01060092CITY
' BUILLDIN DIIVIISSIIONNOPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
10400 TORRE AVE
J & J AIR CONDITIONING
01060092
OWNER'S NAME:
APPLICATION SUB DATE
CITY OF CUPERTINO
1280 N 10TH ST
06/15/2001
PHONE: -
SANITARY NO. CONTROLNO.
(408)920-0662
>_ ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
2
BLDG ELECT PLUMB MECH
i LICENSED CONTRACTOR 'SDECLARATION
Job Description
1 hereby afrmm that I am licensed under provisions of Chapter (commencing
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* NO CONDITIONS
wwhbsecamnoannlpi� 3nftheBnxine..anaPrnfe,.i rnd gl came
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is in full bac?ltr�r t.Zo 3 y
¢'J License Class Lic.k
JDam �( —Zd(� Carmelo,
7� ARCHITECT'S DECLARATION
/
g 1 undetswnd my plans shail be used as Public re rr ds
2 Licensed Pndeesiomal
LL OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Cormier r'a License Law for the
a following reason. (Section 7031.5. Business and Professions Code: Any city or county
C 1
D which requites a pe,mit to construct, alar, improve. demolish, or repair any smuaure
Y
.� priomo its issuance, alsr mquios thcappli,ant for sae pcnnitIn fil<aai,buddamocnt
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I pf�l^. r
Valuation
- dedImisliucnwil pursuammthpmvi.ionsofthe Contretoisl.icen,a o,(Chopper 9
(commencing with Scuion"IW%of Division of me Business and Professions Cate)
or that he k cramp, therefrom and the basis for the alleged exemption. Any violation
-- of Saturn 7031.5 by any .,plicant for o permit subjects ,he aPPI¢ant ,o a civil penalty
five hundred dollars
Occupancy Type
or not mom than (s5ool.
302"1l§tWkrH PLUMBIN
.. ,
01. as owner of the property. or my employees with wages as their sale compensation,
_
St
304 — ROUGH ELF9Ql McttDPMctions'"
" will 'do'the work. and ,he s,mcmre is not intended or offered for sale'(Sec: )BU,
Buslneix and Pmresoors Cave: The Contractor's License Law dims not apply to an
owner of property Who bullas or imposes thereon, and who does .such work himself
0 5 - FINAL ELECTRICAL
or through or own empinyeea, provided that such impmvem<nts are or intended a,5
_offered for sale If, how m n IJ' g p ,-s'. la ,h n u m year of
.. .._.. _. ., . _. ... .. .. _. _ .. .. .. _.
507 - FINAL PLUMBING
camplawn the own«nilder, will have me burden of pmvrgtha, held nm bold or
improve fia"u"taeor soler
508 — FINAL MECHANICAL
uvrmw
..'.
pl. as owner oftn property. am CXCI.i lCollimating lTh t
construct the project (Sc ]B adP f:sars Code I The Counselor's
cI
License Law does not apply to an owner r pro,party who builds p s ,hereon.
and h computers f such pojats with a <onuacmrfs) licensed pursuant-on the
_ __.
Contractor % License Law.
❑ 1 am exempt under Stt. . D & P C far this revwn
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Date/
/x
Q/
- WORKER' S COMPENSATION DECLARATION
/
Ihemby,alfirmunde,penalryofp=rjury,one of Ne following dmlam,ione
`n
t
❑ 1 ha0e arid' will-lnainmin -e Ccnificaic -of Conserv, to elf-musia For Worker's
Compensation, as provided for by Scene. 37W of the labor Code, for the
perfmorance of the work for which this Perini, is issued.
01 have and will maintain Worker's Compensa,ior Insurance, as required by Section
37W of the Labor Code, for the performance of the work for which this permit is
Inmnc<artier andel Policy no tb am
- issu J My 'n Co.u m
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Cu P .O ,Ise
At
'
' CE OF EXEMPTIONROMWORKERS''
• ,,-. COMPENSATION INSURANC[ " ...., .
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pnvi station need not be varadeped iffir permit Is for one hundred dollars
t' .
(SKID) or lass) „t -
I' cr ify that in the performance of the work for which this permit is issued; 1
"sliall
not employ any person in any manner so as to become subject to the Wmkers'
Compensation Laws of Colifomix. Dote
Applicant - '• - - -
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'v
NOTICE TO APPLICANT:ILnfser making this Ccnifia¢of E.acmp,ion, you NovlO
becdnm adjem 1. the Worker, Compensation provisions of ,he Wbu Code. you must
forthwith comply with such provisions or lois permit shall be deemed revoked.
"�• CONSTRUCTION LENDING AGENCY
s' I hereby affirm that ,here is a construction lending agency for the performance
k'
., of thcwork for which this fermi, is issued (Sec. 309). Civ. C.)
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Lenders Name.- I.....• - •._,. . - _.. . ...
Lender's Address
. I certify the I have read this application and store dir, he above Infomsmlon is
Teat. I ngrce ro comply wire all city arta county aNinan<es and slate laws relating
m building cum,,, ulnn,'anJ hereby.nmhoriae rcpresenmtive.s of this city to `mar -per
Fi 'the anovs�...a..ionad property for inspection purgmep,
y . ( we) agree ori rasa indemnify and keep ha mless the City ul Copedlndago ad
n Iluhil hies. judgments, costs and espenses.whiph may, in any way acerae ago est .said
L Ciry in eons=qucrce arm, granting of'his'Pmmii
APPLICANT UNDGRSTA ANp w' ILL COMELY WRN ALL NON-POI,YT
[ssuedb Date
y'
SOURCE REGULATIONS..
Re-roofs
Signature bfApplicanUContocmr,Data
ica]INRDALS nwilltneaIndmre building ooupeddoe, or handle hroat ma coal
Type of- Roof
as defined by the Cardia Municipal Cole, Chapter 9.12. and the Health and Safety
•s-
CWe, Section 8• 533(2)^ t; j