01100128 CI TY OF
c DIVIISSIIONNDPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
5939 SUTTON PARK PL AAA FURNACE & AIR CONDIT ONING 01100128
OWNER'S NAME: APPLICATION SUB DATE
NAPOLITAN FRANK J AND YOLANDA 1712 STONE AVE 10/24/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 293-4717
o-O zARCHITECD`ENGINEER: BUILDING PERMIT INFO
m BLDG ELECT PLUMB MECH
I= LJ
8y Z LICENSED CONTRACT'OR'S DECLARATION Job Description
5z_0 loony )offirat mat1nmoftheBunderpndPrfsofnsCode9ndmmenense REPLACE FURNACE 100000BTU.
with Sermon]OOU) fDi Division Business and Professions Code,and my license
is in and
zso
6
License
Lic.mrX �
S aenm,ar
O 4 1 understand my plans shalCHIlLbe used as public armed,
u,
O O Licensed Profceaional
-°' OWNER-BUILDER DECLARATION
ti1 hereby saffron Na,12M exempt from the Contractor's License Law for the
H z< following momp(Section]03 L5,Business and Pronasions Cove:Any city or county $1950
Tjwhich requires a permit to construct.idem improve,demolish,or repair any soucmm
�a. .pnmmiu,ssaaoip elmreq tM1 isiom If Contractors
is .Ledau¢mem.
That hda io,witpSiseti tgtldpof Dou, ftWC trap! L Is ons(chCoe) Valuation
(commencing with Sar n,]o00) rhe bio 3 nn Burnes( data ions Code) ^O,r.�
or Nut o is exempt tmy applicant
li and the basis for the subjects
th d exemption.Any l Penton '
of Section 7031.5 by any applicant ror a permit subjuu the applicant to a civil penalty-
.nr net mpre than five hundred dollars(asoo). 301'4 kfPLUMBIN Occupancy Type
El I.ns owner of the pmpeny.or my employees with wages as their sole compensation,
will do the work:and the soucmm is not intended or oRened'for sale(Sic.1000,
-Busineis mW Professions Cod,The Contractor's Licerne Law does not apply to an 304 - ROUGH ELIEWRd UAllirctions
owne
r of property Who builds m improves thereon,and who does.serh work himself
or through his own empinyeea.provided mar such imprnvemenla are not intended m - - 5 0 5 - FINAL_ELECTRICAL_
-!offered for sale w
If,however, he Wilding or impivem
oern is sold within doe year of 507 FINAL PLUMBING .—i
, ��• "if :, - _
completion,the owner-Wilder will have the burden of proving that he did not Wild or
improve fmparposeofsale). 508 - FINAL MECHANICAL
❑I;ax owner,of the PmP<nY mo asel.6valy contracting with licensed contractors to -�- �_..."...- ._"._..__. .'..
J
' c
onswa the pmjm(Sec.7000,Business and Professions Cudo:)The les tncmr's _, ., o ,• .I,
License ,co mnen not apply m an owner with
a confer who builds or improves thereon, -
.- + andrarmea micams,L . .pro_ with a commaogs)li<enud Dursuem.w.Ne.. -
01 am ase pa mida Low.
- ❑lamexempt under 5e<. ��' � ;B&PCfonhis reason
_
OwIns, :Dam"
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty or perjury one of the.following declarations: FINALE®
❑ 1 have and will maintain'it Cenifcmeof Consent to sdr-inure for Worker's
Compensation, as provided for by Section 3700 of the Labor Cade for the NOV O 2 2001
'pmium,ance of the work for which this permit is issued;t
m'11 tl II m Wode Co t m
'1 s u,u,as re amid b Section
7
00-f Ih f toCafe f theperfp of th k f which the by
t is
-- ins ed My W k aconpenati obis IPoIBUILDING-
.�. s ......... .._,_..___._.. .._
Croner 4 •(`f POI CY No..'J L�.f��y �� "k A1: iY }•�. 11Y t- (.t�'IyY ittR 1'1 h:. \:,12::s•
-.t, ERTIFICAT10NOFEXEMPTION FROM WORKERS' � 1 ,` e (•\'k I�rtf r .•Y•]1sC;:a .
u , COMPENSATION INSURANCE.''"`"'"
" npmi'.nidn'nxd a.be eonle¢d if,he cmni.is for one hundred dollars ,. �.rilp_.,., 'f:�'e
(51(10)or less.)
I canif that in the l fioh
nomm of the work for which 11 o uts c.. d..
.i y � � ti a ' ocd'I
shall not employ any person in any rmbnmeco m to become subject to the Workers'
'
Co pc . t I�ws of C l f mi .Dole"
'
Appl cam ..
r7 /
NOTICE TO APPLICANTIf nllmlooll this CemGcam .on.you should ` •s f
Q Oborome subject to the Workefs Colhpensauon provisions of the Labor Code,you must
foolivshk6r,ply'with such prevision,or this permit shall be deemed revoked. 7
fp '^''`I�'.r r, \-CONSTRUCnON LENDING AGENCY ;
Ey""' ' 1 Ii-by affirm d t Ne conswct Ind g agency for Ibe pmroh;vmoe t -
W,� soff
the wok for which this perm 1 i;issued(S 3097 Cis C)
Q
over's Name I. ,. , ,.
Z)-Z Lender's Address'-
I certify that I hely rend this application and sorra that the above information is
Ise-F
comet.I agree m comply with all city and counts,ordinances and cute laws relating
to ad,we-mentioned by
of Nit city to enter upon
the obo(We)igmeto propend for inspection purposes.0. . .
E„-V) (We) g ams s d penseedy it is nity itII'sm wayaccj of pe again Immt
^bin Ctyliabilities.1 dg nu,costs d expenses which y n any y me age;nat said
f) ,$ City n q of the gooding ofthisWILC t
KFKF
ICANf UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: � Date
IURCR REGULATIONS s 4'
Sib m fPpplomVC t t r a', - -Dam: Re-roofs
',HAZARDOUS MATERIALS DISCLOSURE" P. .
Wllthe alphimmoffuture beirldingroacce;mauestom or Wallis hazvdWs matelot Type of Roof
as defined by the Cupertino Municipal Code,Ch pt 9 l i and the Health end Safety
Cnde S❑Y n25532(l '. t 15'. t, - `� 1 .1 :. � i,p Ar t} . f \.e a.°Lit.?
t t, ;�.,\ +',' ,All roofs shall be inspected prior.to.any,roofing material.being.installed....,_.-
Will the applicant of future Wildingoc p t secau p t p deviceswhin If a roof is installed without first obtaining an inspection; I(agree'to remove
clot Wincilms air coution armsd f y th Bivy AearmArQualityMon.,facrou
D,,t ally ' Nn all new materials for inspection. Applicant understands and will comply with
j all non-point source regulati(ins., ,
4y have read die haavdous mamnals rz,winnams under Chapter 6.95'of the
Caldmaia Bruhn&'Safely CmIc Sections 25505,25533 end 25530,1 understand that _
if the Wilding does not currently have a tenant,that it is my responsibility to notify the ,
oceupant.of toe iequirtlnenta which must be,mei poor to issuance of a Certificate of
Oc Parts'.
Signature of Applicant Date
All roof coverings to be Class"B"of better
Ow e o udimict,ed,get , t.,, Da♦t coverg
�I. .,i,.; „,. ._ OFFICE .. .. .