00070123 (2) CITY OF CUPERTINO - -
BUILDING DIVISION PERMIT ' CONTRACTOR INFORMATION:
BUB.DINGADIA222 CATALINA -CT ALLIED AIRE 'SERVICE 11MGNO.00070123
OWNER'S NAWUS JOYCE - ISE,1 ,` SINCLAIR- FRONT BER"RUWIPEIB/2000
PHONE: ' (408) 934-8844: SANITARY NO. CONTROL NO,
L, : 4 _
Cm z ARCHITECDENGINEER:
w O oBUILDING PERMIT INFO
upg BLDG .LF.CT - PLUMB MECH
t7dE - IJ 1=1 —
z�Nz Ther LICENSED
RnseJ undcRr pmvl ir,n^of CM1optn9frommm�cing .,Job Description
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GF S3 t. ,.:Ilhse �nt�(n nromi,n,n7anne name„arta l'mre„ran.care.and my naen,e ADD A4jC-
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3 a -\HCII1TLCr'S UECLARA—T16dN Ez
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aki^I'' OWNER- fDECLARATION
I h easy R that 1 exemptpt from
the C nt , I Ire 1 for 0e O -
C=�Q (tri grt (Section]011me 1,, dPnr kCd eAny citypuran curve - y
ZO wh h q l p tl ( ( pit P In tile
Y:t structure
6 3 s Pant c l s a n i thepie t f h Peoria I I IcSigned(Ch nem - •' '
(noon 1 "kip a on ill U v n ret cmacol License la (Chinni, S Ft. Floor ji�p00
Icnm 'ng (p,Sectionbo�r ad fhe 3 the leg and lumn,Profession,, Codlatt.n 9• _ Val I
I,,Ism he is 31.5 b Ihee:.from and the hues for the alleged exa,n....to Any violation -
nfSeInume''I 7031.5byanynppli dollrs($50rmit slhjensthe eppllcn;n oacivil pcnnhy - -
maallnoreroanBvehannreaaonar.fssaB). . 'ApNb' e�`043.'00 vOccupancy Type.
Ol,as ownerof(he property,or my einpinyceu with xagci as their sole comp,mern e. '
All J (h k,and(h .Ira t not meeJ a ffered for sale(Sec 7,14,
.HUs t-.. d;lrol w la e Tnorles t Il e.docsSemt..Plr riser 304 ROU99n�EL`1"W IML.
fpni ty Whol es 'nidvasth ' n, 'a h.docs mea int h,ed 0, '
orthrough Nilsen eirs,however,t Wildined torrmprvementemiols arch intended ar .501 — ''FINAL ELECTRICAL ENERGY
offered for sale.If.however,the Wilding or improvement lowing
sold he(lid not year of
,mpleran,the owner-I,we'),will have thebaleen;,(proving mail he at,not M1mla or 505 - FINAL ELECTRICAL .
completion,htlrpa.e aame). -
01.as owner of he property,set exclusively emotreeting with licensed ematruch rs m '
L"sumer he pnoce,(Sec.](W,Bllnlue,s and Pr..festoons Com,)The Contractor',
icense Ww does not apply to an owner of property who builds or improves Thereon, -
and who contract,for,coir pmjmhs with ” manuaoK,)ilce"aea purstm"t to tM ..
Cnntmemre License Law.
1 an.exempt under Sec. ;B A P C for,his reason
owner. Dote
WORKER'S COMPENSATION DIiCLARAI'ION
I hereby of0rm under Penalty'of Perjury one of the following declarations: - -
❑ I have milkrill nwi Unit a Ceriincme of Consent to Self-in ro,for Worker's
CompelitswK, v provided hie by Seeman 3710 or (he Lnlxa-Coale,for the
pert once of the work for which this recruit is..sued,
1 have and will maintain Worker's Compenwciou Insurance,as required by Section
7Xt of the Lubar Code,for the perfannmce of the work for which(his rami(Is-
s.wcJ./M!�y�Wo/p/��C'yrry/'e �a(y/ran Innul'unac carr`ier and Polley number no:
Carrie Policy No{._- t.�717 .
CIIlTIFICATIONOFEXHMPTIO ROMWO� RKERS, I
COMPENSATION INSURANCE
(This section need not be completed if the pam,it is for one hundred dolims -
_
IS I W)or lees)
I cenify Thal in the performurre of the work Int which this fenni(is I..ued,i
ca '
,hall not employ any person In any manner so as to becom .ubjem a,the Work,, -
mpenwLa
tion x.of C"B ,m
fla.Date
Applicant e
NOnCE TO APPLICAN'D If.after makin'this Ceridn"a of lixemptum you should i
Z becomemhjernn thew"A"'SCotnputsaIi,nPo,W...is of the Luhnr Cade.you im,r
Q C forthwith comply with Such pmvislom or In,paruni,shall be dectned revoked
z ..
EP 4 CONSTRUCTION LENDING AGENCY -
a ' I hereby iffmi that here is U el immlon lend:",agency tis the peittinm:race .,
91 the work till which this prion,is i,e,ned(Ser.3097,Civ.C.)
y ❑ Lender's Name
Z Lcnder's Address -
Q1 crit!fy thm 1 have read(his sppheuian und,om(hat the above oururmmion is
[y 'iteen.1 agl'ec Io wntply with all city and county ordnanees'and state laws I'clating
O in bwlJin6 un,nwctinn.unit herehy auth"rise repms.rer,esof his it,to enter upon
y r�
the above mentioned protsenly f .pet '._
6( OVS)age c c indemnity Ilk purposes.
the City(it C pen' ,"'sins('
(nI'ahirlie. j Ig a n. b,und exp. ::ishurh'mayin any way aelmo against sail
V Cdr in sTUNDERS gr,un, ((hope it c
APPLICANT UNDERSTArA'�WILL COk lLY WITH ALL NO PGIT,
SOURCE REGUIwnD^ /f" 7 Issued fs - Date
Signawre of Applic
HAZARDOUS
`fS-'—� �)tl({” Re-roofs -
HAZAItD(lUS MATERIALS DISCLOSUREreorhandle
Will the applicant Cupertino
nr(mare building e.Chapter
r 9.1 m soothe Healmhaeoundous numeral Safty Type . .
Us defined it the Cupenina Municipal Code.Chapter 9.12,and the Health unit Safety -
Gv3c,section 255720)? „
El Yes All roofs shall be inspected prior to any roofing material being installed.
Will he aircontm manta Wilding occ"pamuse Ae.AirQmlil,MeasxhicM1 If a roof is installed without first oblaining,an inspection, I agree to remove
emit h;iWill he mplil it or Imsas ilding eche BUY Area Air Umt or hlanagwhich
D`law,�Yes nno,ru - .all new materials for inspection. Applicant understands and will comply with
Lill non-point source regulations.
I have read the haesnlous ha clod,related,can,under Chapter 695 of the
Culifomia Heahp&Safety CWe,Secrions25505,25533and25534.l undemmnd(har
-
it building doesaoc currently have"unanLchm it"inymsponsibilaymnmity the
ruPtu,or 'ui ro encs which nom be mea prior io issuance m u Cetillicoe of
Gavane � ,
Ie: Signature of Applicant Date
wn°e or into oriae All roof coverings to be Class "B"or better
I
.OFFICE