUMBING (; i `
Improve for puryow of -----
.__---......________,-,.--_—...-_
508 - FINAL MECHANICAL
I:tlowner athe p(Sca.7 am censed�...__.--
to
eantracdlanuflingW CW.::)Th
i. ,+
rijecf tell....
Bull Conoism
Lion. the pme no fWI70ad, owned are Pmfes{ioca CW.:) The Conlrwlrae'a
licenee law dram not apply to su owner of popery who Wilda or impova Merton,
,,, q.:;.:' ILECIis
•' .'-�\ r7 'i C'45 •LC!,
..cad.wubm'.Lncss for.uicb.pojcss.wiNu-romraaar0l ligased.puauwao the.
.. __. .. .• --.-s-. ..--_.._ ____.�
ContrecmM1 uttneaU �
❑lam exempt older Sec - - �B $PCfa
Data
c _ WORKER S COMPENSATION DECLARATION
•.- I bertby afRrm undo pamhy of pcOuN one of da: fallowing deeWsuwu: -
❑ I IYVa Yd WIR IIYin4in CCNEeete of COOsent'ra wlf-ImYn f01 Worker's
Cpmpel®tion,-a- pavWed-for -by Section-3700-of-Cle-Labor-Coda:'for Na
perforfmdce'df tiro wok for.which this permit u iwuad-,
I,O
0I hale vM wall malate. Wast [ Csmism
V regolrtC b'Wnuit
ofOlmu`rjna
3j00 0( Ne Labor Cak far the piifomunee of Ne wok far which Nu pemut b
I.
1'ssaed My WakeTs CompedAuRn IdsuunW � er and�p•O1r1C',y number ale h i
"_V:�It:,..'�!').
�`'F 'RT CATI NOF E7tEMry ON FR9lM�N O1iKh�e-'�'S.
f'(F.•.4A'tv71
_......._.,»..,....,_-m .. •
"` 5Thficdrldn deW na be rom lewd dthe 1 far rare hundrtd doll
p pemu ,n
""tenant:"'•"""•.wry
'ic'�� l♦UiJ n• 1 1 �IU'I"'9 l)CCU^un;:
(' .. 1 e mf� slut in the peiformoge df alk ark fdr ,hich thu permit li Ivued I
IFoR no{ amp oY any,Perso^ In W
s ;r•}t- r \ =tv
' �'_ h-'
a Y'mddner ca become wb3ect io'Na Workeri'
Comppnulion Liws,pf Ctlifomla: f)am1^"^"""""..: ••"'.'.•.. ,,. ..,..
,i2.f`i
I
'
_- .._
'NOTICE
TO' (CANT I us maklnp thus Con nigh, of empvon. you-ihould
*T!r subject to the WOkels Compeawtion 0;6visiau of die Labor Coda'yoomuat
-
foMwiiA'caaply'via such yeovialom or this pamil {hall he deemed! malted,
-' - - -'
+F: a 1- '. �CONSTRUL'nON LENDING AGENCY ` "': ••
- - -- ' -- --1--'. (' x
''°' 1 Mieby �ffifm that then 6 a <odiink, on Igndirj agevcY for dw perfomj,nce
of the welt for whldh this i u issued (Sea 7 7 'v, C '"
9, •.� ,. 'r-' -, ,,, t,; n
mi 7
headeriNeme •' � .._ .� `r; _,_ »y .,a..";..i L...
._.....—..._ __—_.__.. _... .__..__._. _._ -._ _,._.._'
Leiters Addresfi 'r c
' l cmlfy Net 1 hove rtad NuOpglitnien antl lute Out the dbove infamkton is
t$i¢ki:7 gree w romply wiN alLpty Yod coumy,oNi(,once, end,nm Mw mating
�'
10 Wllding nn{,NGrIOn, alit IlenbY aYNUd2a Kpre{CnleiiV4 dltlYf city. W Cher upon
the above•men,joned pr0peiry for igspc4ov purppua,
i tWej'i{Tie i'oYNe.IndemEif(y and keep hlrmYesilhe`city of CupeHmO.Saml
_
lubtwn, Judgment{, caste and expensca h ch may jaeny way wcrpe gainstsid
City m c equente et the gpnimg of 0�S pe[tmL '
real a,rlNOr ST�.T A pnLLeo Yi 4H N. Gra ,
r
E
sG e vILs 9n )...,•
Issued by: Date
R w cw n to a.;, Dims..Re-roofs
'- d vs I`s DISCL.DSURE .. '1 q. t �2
_
"M Applicant W so lnae a handle.-_ ,. m.mial
Type_Of ROOF _. _.. ...; _
nIhr ned by the Cupenbro unci CMpta912 aM the HalN and Safety
Cotle Stamm 11132(s) z , ,--
7tA V012r�,a,J.
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❑Ync,+. a•L-,l u.a lA'
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Allroofsshall.be.mspected.prior.to.anyrbofing.material,beinginstalled....._
Wdltheepplhcmt"Aamw W dm{{acwpentuse quiprmetordo0ces; ch
emit h cirdwf ,vc numinwUse ruled by Ns BNArea Mi
If a roof 3s insialled without first obtaining an Inspection Pagree to'i•elilove
Quellry Menxienent
DI{tiaOYn 1 f� t Na
'
all new materials.,f9r,iASPection..• Applicant understands end_will colo 1 w tl7
P X- i --
all non -point
•. ,
source regulations. • . I (. a.
i
1 h,y'rtd Nc hwardout muendf regtiocniNi dialer Chaptn 69S�ef die
Ctllforma Health A Safety Coda, Soctians 25707: 77733 wd25534'1 understand that
';i(jha
lad YduigdoesnaLtunendYhav nnenL Nat It is
f myrtspons responsibility notify
peFdDwt rat the yd ads xb vii bent da,to I mhc¢ of a Certacete of
r P
_.. _...... _ .. ..__. „. -._- .. .. ..__ _ ... _ .,....... _ .. __....
•,r ., a
ptxuppic -
(� D
,_ .Signature of Applicant ..._.,, . _ ... ..._ Date -..
All roof coverings to be Class B' or better-
etter
net or vol piem co t , s
..._,_ OFFICE -....-
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