08040024 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CO£�I,TRACT01.2 rrt'FUrzMa`I�raN °'
BUILDING ADDRESS: PERMITNO.
11060 SANTA TERESA DR AIR CONDITIONING 08040024
NER'S NAME: INNOVAIIIJN�lINCPERMIT ISSUE DATE
COLLINS DOUGLAS E AND P 0 BOX 270075 09/26/2008
PHDNB:c'n T i srirn7 SANITARY NO. CONTROL NO.
(408) 297-6209
ARCHI'IECT/ENGINEER: BUILDING PERMIT INFO
BLDG EIF.L7 PLUMB MECH
uOp LICENSED CONTRACTOR'S DECLARATION
1 bercby affire Oil 1 And II¢nscd umkr pre isimu of Chmem,9(mmmereing Job Description
with Sectian 70(n ad Division 3 arum Business sed,�Psrr�or•kssiares Onto.aw my ucc=is RELOCATE FURNACE TO ATTICE (NEW FURNACE) ADD A/C
Liiec forcell and ellen! •70 LA.N q7(•Wit;
p .s.
Dam Cnlaevl�nl0 GSDECr 'L Aletrinrs..]r..
—'P'—
ARCHITECTS DECLARATION
toaI understand my plans shall W used u public recomis
OU
g
Lic
C ensed Pmfcssional -
OWNER-BUILDER DECLARATION
.�i M 1 krthy aDinn that I am exempt found the canvacrers License taw for On
00 following moon.(Section 703 1.5,Business and professions Code:Any city or county
e 8 9 which requires a Permit at construct,alcor,improve,demolish.or repair any swctum
yiy prior to its issuance.also.quires IN applicant(onuch permit to file a signed statement
EEM the W is licensed pursuant to the provisions of to Connector's ucenm Law(Chapter 9 Sq.Ft, Floor Area Valuation
%HF (commencing with Section 1000)of Division 3atOcBusiness and Professions Code)or $7200
Q that be is exempt therefrom and the bub for On alleged exemption.Any violation of
Section 7031.3 by any applicant for a Permit subjects the applicant to a civil Penalty atNumber Occupancy
ream than five hundred dollars(SIDt. 35617032 Pane Y Type
I,u owner of de pmpcny.sir my employees with cages u theb mlccompcnsadon.
and dathewads Crude:
he Contranot Intended.awrdo(mulepply An So MANO Of
and property
Code:The Contractors Licensendwho Law does ret apply lf an owner is Required Inspections
manse.wW Wilda provided
Oivasch improvements
aredonnot intended
himsr�fmthr sal his
awv emplace Wiping a,i pr such impmsemenuart not earofdmoBrmd for sale. ,
h haler
are Wilding orimpmvammttsacold within are Year sir mposon fo.theowtar-
builder will have the Wrtlrn of marina that k did Not build m improve for purpose of
sale.).
0 1.an owner of she property And aelusinly contracting with licensed ren ss eon m
constmct the project(Sec.7014.Business sod professions Cade:)The Comtrcmrs U-
cense Law data not apply As an owner of pmpeny who builds or Improves t ertan.and. .
wW cantracts fm such projects with a camnclar(s)li.d pursuant in the Canuvmors
Ucros Law.
I van exempt undo See B g:PCIm Nis resloo
nv Dam
WORKERS COMPENSATION DECLARATION
I beauty afford under Family of perjury mon,of the following declarations
0 I haw and will maintain a Cernifiae of Caoem m self-iesure far, Workers Comprn-
smor,As provided far by Section 3100 of the Labor Code.for the Performance of the
wort for which this permit is island.
0 1 have and will maintain Workers Comporeation hwramcc,As required by Section
3700 of the Late Code,fm theperffer ance of the wort for which this Permit is issued '
My Workers Compensation Insurance artier and Policy number m::
Carrier. Elnet'14'c n- c in peoh No.: Ls1 O I
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu cctirn need not W completed if the permit is(mane hundred dollen($I00)
or]oil
1 ment that in the perfmasenen of Ne work for which thle Permit is issued,1001 am
employ any Person in my mancrm As in become subject o the Worked Comp,rom on
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this CeNRcau of Exemption,you should
Income subject in the Workers Compensation previsions of the lobar Code,you am
.,O forthwith comply with such promif visions or this pershall k deemro
ed oked.
Zy CONSTRUCTION LENDING AGENCY
FIherebyarm saw dam u a construction lending agency for Ran perfmmamx of
p:
On work for which this permit u issued(Sec.3099,Civ.C.)
a0 Lenders Name
D z Lcmdera Address
U O 1 astify Rut I larva read tills application and sato this the have information is
F correcL 1 agree to comply with all city and emery cNinweea and assn htws relating m
O U Wilding conamc m,and kreby auLutis rtpmaenudvas of this city to enter upon the
{t7 above-mentioned properly for inspection purposes.
g), (We)agree to save,indemnify and keep harmless da City of Cupertino against
In liabilitica.judgmcmu.costs and experucs which may in any'w'ay amu,against said City
U Z in cmcamsmse of the grunting of ' Permit.
^ APPLICANT UNDERSTANDS ND WILL COMPLY WRH ALL NON-POINT' ISSUCd by. Date
SOURCE R ULATIONS.
Signature ApplianUCa erRe-roofs r Da ,
H US MATERIALS DISCLOSURE Type of Roof
Will the appliesmt sir future Wilding=upset rtorc arluMk haummus material
ha defined by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
IF ode. ecuredcy.2ss3z(,)1 All roofs shall be inspected nor to an roofing material beim
❑Ye, �a P P Y g g installed.
Will the applicmt or future Wilding occupant use equipment or deviecs which If a roof is installed without first obtaining an inspection,I.agree to remove
emit hvirdous air conuminamu„
District? fined by the Bay Arca Air Quality Managemcm all new materials for inspection.
DY. No
I have cowl Ne boredom materials requirements under Chapter 6.95 ofthe Califm-
nuHcolNhSafctyCode,Sn am 25515,25533 and 25534.1 understood that if the Wilding
na
dnot cmmody deme ani dot If u my reaponslMlity m notify de ottupmt of Ne
requm, which. IkmmPtioraiesuma,anCenineaeofoceupm . Signature of Applicant Date
i
owner0 auffigelamil agent bmc All roof coverings to be Class'W or better