00070158OFFICE
CITY OF CUPERTINO
CONTRACTOR INFORMATION:
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BUILDING DIVISION PERMIT
BUI LDING ADDRESS
PERMIT NO.
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O'SN E
APPLICATION SUB DA'1li .
883 SEPTEMBER DR
ATLAS HEATING
00070158
SANITARY NO. CON'T'ROL NO.
VEN
155 SAN LAZARO AVE
07/25/2000
ARCIIITF:Cr/BNGINEEH:
BUILDING PERMIT INFO
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(408)739-0516
BLDG ELECT' PLUMB MECH
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LICENSED CONI'RACTOH'S DECLARATION
lob DCSCrIpl10D '
I bareby al nal that I am IimnaA under,...ckion, of Chapter 9 (annnencing
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l)fitOvieion3 nftnc ltunincvanm ,fu+i'�: and any licence
fall
flame
in full force and
isin
VLicense
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Class Lic. p
n
v
1
Uac aL� Commctor
ARChall be oDECablic I
IunJcnranJmyplunnnhallne,:.cJa.pnhlicreeorJn �.
REPLACE FRN AND A/C
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pIr
Licensed Professional
RATION
OWNER-BUILDER,oe
_
unIa. fire law her the
I hembY alarm Ilat am eEasin from Iw G,,osw
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Co e: Any
re®on. (Sellperoutnt ID.H.S. ions CMG: city
and Ice,
loghwanwhich
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%aconmy
l,.1on..
da
which ,ryuircn a Mrmil pi cnn,wct, dmr, improve. Jemnlish, or rcpnir any strvcwrc
un Tu
an
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prinnbid, i.... r ,also cocaine, the applicant far such pehi file a,igandaa¢ment
that he islicensed pntsuaana the provisions ofthe Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
Iconmmncing with Section 710111 ut Division 3 of the Business and Pndcomm Core)
or Thal he i, exempt thcmfmn, and Om basis for Tho alleged emm,n...n. Any violation
of Section 7031.5 by any applicant far ...email ..bill' tae applicant Io u civil .malty
APN Number
Occupancy Type
of not more than five hundred dollar. ($500).
$1
vacation,
we, as their ale .otnpm'
❑ h as owner of the pruln'ny, or any mnployce, with ag
Required Inspections
will Jo the wank, and the smi is Bat intended fir olfurcd bar vote (Sec. 70-W.
Business and Profc,sions Code: The Commi Licenm Law d«s nal apply to an
of propety Who wilds or improves demon. vnd who does such work himself
3621.2021 00
thrnrgh his own a nployces. provided that such haprominews an, not intended or
orr
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oIR+N to rode. It. howr, the moilting improvement is udJ w'nhin n c Year of
Impletion, file eranor-builder will have the burden of proving that he did not build or
inprmeforparpieeof,,le.).
FRAME
204 — UNDERFLOOR
❑I.n, owner oill, I.o...1,.:n udncivcly.rm,m9ing I" It licensed ..... 1,.,, m
301. — ROUGH PLUMBING
the project (Sec 71,14. Businu,v and Prnfecsinns CMC:) 'Tile Contfalla"
i¢nrvcl
xl-uw does nor apply fr an limner of property wbo wild, or imp,om, Immon.
303 — ROUGH MECHANICAL
and will) cnntmc,s for such projects with a counteracts) licensed pursuant to the
304 — ROUGH ELECTRICAL_
Coaracr,A Llae,m Law,
Oil Iasmill under SCC, . It& P c Por hi, re; ,a
505 — FINAL ELECTRICAL
o»fie. Date
507 — FINAL PLUMBING
woHREHscom.ENsnrIQN DECLARATION
lie ,powlng JCalamtil„s.,
I la,mby dfinn to ik, pvattty id Il , I or n
6
508 — FINAL MECHAN I CAL
514 — FINAL PUBLIC WORKS
1 have and will maintain a ceNrng, of Consent to wit-inure for Worker',
for by Section 37W of the Labor CMG, for the
pompemation, as provided
rl'ormunea of the work for whka Ili, permit is !,,.ad,
❑ I have and will mainmin Walker', C'orepcnzainn bicameral, a, mquircJ by Section
3700 of the Labra CnJc for ,he performance, of the work for which this permit is
Pcnsmion Insurance curiae and 1'nllcy nmynb�er'are
issued. My Wer ken's ComL49-
Cxricr 1'ollcy-C11W--
Cli%EMI�1'ID FOM WOR E
'
COMPENSATION INSURANCE
('Ilii, ,,,aaaa need nm to Co:n,lood it the par nit i, lir, one hundrcJ dull;
(Slip) or In,,.)
T samily that in [lie Performance of the work for which this permit is issued. I
%fall nal employ any person in any ne onur so as to benne ,object to the Workers'
Cntnpeire lan Laws of Call ma. Done
Applicant
NOTICE TO APPLICANT: If. after snaking this Certificate if Eamption, you should
'he Worker, Cnmpenti in..... kion, of he "Nal Corte, you must
bon ac object m
Ofidbwlth
comply w lm ,ncla pooviki cur mix permit ,hall be, deemed necked.
.
V)
CONSTRUCT ION LENDING AGENCY
'
1 hereby aRlnn that them is a construction lending agency for the perfr anown
fine work for which this pa..it is issued (Sec. A197, Civ. C.)
QLeader',
Name
Z
Lender's AJJm,s
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1 minify that l have read this application and .ante tart the above information is
err a 1. 1 algae m Comply with all City and county ordinances and score laws elating
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h, halloogn:mnrclinn, and hen-0Yspectin ynccantm vc,ul laic cilY to mnenman
s t�
IM1c abo(We)agree to ndfor inspectionpurposes.
a 6.
save. keep
(We) ($,save.. he Cityofcome
V1
rat liifyund
agno ain,, amid
which may in any way acerae ugaimt mid
whih. tiny in
liabilities, judgments, Cohrs and ea.'It
me A In permit.
City in ,ANT
UNDERSTANDS AND WILL COMPLY WITH ALLNONROINT
Issued by: DDIC
y'
SOURCE REGULATIONS.AND
SOURCE. REGULATIONS.
Re-roofs
Signature of AppBcart/Contmcmr , Urte
HAZARDOUS MATERIALS DISCLOSURE
WillthcapNienttlorram,c ballJingocca,rm hmm rehandle I.Iobax,naladul
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Type of Roof
as Jeraed by the Cupertino Municipal Cole. Chapter 9.12. all the Nabil and Safety
.
CMG, Section 25532(($)'!
O Yes C1No
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment fit devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air conmminam, a, defined by the Bay Area Air Quality Management
all new materials for inspection. Applicant understands and will comply with
Dinmins?
wet Cl No
all non-point source regulations.
1 have read me hacardous materials requirement.. under Chapter 695 (if the
Culifumia llealm&Safcty CMC. Sections 255V5. 25 nJ 255JJ.1 undemmid mm
if the huildin snm cummly basso temml, tbm-' ,ry respnn,ihiliD to no ify file
,...punt d a ...n'ac:.eon which asst he or ¢, k'n lir of :,�yt' e,m of
O'O,ane (
Signature of Applicant Date
All roof coverings to be Class "13” or better
,r:nnhodzed agent Date
OFFICE