02080138 OF
CI BUIL.DNG DIIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
'BUILDING AJ)DriEss IPERMIT NO.
10466 S . TANTAU AVE. ALLIED AIRE SERVICE INC 02080138
OWNER'S NAME: APPLICATION SUB DATE
BRAHMAJI POTU 661 SINCLAIR FRONTAGE RD 08/23/2002
PHONE: SANITARY NO. CONTROL NO,
(408) 934-8844
0 O O ARCHITEC(ENGINEER: a BUILDING PERMIT INFO
F w- BLDG ELECT PLUMB MECH
I__I CJ
as
LICENSED CONTRACTOR DECLARATION Jqqb Description
Section
affor Division
3oftheBusinespddPronsofChapter.ndmmccense REPLACE FURNACE/ADD A/C/PANEL UPGRADE TO
�_t=w with Stttinn 7gN))of Division Jafthe Business and Professions Co2de,ane my license
�§Y is in foil force an ,e4e Q 2 �7✓S -
O y u L"im Lie.#
Dae ` Convector
ts�3 a ARCHITECT'S DECLARATION
Lundcaund mY Plans shall M1c used as puM1lic rtcnrds F1N l�
a�a 'C'�
Waled As p pre Licensed Profe anIn
OWNER-BUILDER DECLARATION O 2�U2
a w-mI Writ,affirm Na 1 Am rumps from the Conuucmr's License Law for the L
c-z a following reason.(Section 703 L5.Business and Profeasions Code:Any city or county SEP �' $4405
I x G which rcyuircs a permit m mnstmd alcor,improve,demolish,m mpair any structure
prior or its issuance.also mraines the applicant for such permit file 4.gned statement
H - --___. ' . ._.-._..
that ns
Icenled pd...to rte p af the Casxtors
nLicense (Chapter 'LD laation
(commexm with Sectio 7")of Division 3 of the Business d Professions ns Codej - 3' 9 �n�tpa,' r.•-'y r `-1.
of Sec he is 31.5 b therefrom and the basis for Me cts the
pplicant t,any l violation
of Senior than by any applicant for a permit subjects ih<applicant m a civil penalty
afoot mase noon ave nanarta dollars($soB). 301ApN r*00Z9i-I PLUMBIN � Occupancy Type
01.as owner of the property,or my employees with wages As theirsole compensmion, SOUGH-
willBusiness
usine the wark-ane me:wemhe tent intended Li or enseLoffered for ole(sec:70 A 3 04 — ROUGH EUS411IRS BAkictions'
d s ork.and ns Core:The is nttninten License law doev nen apply to an
owner of propeny Who build%or improves thereon,and who does such work himself 505 — FINAL ELECTRI CA_L
or through his own employees,provided ma such improvements arc not intended or
'-offend for sale.If,however.the Wilding - - t is sold within one year of - - - ------— - -- -'completion.the 507 — FINAL PLUMBING
e' pemo, 508 - FINAL MECHANICAL
improve for purpose of sale.l.
_, J pl,as owner of the property.nm exclusively contracting with licensed contractors to
J - _
construct that project(Sec.7011,Business and Professions Code:)The Contrecwr's ILici t
r' and who
Law does contracts f rapplysuc .p an owner of propcny who builds ord pen a tt to the i
ane-sono s LicenfLa,, injects with.a contractors)licensed Pursuant to the
01 am xe License law.
- ❑Ism exempt under Sec. .B&PC fm this reason
Own Date
WORKER'S COMPENSATION DECLARATION
I hereby Arron under penalty of perjury call of the following declarations:
0 I have end will maintain A Certificate of Consent to self-irsum far Worker's
Compensation. as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
`%have aAd will maintain Worker's Compensmion I..samnce,as uquired by Section
3$MI of the labor Cade,for the performance of the work for which this permit is
.sued.My W k-fs Compensation Insureiwe carrier and Policy number are,
Carr er,, .•-�—X• Policy 714 -' S8�-^/ - '
l i •- f CER I'IFICATION OP EXEMPTION FROM WORKERS P � ,Y.i-�� jlr ,ss'
., COMPENSATION INSURANCE•-
,(This seaibn need nm rte nimpineJ If the permit is far one hundred dollen ' .n 1 y
131001 or Icss.1 ,
• Icertify.thin in the
perfronuns,of the work for which his fenit is ka.rd 1 ';(1'Y 1t •1:' 's.
shall not employ any person in any manner a as to become subject to the Workers
Campmelion laws of California.Date
_ Applicant. _:: .. ._. _ ... . .. .. ... ... .... .. . ..... .... .. ... .__.. . __ .. -
"NOTICE TO APPLICANT,It.after making this Certificate of Exemption.you should
!] Obecome subject to the N rk ,Compensation-Provisions of the Labor Code you must
fonhw nh comply w th such pro' ms or th.pe l shall be,deemed mvoked
Z fn CONSTRUCTION LENDING AGENCY
I hemby affirm that themconstruction lending agency for the performance
''If the work far which this permit is issued(Svc,3097,civ.C) ._ ----- ...... .-.... .-_. ... _ ..
W E :Cnde m
xNac - _.._ .. _._ ... ... .. .__ . . .. _.
L.
Z, Lend .Address
-
V 1 c n fy that I have read thin application and.t t that the Above information is
torte t 1 agree to comply with
II city and county onfinames and state Iso mlating
to buildingconstruction,pi srtha¢ repen aT of city i corer open
the above
eproperty for inspection paposcs.
0. (We)AgreeI.san.indemnify And keep he,mlees
the City of Cupertino against
(n liabilities,judgments,costs and expenses which may in any way uccme a amv said y/y
C'ny in consequence of the graming of this pnmit.
APPLICANT UNDERSTANDS Al' "`LLCOM .YWITHALL •-POi:f Issued ; Date
SOURCE'REGULVION- r2S OZ y
Signature of A,pIiumA9C.hnr.nm . Dae Re-roofs
.: HAZARDOUS ATERIALS DISCLOSURE
the aFfficant or future building«e ipam start or handle haaaNuac material ... -Ty
es defined by the Cupcnl k 'cipal Codc.Chapter 9.12.and th If alth and Safety
Cala Seefon 2553z() -/` t•,y •' �it�„'�. I il`'�V•^.w
❑Yes” r - -t N _ ,. ,All'roofsshall be inspected prior.to any.roofing material being installed_ .. .. .
w lime pylic oto (tet a Wileing occupant use eq at, an,A,devices which If a roof is installed without first obtaining an inspection, I'agree to:retnove
mot Innardous aircontaminants defined by the Bay Area Air Quality Management
Di t ? all new materials for inspection..Applicant understands and will comply with,
oyes all non-point source regulations.
- 1 have mad the humNuus materials requiumcros under Chapter 695 of the
California Health&Safety Code Section 8505,8533 and 25534,1 understand that
if the bolding does net cutrcndy have A tenant.the,it is my reeponsihillty an hanify the
acupam of thquiremcn which must h met prior m issuance°f a Ce t of
° "pi '' Signature of Applicant Date
2 Ot—
owoefofAannoriaee alt Date All roof coverings to be Class••B"or better
'i
,., ,, _......... .. . . .. .: _ . . - . ._.. _ OFFICE . . . . ._. _. .... .. . _. ._... .- . _.. _ _