01100079CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
'21887 SHATTUC DR
ALLIED AIRE SERVICE INC
01100079
OWNER'S NAME:
APPLICATION SUB DATE
HAMILTON RICHARD E AND KAREN
661 SINCLAIR FRONTAGE R
10/10/2001
PHONE:
SANITARY NO. CONTROL NO.
(408)934-8844
: ARCHITECT(ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION 1
Job Description
I hereby of ire thm I am licensed aader farwi,mits of Chapter 9 (commencing
withSmtion70001ofDivision3oflhe Businessand Pndesslorw Code.andmyliermse
FURNACE REPLACEMENT
is in full Tome and of e l 1
. License Lica
Data yc� Cantnaor
ARCHITECT'S DECLARA O
I undersmnd my Dian, shall be used as public mcoNs
Licensed PrnfsWonvl
OWNER -BUILDER DECLARATION
1 hereby affirm :he. I am exempt from the Contractor's License Low for the
following reason. (Section 7031.5. Business and Professions Code: Any city or county
. wM1ich rtgmrcs o permit m conswet, ahcq improve, demoliN, or repair any mrv<wrc
$1224
I priortos'ssu rce. also req' m ppheri tf such permit m fit... i,.W statement
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-- - - - - - - - -- ------------ -- -- --- -----
jJ }y' QD Vye� }1 ::
Valuation
thathe BI« dsedpursuann th provisions of the Contractors Licenselsw(Chapter9
that he
Sawn 70118) f Division 3 f far Basuneu and Cade)5S�S
(cammeac ng wish PrNesswns
or tont he hs exempt therefrom cad the basis (.,,he alleged exemption, Any violation
l
of Section 90315 by any opplicvm fora paresh subjaca the applicam w a civil p .I,,
of as mom thin rive hundreddollars (s5oo).
Occupancy Type
API Wnbd�
301PLUMBING�r"�:•'
O Los owner of the propcny, or my employees with wages as their sole compensation,
_
will do the work, aM the suucwm is not intended or offered for sale (Sec. 7111
,will
and Professions Cade: The Contract's License tow does nor apply to an
r
304 - ROUGH El]GC1T]X cti oils' '
owner of property Who builds or improves thereon, and who does such work himself
qrthrough his Own employees. prosuce! that such improvements are not inended.pr
_-
.505. -_-. FINAL .ELECTRICAL_._._.._.
'offered for 6alC. H; however. the wilding ah imp rovemeat is sold within ma year err'
completion, the owner -Wilder will have the burden of proving that he did not wild or
507 - FINAL PLUMBING
improvemrpurposeofsolef
508 - FINAL MECHANICAL
.D I, as.. W the Ptolemy, nw exohaevely coouacuvg with Beraud
continues the project (Sec. 70`14, Business had Professions Code) The Contra .....
, I•
License Into docs not apply bac an owner of property who builds or improves demon,
1
and who convects for such Project with a conuadorfs) licemaxi pursuant to the
... ......._._ . _ _ .._ .,
Contractor's License Law. ,
D lam exempt under Sec. t .B&PC formis memo
l'r't�s'.i 't�llfgl
Qwnar orae
FINALED
WORKER'S COMPENSATION DECLARATION
I hereby arum ander penalty of xrj�ry one of the following declarations
N O V 4 2001
7 I have and will maintain a Ccnifcmc of Consent to self -insure for Worker's
:.bmperatimm, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
have oath will imtinmin Worker's Compenwtiun,Insurvnce, as required by,Smion
BUILDING
700'of the Lvbor Code, for the lerforrhunci of the woh for which this punct is
mauW My WorkeYs Ca pc nail 1 umnce comer and Policy num/b�er are
.,w.
Cfamer '...CERTI�EXoEMPTION
.
: `(: if �- '.I � �tj tt::� s/ � B %;, As. t•
OM WORKERS' 1�
a .. �
. .... COMPENSATIONINSURANCE �. ,. r,. ..,,,
._
.___......._-.________ ____._..__.__-.___.
,:. .,. .,
" (This erection nccd nm be comphitQ if the permit is for ane hundred dollars '
t' .,. �1:`r
-
(51007 or It
I aalifr Elias in Je perfamurce orthe work' for which that perost isissued.I
... .fZ..11l ,... ..., I'�C.!is'I`»•Y - --'-' -
shall not employ any person in any manner, so as to become subject to the Workers
Compmsvdon Law, of California. Date" -
- -- - -
'licant
NQIICETOAPPUCANT.II;aftermak.;
making thisro cnifcete of Exemption. Yoyshould
fi
becons subject to the Workers Compnaaaonp virions of the Labor Code. you must
forthwith comply with such provisions or this permit shall he deemed rcvokrd.
' ` 'CONSTRUCTION LENDING AGENCY
i " I hereby aRrm that there is i consvuciibn lending agency fon;he performance
� ufthe work far which this. ec. 3097. Civ. CJ„ ., ,y ,�,,.-
- ... _ - .. -. .- _ -
Isndn's Name' --„ .,•
LeMda Address"
,' 1 e,•„ �'pt•it
I agiee tom 1 ham mad this and smm that the above information is
'
C.I. I scree to comply with cityordinances arta oily laws
coy pod c
and
hallereby mpre of this mymcmer upon
j to building conmrvetionoperty rtenter upon
property far inspechrimmprtscnmtives
.-
1 tM ebo(We)agmeto
adion kepuharmles
I We) agree to save, indemnify and keep harmless the City of Cupertino against
1 liabilities. judgments. costs and expenses which may in any way atom again.. said
-
City in bonuquenbe of the Starting of this pd?M
' APPLICANT UN TADS AND W L COMPLY W rrH ALL NI.O,y- POrN]'
Issued by: Date
SOURCE REGI 1 ONS, r. �0"/ a /O/
Signal fApp�raC c - //,Dam /%..
- HAZARDOUS MATERIALS DISCLOSURE ,
Re -roofs
�..
wdl the ppumrn future molding oceudunt slam err ha.d)e hamawus material
,Type. of Roof .. _ . _ �-'%. _. a f _
.�
as defined by.thc Cupertino Municipal Code. Chapter 9.12. and rhe Health and Safety
-• ,...i..,
•..
, . i , i usyl , :. I I^"I b
I-!t�k -lu it iy'J-(1 ;rV.
C : a^a: e
Code, Sermon 255321a1" 1;.....,' '.�`.:'.':''•'
I-) Y. y ❑No',,, i' , '" "'
nl. - -
,.
-- All.roofs shall-be.inspected prior_to_any.roofing,material being. installed.
..
i• .,tonthariPpuestiomfunimbuildingneempiamumegtiipmemordevic<.wnien
- if a roof is inst911ed'without first obtaining an inspectiori,-I'agiee'to remove
emit haraidous as compositions as daimmi by the Bay Anes Air Quality Management
Dicoria'!
all new materials for inspection. Applicant understands and will comply with .
❑Yes, a.ONo ...,d1 'v "' -,3
all non -point source regulations:.,-.
1'haJc read she hazaNuusmamrials requirements under Chaptcr�b.95of the
orms Health & Safety Code. Sections 25505. M533 and 2553`1. 1 understand that
ildinIy have a¢twt
-
of the ir ems which mu w mei prior m ia....m'of a Conificam of
pvnc(' "Signature
Lan
of Applicant Date
All roof coverings to be Class "B" or better
ror thadmdage 1. Date,.,
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OFFICE
I