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00080075BUILDING DIVISION PERMIT I owner Data WRRFR'S COMPENSATION DECLARATION 1 h.ebY affirm under pvWty of perjury onc o(dz fmlltwim8 daWmiom: 1 have end will maintain a Ccnificate of Content to self insure for Workers Compen- setim, to provided far by Salon 3700 of the Labor Code, for the petforrunce of the wwk for which this permit is issued. C 1 have and will maintain Workers Compensation Insurance, m required by Smtion 3700 of the Labor Code, fm the performance of the work for which Nis permit is issued. My Wmker s Compensation Insurance carrier and Policy number are: Cartier: Policy No.: CEUERCATE OF ID EMMON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ifthe Format is flume hundred dollars ISI W) or Icsa.) I certify that in the performance of Or work for which Nis Front is issued. ) shall not employ any person in any manner so as to becom, subject to the Workers' Compeer' setion laws of California. Dem Applicant NOTICE TO APPLICANT: IL after malting this Cri iOaa of Emnaptim. yon should become subject to Iw Wasters Compensation provisima of dee Isom Code, you must forthwith comply with such provisions or this Permit shall be deemrd mvokd. CONSTRU=ON LENDING AGENCY Q O I hereby affirm Our there is a conwcdon lending agency for Pmf.a ,Z—, Ne work for which this permit is issued (See 31(y97. Civ, C.) Lenders Name ya 7Lender's Addrev, fR] I certify shut 1 have readslu this application and e dont the above information is d 0 .tercel. I .gra to comply with all city and county odirnmes and sate laws .1.6.9 to D z wilding consuuction, and hereby aothono npcaenwives of this city to enter upon the move.mamimnd pmpcny for inspection pumurea (Wo) agree m save, indemnify and kap harmless the City of Cupertino against 0 V lissinhi., jndgmcnrs, toss, and eaptues which may in any way accme against mid City >o (gi in consequence of the granting of this permit. f" M1 APPLICANT UN DERSTANDS AND WILI. COMPLY WITH ALL NON -POINT - SOURCE RIiGu I.A'rIONS. 7� z Signemrt of AppliunUComnDataor Data HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future wilding occupant am. or handle hoodoos material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Scam 25532(.)^ C3Yes ❑No Will Ne applicant or furore wilding nccupant use cquipmeat or devices which mit heudous air conumiuna m defined by the Bay Ares Air Qmmelity Managcmcm W R ❑Yes CNo 1 have tun be intension. marenals ra inimmmrs under Chain. 6,95 .(ft Cali- fo reds Health & Safety Cade. Sections 25585, 25533 and 755.U. I understand that if the wilding deer am ,urmnly have a amnl, dal it is my sespomibility m amifY the eceupmt of the nquircrtenrs which must be men prim to iaumwa of a Certificate of Occupancy, Owner m odhonad.gem Data 508 — FINAL MECHANICAL 51.4 — FINAL PUBLIC WORKS Re -roofs Type of Roof All roofs shall be inspected prior to any roofing material being installed. If a roof is Installed without first obtaining an inspection I agree to remove all new materials for inspection. Applicant understands and will comply with all non point source regulations. Signature of Applicant OFFICE Date All roof coverings to be Class "B" or better DESIGN HEATIND & COOI_INGO0080075 OWNER'S NAME:HVIENUE—AIR - NIC CONTROL# .480—A SAN RAMON V41-1– B_V08/11/2000 ,go HON, COATNEY ARCHI"fECrIENOINEER BULDING PERMITINFO °.Oz (925)837-4328 ZE LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm Ulu 1 sum licensed under Provisions of Clutter 9 (commencing Job Description p F=f_w wiNSction70IXeaf Division3of Ne Buain.uN RofeviansCde.and mYlicertxu � c�6 in foil force and ellen. D a�N ucen.e claee tic. « one Comtam INSTALL A/C UNIT ARCHITECT'S DECLARATION 1 undennnd my plans Nall w used. public records z I pressed Profossio til H OWNER -BUILDER DECLARATION t_z T 1 heathy affirm dont I am exempt from On Contactors License Law for On iso following .. (Section 7031.5, Bonuses, sProlissiom q Code: Acity m roomy Sy. Ft. Floor Area alua[ion w3X. m which requires a Permit m comwct, alar, improve, demnlieh, m repair my nmcmrt piiwto its ioumra, also requirts the applicant farsnch permit m file a signed statement that he is licensed pursuant to the provisions oldie Coneredrs Licente law (Chapter 9 eatheisingwims«wmnwolthebasfrthealfthe eed!eaaenaon.An "ohmeaofaCe,10 or Natio is exempt APN Number Occu ane e any applicant For a Permit ubjecrs the applicant to a civil penalty of mon Nan five m dollars 0 (5500). 1, an owner of N<propeny, m rota emPlgaa with wages. theinolc compcvuim, Inspections will Bothe wmkand the is Rudd m oR<rtd (m(Sc 375 14 and RofuoCadeTha Can.... License law does harispinly . sho water of property who WHO, or impnvea therein. and who does and work, himselfor IMugh his own employees, pmvidd IAst such impmvamears arc and intended as orternd flu 204 — UNDERFLOOR FRAME sat. If, however, the building or impsownsom is sold within mer yearof wmplatima the weer -wilder will have the wden n(proving Net ha dm not brad m improve for pus, 301 — ROUGH PLUMBING Dote of sale). Cl. in owner of the pmpeny ten exclusivelycontracting with Land cnnvacmrsro 303 — ROUGH MECHANICAL consOa pmjcl(Sne.70WBminm. ad profession. code:)Tlscmdmcme.Li- 304 — ROUGH ELECTRICAL cense Law doe. rot.PPly to. owner of propcny lulu builds m improv. thereonc and who contracts for such poj«u with aconvecmHJ licensed pursuant in On Camfacmta 505 — FINAL ELECTRICAL u«ate law. ❑ I an exempt ander Sec. .9 &PC for this nasion 507 — FINAL PLUMBING - I owner Data WRRFR'S COMPENSATION DECLARATION 1 h.ebY affirm under pvWty of perjury onc o(dz fmlltwim8 daWmiom: 1 have end will maintain a Ccnificate of Content to self insure for Workers Compen- setim, to provided far by Salon 3700 of the Labor Code, for the petforrunce of the wwk for which this permit is issued. C 1 have and will maintain Workers Compensation Insurance, m required by Smtion 3700 of the Labor Code, fm the performance of the work for which Nis permit is issued. My Wmker s Compensation Insurance carrier and Policy number are: Cartier: Policy No.: CEUERCATE OF ID EMMON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ifthe Format is flume hundred dollars ISI W) or Icsa.) I certify that in the performance of Or work for which Nis Front is issued. ) shall not employ any person in any manner so as to becom, subject to the Workers' Compeer' setion laws of California. Dem Applicant NOTICE TO APPLICANT: IL after malting this Cri iOaa of Emnaptim. yon should become subject to Iw Wasters Compensation provisima of dee Isom Code, you must forthwith comply with such provisions or this Permit shall be deemrd mvokd. CONSTRU=ON LENDING AGENCY Q O I hereby affirm Our there is a conwcdon lending agency for Pmf.a ,Z—, Ne work for which this permit is issued (See 31(y97. Civ, C.) Lenders Name ya 7Lender's Addrev, fR] I certify shut 1 have readslu this application and e dont the above information is d 0 .tercel. I .gra to comply with all city and county odirnmes and sate laws .1.6.9 to D z wilding consuuction, and hereby aothono npcaenwives of this city to enter upon the move.mamimnd pmpcny for inspection pumurea (Wo) agree m save, indemnify and kap harmless the City of Cupertino against 0 V lissinhi., jndgmcnrs, toss, and eaptues which may in any way accme against mid City >o (gi in consequence of the granting of this permit. f" M1 APPLICANT UN DERSTANDS AND WILI. COMPLY WITH ALL NON -POINT - SOURCE RIiGu I.A'rIONS. 7� z Signemrt of AppliunUComnDataor Data HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future wilding occupant am. or handle hoodoos material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Scam 25532(.)^ C3Yes ❑No Will Ne applicant or furore wilding nccupant use cquipmeat or devices which mit heudous air conumiuna m defined by the Bay Ares Air Qmmelity Managcmcm W R ❑Yes CNo 1 have tun be intension. marenals ra inimmmrs under Chain. 6,95 .(ft Cali- fo reds Health & Safety Cade. Sections 25585, 25533 and 755.U. I understand that if the wilding deer am ,urmnly have a amnl, dal it is my sespomibility m amifY the eceupmt of the nquircrtenrs which must be men prim to iaumwa of a Certificate of Occupancy, Owner m odhonad.gem Data 508 — FINAL MECHANICAL 51.4 — FINAL PUBLIC WORKS Re -roofs Type of Roof All roofs shall be inspected prior to any roofing material being installed. If a roof is Installed without first obtaining an inspection I agree to remove all new materials for inspection. Applicant understands and will comply with all non point source regulations. Signature of Applicant OFFICE Date All roof coverings to be Class "B" or better