02040028 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20738 SCOFIELD DR ALLIED AIRE SERVICE INC 02040028
OWNER'S NAME: APPLICATION SUB DATE
NEWMAN MARJORIE R AND WILLIAN 661 SINCLAIR FRONTAGE R 04/05/2002
PHONE: (408) 934-8844 SANITARY NO. CONTROL NO.
O ARCHITEC(ENGINEER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S
DECns of CON Job Description
i a n ad 1 hereby gT of that 1 am licensed under provisions of Chapter 9lrommencing P
_C J wnnfahan900)arDiviaon3nnneBa.me:a andrmn•,.mn.c m.and myueense INSTALL 3 TON AIR CONDITIONER
is in mu faire arta d..
3miLicense
� Class �V Lic.M
Dam ARCHITECTS D
iii EC lal
.
:L0 5 1 understand my plan.shall he ueeECLAR 1 seJ as puhlic remrdz
1�pO Licensed Professional
uxi°' ,lot I. comornER DECLARATION
Q—' I hereby (Sect mat 1 zm cacmpt from the aWme, a License Law for the
t Z n following recon.(&abort 703 L5.Business and Professions Code:Any city stcounty $3468
F o wn an q a perm I I consumer.I e mProve eunorsn.or repair any almnnre
i30 prior tons issuance, rdlums the applicant for such permit o file u signed statement -
'balhe licensed p rt btn1 he ptb ' ofiheCummnnr.License Law Chapter 9 9, p Ft�C)brga Valuation
(mmmenc n6.,'thS Iia ]D0o)nf Div zonJol me Busmcss and Professions Code) I, s}k � �3.�7L1 t7(J,[ ', U V,r f a ( r „
or that he is exempi thirefrom and the basis for the alleged aaemptiori.Any violation
of Section 703 1;5 by any applicant for a permit subjects the applicant to a civil penalty
nfnnl tuna than rose nandad dollars ls500). 3 0--�PN YffH MECHANIAL" Occupancy Type
Ell,as owner of the property,army employees with rages as iheir.sole compensation. qnza _
will do the work,and the structure is not intended or oRcted for sale(See:]flea,
'Business and Professions Code:The Caron 'x License Law does not apply to an 505 — FINAL E rMIplgpgFtions I
owner of property who builds or improves thereon,and who does such work himself
or through ti. ployees,provded iha h_ p, t: _ t intended or ..08....--FINAL MECHICAL
..of(e-dl le!If,nwever the building ur' p is,.Id d year of - -- -. - '- '- -.AN _ ... ....._.._ . ...__..._._.
completion the owner builder will have the burden of proving that he did not build or -- •
improve for purpose of sale.).
❑Lusowner ofthe pmpmY.am Business and Professions
Code:)
Contrtorsm -1,1.: ...� .. -
- License the oejen(Sec. to a Business and Professions Code:)The ves tat rcon,
-+ - License Law does not apply mon owner th progeny who builds or improves thereon, F i N A L E
..and whucommcls for-such P 1. .with.a.cammnorfs)licensed pursuant to the. __.. ._. .. .._.. ... ..__ _.... ..__....._. .__...__.._.
01 mm sci License Idw. .. .
' ❑I am acmpt unddr Sic.' � .B&P C fonhis rwspn - 1, .. ,
Owns ,. . Date APR 2 2 2002
WORKER'S COMPENSATION DECLARATION
1 hcrtby efrtm under penalty of pmrjury one of IM1<following leelamiions:
❑ 1 have and will'mointain'a Cenificate of Consent to self-insum for w'od,ert BUILDING
Compensation, as:provided for by Section 37W of the Lalan Cale, for the
performance of the work for which,his permit is issued.
,0/�s'h.
have and'will maintain Workers Compensation Insurance,as regeired by,Section
f /i'I.of the lmbm'Code,for the performance of the work far which this Permit is
issued My Workers Co pe ws o I vane - and Policy number are
Cartierthey N
. b
t "CERTIFICAT N OF BKCMPTION F WORKERS'. - - i - • s s f - •. -
COMPENSATION INSURANCE ' ;' ''`
l '(This section need nam be mmplmcd if the permit is for one hundred callers "-i• " '' i
IS100)or laws) ,
1 i n ly that in the pert myoma f,hc work for which u perm, issued,I •I 1 h,
shallrepent amployary os of in anyma ash o become.wb3kt to the Worked
A lucent' nncY.see'
Compensation Laws of Californiaalif :Data
INOTICETOAPPLICANT.If.after makingthro Ccnificaeof Exemption,you should ` • "
Beed bj a llie Wa k C" ptnsaiir t me of themust
Labor Cale you must
Q O fonhu th comply with such provisions or this perm t shall be deemed revoked.
. . .. .. , _ .. _
.. .. ._ . . . . . . .
_ - - --
Z y I ' "uv _t -'CONSIRUCDON LENDING AGENCY
"'
-� I nerecyalarm mat thea is a canstrualnn leading agency for the performance' .
flrwhich perms' eaIS .309],civ.c.l .. _.._ ._ _ _... .. ...
'(a 'nd rN , , _. .. ..... _ ..._.... ._. _ .. ..._.
.7 Z Landar'isAddnaos ,r 1
UO
1 certify that I have mal Ihis application and stoic,hat the.Wsa information is
I. E., correct:1 agree to comply with all city and county ordinances and state laws relating
O'U as Wilding construction.and hbraby authorize repre@enmtives of this city to enter upon
L4 the.ahuvemciati.mcd pmpcny for inspection mpurposes.,,
. A. IWe)agreesaharmless ve,indemnify end keep hathe City of Copertimm'idonst
Zn liabilities,judgments•costs and expenses which may in any way accrue against said
V Z City in cunsequcnce of the granting of this permit.. '
- APPLICAN'r.UNDERSfAN'DSAN COMPLY YITHALLNONPFNT Issued b r Dale
SOURCE REGULATIONS I IV,4 Y
SignaWrcof ApPlicaWC t I ' Re-roofs l
.. HAZARDOUS MA ERIAIS DISCLOSURE
N 11 the epplicam f twe Wildcallecoxiontaluoulaorhandle boeardous mmenal Type of Roof
as darned by th Cupertino Municipal Cale Chapter 9.12.and the Healy and Safety
Code Section 255321a1? a-luAiol 11
.-
All roofsshall be inspected prior to..any.roofing material.being installed._ _._.._..
Will heapplied"orfuture Wilding occatual.,aagwpmeriiadevices which If a roof is installed without first obtaining an inspection, I agree'to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Managetrent
District? all new materials for inspection. Applicant understands and will comply with
❑Yes , ,
0
f ,. 'y-� , all non-point source regulations.
�.- r have�mad�the huzerdovi materials reyuirmn<nli mndei CltaPter�6.95 of the
California Health&Safety Coda Sections 25505,25533 and 25530.1 understand thatr�c building docs nee currently M1arcmmant.thalit ismY rtsponsibility to notify thelt nt f th eons hich must b< t p' m ixsuance of a Cemficete of P. Signature of Applicant Date
owner a aathon agent All roof coverings to be Class "B"or better _
s; : . ,
_._..- - OFFICE . .