03020112 (2) ;'E;
Y OF CUPERTINO z^ • m' .��• � *� % a •� '
BUILDING DIVISION PERMIT VCONfRACyfO NFORMA�ION ,'
ING ADDRESS: +• PERMIT NO.
6368 CANDLEWOOD CT 03020112
R'S NAME: PERMIT ESUS DATE
ELENA CHEN 02/26/2003
SANITARY NO. CONTROL NO.
ARCHTIECTIBNOINEER: BUIIDINO PERMIT INFO
BLDG ELECT PLUMB MECH
0
300
LICENSED CONRIdunderSDECLARATION JobDescri tion
yt I hereby alllrm dol I am Ikwlecd unser provisional or Chaplet 9(commencing P
with Section 7E0E)OfDlviiiOn3ofdm BnillLL'11 and Pmfe4illNf.'ndC.and myliCCnee is
inrullfnevande11 is REPLACE FURNACEin& . C
lace Iw 7-0v uaR
Dana Contractor Val CONTRACTOR: REACO HEATING & AY R'NALE®
ARCHTIECTSDECLARATION
I understand my Olana shall be ucdupublic rocnrJa MAR 2 12003
5 0 Licensed Professional
OatNEm BUILDER DECLARATION BUILDING
a I hereby.m.(sect on 11. exempt from the Conlnal Co e:censeAny c law for rhe
O O following neon.(Sadat 710 L5,m afwaa and Improve.
demolish.
Code:Ansi cm or county
$12 which its lecou a permit re cnmwcL elle[,impmw,de ermit t ri erepairaft any moment
h, C Odor o its issuance,alumnirequiresthe the applicant for suchCoo be'o rile Law(Chapter
<
(cohe mmencing
licensedpursuanttiloprovision oftiloCanusiness Lcem�law(Chodcr9 Sq.FL Floor Area Valuation
$ that he s acre t Swoon 70nd the basis
r the
the Business and Proem.M vi Code)or $2000
that he la ecm%rhrsfrom and the hula for the alleged exempEam MY violation of
Swim 7031.5 by any applicant for a permit objects the applicant to a civil penally of flN Nttt�3Occupancy ber Occas
rot mon than fire heloma dollars PSM - 3691SU.i4 . 00
❑1..anwnwartmpmpmy.wmyempinyeawlth attiadzirwieewtpemdm. ���,�3,Tw,�,,,,
will do Newark,and the svucture labor intended"offered funk IS=7041,Busirw 301 — ROUGH �Ln71Y1'r5Y'tVC`5
and Pmfexsiom Cade:The Commofa License law does not apply o an owner of Coons
properly who buildmrlm%oes thereon,and whodoeuuch wohhimadf orNmuth his - e —
owemployw,provided that such improvements and not intended wolfered forams,If. 303 — ROUGH MECHANICAL
however,she building or Improvement is mk within mass year orcompkdon,the ownu- 304 — ROUGH ELECTRICAL
bottom will have the burden of proving that he did not build or improve for purpose of
ale). 505 - FINAL ELECTRICAL
❑1,a error of the property,am exclusively contracting with licensed mem en to 507 - FINAL PLUMBING
construct dlo project(Sec.7014,Business and Proretmom Code:)The Convenor's LI-
ceose Law doss not apply to an owner of property who build,or improo,darner.and 508 — FINAL MECHANICAL
who comtacu for inch projects with a convector(,)licensed pursuant oda Coauscror's
Lee..law.
l�101 dos Sm. B&P C for this oamn .
`Lv net 4 Date
WORKER'S COMPENSATION DECLARATION
I hereby of iren under penalty of perjury on of the fallowing declarations:
1 haw and will maintain &la
n a Cenl6caof0ment la me) um for WorkerYCompen-
atim,a provided for by section 3700 of the labor Cade.for the performance of dm
work for which this permit b Issued
I]I have and will maintain Workers compensation Incomes.u required by Section
3700ef the Leiser Codd,for the performance of the work for which this permit is issued.
MY Warker'a Compensation resonance,artier and Policy aumberam:
Canter:iQ MMIl1WQ At. CA$Policy No.: t L'
CERTIFICATE OF EXEMPTION FROMWORKERS'
COMPENSATION INSURANCE
Plhla claim nand not Mcomplelod ITNe permit Is fnmne hunortddollsri(SIM)
lar less)
1 ceNfy that in the performance of the work rw which this permit is blued,l shall not
employ any person In any manners as m become subject in the Worori Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cmificam of Exemption,you should
become subject to No Worker's Compensation previsions of da labor Code,you mum
=O forthwith romply with such previsions"Is Permit shall M deemed ranked.
CONSTRUCTION LENDING AGENCY
ti INT I hereby affirm that thew Is construction lending agency for the Performance of
yG the work for which this permit Is bound(Sex.3097,Civ.C.)
it Lender's Name
7 z lender's Address
Q i unify that I have no this application and sue East the above information Is
y F cwmck 1 agree m comply with all city and county ordinances and mate law elating rex
V building construction,and hemby mthodre reprcacnutiwa of Nu city to color upon the
r aabove-mentioned property Per Inspection purposes.
(We)agru to law,indemnify and keep harmku the City of Cupenibo agaWr
rN IlabflWu,judgmtma,eaa and expenses which may he my may alarm gaunt said City
7 In eomequenu da of Sterling of this permit. RV
m� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
13g1B0uI.M19N . -
!'�_ s f/ z(z('(c,3
Siof AppbcauConucmr Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliunl or future building occupentsore or handle hazardous material
me dented by the Cupertino Municlpal Code,Chapter 9.11,and the Health and Safely
Soden 25531(1)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea Nr
Will the ircomapplicant w furore building occupant y A ea Air Qu or Mara which
If a roof is installed without first obtaining an inspection,I agree to remove
It harardnus air cenuminanu u defined by da Bay Area Mr Quality Management
Dinricli all new materials for inspection.
'
❑Yu �No
I haw mW the tremendous materials requirements underCha ter 6.95 ofthe Carrot.
tis Health&SarCIYCode,Section 25505.25533 and 8534,1 undersand thanif the building
does not cummily ham a anal,that it is my responsibility in airy don occupant of the
myoiuLomdlp iaaanaancerfneate yr�{aea%ti Signature of Applicant Date _
Owner or authorized agent `/( Dan All roof coverings to be Class"B"or better