01090068 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0,
11012 SWEET OAK ST A & H HEATING 01090068
OWNER'S NAME: APPLICATION SUB DATE
YUN SHAW 770 CHESTNUT ST 09/18/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 279-0722
O�p ARCHITECT/ENGINEER: BUILDING PERMIT INFO
ea- BLDG ELECT PLUMB MECH
LJ L 1 I_I L:.1
v
LICENSED CONTRACTORS DECLARATION
�, 1 h by R that 1 am licensed d p 'ons or Chapter 9leomm ming Job Description
to xthS,c 10001 fDvrslon3oftheBu. dProfesuionssCode.and myliceme REPLACE FURNACE .
(� i cental force and c- L a Lr. T /
'O c O Dam s CD DCLA� C �`/
3 3 u ti AR HTTECT'S UECLARATIN' `�Jl
ts�=i O 3 1 and<rssaad my plans shall be used no public Porti
i 6 p p Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm but 1 am exempt from the Convaclnr's license Law for the
f_z following reason.tSection 0031.5,Business and Predications Code Any city or county $1375
S S O which require,a permit m consumer,alar,improve.demolish,or.,it any murem.
to 3= -prio to u' I q rc the applicant for such permit fl signed shimmer
Valuation I at
that he licensed5p nlnm the pro Ons of the Convector.tr Law(Clisper9 - .. .. ... .. .........
2'&Y.1
(yip. FJ�_�':I�.r• �Qa ox . a u ion
eco he is a who Sem '1(1!10)d Division isfor
the Besid and Prof ss Dna code) .;t' f 13 L 05 l
or mat he is exempt th'crtlmm and the bears for the alkgw exemption.Any violation
of Section 7031.5 by any applicaal far a penrdt subjects the apPlicnt too civil penalty
or not mom man five hundred dollars($5001. 3 01 JPN K"�l PLUMB IN '` Occupancy Type
°1,as ox net ofe.
thproperty,or my employees with wages as their sole compensation, _ I
'wilPdo the weak,and the awerme is not intended or offerest sale(Sec.7014,
Business and Professions Cade:The Contractor:License Law does not apply to an 304 - ROUGH EIV9V1TR(1bX.9Ctions .
owner of property Whe builds or maprvvea thereon,and who docs such work himself
or through his own employeex.provided that such improvements am not intended or 505 - .FINAL ELECTRICAL_
offered for sale.If,however,the building or improvemem is sold within one year of - - -'
completion,the owner-builder will have the Widen of proving that he did nor Wild or 507 - FINAL PLUMBING �'
pm,eforpurpnaeersle.). 508 - FINAL MECHANICAL
"°I;u ownxr of the proper,omexdu,iveiy conimering with Leemrd contractors to .. - .. ., . . .. -
consumer the mojed sec.7041,Business and Professions Code:)The Commaor's
License Law docs not apply ro an owner of pmpcny who builds or imhmves them, t
and who commas Tor such pmjce.with is contractors)licensed prwam to the. _
01 ims exempt
pt enseorder
law..
- ❑lam exempt under 5«. .B&PCfor this rtmon it 'r
_ Ownei Dale
_ WORKER'S COMPENSATION DECLARATION
I herehy a0itm under Penalty of perjury one of the following declamtians:
° I have and will maintain a Certificate of Consent to self-mecum for Worker's
Compensation, as provided for by Section 37M of the labor Cec, for bee
perfamtancc of the work for which this pemut is issue. „
°1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is
i.asucd.My',Worker'd Compensmhm Imo...rc carierrand Policy number Lie:' -
�s1 ...__._ ... . .. _ .._
Cam° TDUCy /M)I`J` Policy No.iLy I<_ rs.r r y•' a, ..
FRO ' ;!r,
RTIFlCAC ON OF COMPENSATION
INS OM WORKERS) s
Thus scar COMPENSATION INSURANCE' •• ' ' .. _
r
' n new nDI ere campineE it me perm is for OM nenarca aanarx .
(stool ar leae�) a _ .
1 certify that in the n in any ma n the work for which this permit a isre;I j•:,;I .,, 1 ' ,'t[•,.;t..,
x ore oat employ any person in any manner eons to become subject to the Workers'
Compensation laws of California.Dale
Applicant _
N - _ .. .. _. .... . ...___ _ .... _
NOTICE TO APPLICANT.r's after or Lamption.youshoulst
become comp y she Workers Comms or this
prom it Mia or the labor Cade,you mon
Q � fnnhwith comply with such provisions or this perosit Miall b<deemed revoked. '
.�.r CONSTRUCTION LENDING AGENCY
> 1 hereby aRrm the then is a consvuerion lending agency for the Performance j
of the work for which this permit is issued(Sec.3097,Civ.C.)
Lender's Name -
z Lender's Address
V 1 unify that I have read this application and state that the above information is
carat.I agree to comply with all City and county ordinances and state laws relating
to building conswnion,and hereby authorize representatives of this city to enter upon
�„ W she aho(We)a innedTee to property for fyan kepurarchle
G. tY
(We)agree to Eva in ndexryand kchiharmy in the way Cupertino against
F. res liabilities,judgments,colla dna eg of
which iruy in any way accrue against said
4.1.z City m conxquence of the granting of mus pcmut.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT !
souR EcuLAnolvs.' I Issued by: Dale 9 n�
signore fAppbc HAAZARC Rmeror .Dam Re-roofs
HDOUS MATERIALS DISCLOSURE
Will me c Culp t m future"unpd Co occ haft t or anal hazardous a mnEa1 Type of Roof ... - .. . . .. .
C�cfe.scd by ort ]SSl2Pa) pal Ce Chafer 9.12.4d tit tHl hit and Safety `,, yp r ( ; ...y
°Y All roofs.shall be inspected poor.to any roofing.material being_installed..
Will In.applicant or future Wilding occupant use equipment or devices which If a roof is installedwithout first obtaining an inspection,'I agree'td remove
emit hazardous air contaminants as defined by the Bay Area Air Qualily Management
Distinct? . a all new materials for inspection. Applicant understands and will comply with
.°Yes all non-point source regulations.lh.iap
'" I hav2read the hazardous materials mquimmemi oder Chapter'6.95 of the
California Health&Safety Code,'Sections 25505:25533 and 25534.Li mdarstae that
if the building does or cumently have a tenant,that it is my responsibility to notify the
occupant of the requirements which must be met prior to issuance of a Certificate of
Occup ncy.
Signature of Applicant
[y �y / ant Date
Owner or nthnntied a a", Date . (— All roof coverings to be Class `B"or better
• 4 OFFICE _ _