01070067 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION'
BUILDMGADDRESS:
20967 FAIRWOODS CT PERMIT
A PERFECT CLIMATE 01077
0067
EM'I VINCENT S AND SANDRA L 10570 S DEANZA BLVD OP7`16r2OAOE1
LI
PHONE:
(4 0 8) 861-9545 SANITARY NO. CONTROL NO.
pZO ARCHITECT/ENGINEER: BUILDING PERMIT INTO
U U BLDG ELECT PLUMB MECH
a n
0 H i LICENSED CONTRACTOR'S DECLARATION Job DCSCpphOn
S lJ I hereby affirm that I am licensed under previsions of Chapter 9(commencing
p:e_m with Section]00ol of Division 3 of the Business and Professions Cale,and my license
z a iam
in of force
rc and e y
`o w v u. Date - 3 co»a�tor�� REPLACE FURNACE & ADD A/C UP/DOWN STAIRS .
u.u.0 ARCHITECT'S DECLA'RAq
understand UMALED
r rsy p far,shall be used as public records
,reap
,i p. --on
i .
k,.,a OWNER-BUILDERscript
DEbeCcuuION JUL 3 1 2001
m- I hereby.(firm Ihat 1 ora exempt from the Contnmmrs License hew Rain,
5 following reason(Smllmt]lL3h5.Business-11111 Inotoloas Cad, Any city ermlmry
ae .,prior wits issuance,also res,airms h,mepairunyslnlLlure
zF� wli11 y l t c let Ilr l- d
instincts littn:tl u u§tin try the ppir if such Permit o file asgned statement. _ -
p provisions offmContractors Licence Law(Chapter9 - - p�(commencing thSodium]0001 fD 's 3 (Ih B : eaaanePrafeaaon,coae) }' :S.q..Ft FloorArea„ Valuation
or Nm he is exempt thercfmm and the basis for the alleged exempfon Any violation d, ` \°•; ' D'Itl�
-oF Section]03 LS by any applicam for n permit subjects th<applicam to a civil penalty
m
lo(act moan how fiva hundred dollars(5500), AFN Number !"c•' . Occupancy Type -
711,as owner of the property,or my employees with wages as their sale compensation, 301 - ROUGH PLUMBIN('��_
Business
ne the work,and Ibro e:T e is not intended er offeree for arae(see.town 3 03 — ROUGH M1�SS K"t'° _
Rei and orore nio :Code:Th Contractor',ed 1 e L d t pplyee. to 4. LL C(IOn$"
owner officinallyWhobuild or,improves thereon.and who don such workhimself 304 - ROUGH ELECTRICAL
a'
thgh h employees,provided that suchimprovements t tended or
-;otrered-fora) If.however,thebuilding orlmprovemeni issold within one,amof 505 - FINAL ELECTRICAL-- - - - - -"-'--� - -
completion.the owner builder will have the burden of praying that he did not build or I`
improve for purpose of sme.l. 507 - FINAL PLUMBING
508 FINAL MECHANICAL_ _,..
111, e f the p e ny m x l elY cat I g lit I' d ora I rs m - -- - --- - ----_-.
onsmu t the p )ct(S 7044 B s d P f. ns C d )Th Commoner's1
Licam e L d t apply t an owner of n
< . ..and who.contrac¢.for such Is with art contractor(t)licensed pursuant the f
-' Contractors License I.
projec per .._ .. . .. _.... _
❑lam exempt under,See. B&P C.for this reason
Owner' Date
WORKER S COMPENSATION DECLARATION
Ihereby fifirmu dlpenalty of pej ry-no ofthe following dclornmrs:
-•O 1 have ne will„maintain Ceriificat f Consent to s If s for Worker's
Compensation, as provided for by Section 3]00 of the Labor Cale, fa the
performance of the work for which this permit is issued, -
CI
issued.M W or Rn I n Insurance is required by .,I on
3]00 f the Labo C 1 r tit Performance f'hek f h ch his pcm,I is
1 have and will maintain Wo kanc ie tl Policy numberare:
p t
Carte �- l I �^ _..,..-..
Ira... -
CERTIFICATIONOF A ON INS RAMC WORK RS ”' V .1/ { F k „' „�- k'
..; .-- . ',"`'COMPENSATION INSURANQE,`,
sx ton nem not be completed if the permit is Forane hundred dollars
(510m0)mleles.)
u
-,
I ciatifytht'n lit porn flheworkf h-l'ch this periall is ks_.'ed,l - `. .. - •• •_...^
shall not empl y any person in any mdnnc so as to bcti
CaAmin subject m the Workers'
mpcnsouon Caws of C.bfarniu Dmc'
._Applidani
I NOTICE TO APPLICANT If after mak angritisCemanate a t Extra prim
beta 5 bl nt'tl W k C I Y should
-
oa
Z Q
forthwith comply wit ti sort,p vizi s or this pert--l skull bea deemed revoked.
F of the work for CONSTRUCf10N LENDING AGENCY
a � h tit e I 8 a encY f tit performance I �
'Lender's Name
Londe Address
n(i Icnfy that have call this ppl t and state that the b e information is
�+ E+ 'eartect I.,me to with II city d county ordinamn,,s and state laws relating
C:) mbuldingconstruclon..md herebyauthorme repreemm,ives ofthis city to enter upon
the chown-amatimcd_prop n for inspection p rpo
H a (We) g t sala,i Merin ify and keep h y tit City f C peri ag last
h City in p n. . wit h may in.any way gainst said
U
City In m) ggm't fiht cont gotth'cpe n /
PPLICANT UNDERSTANDS NO WILL COMPLY WITH ALL NUN PO
S RE s 7/I r Issued by: . ./J - _ Date
e of Aliplican Conlrac¢Ir Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will theapplicant ocf rare l Id ag occupam smre ar handl ha:emaa,material. Type of Roof-
Cone,Sect n he Co a^ d the Health and Saf ty
m def ed by lite C p rti Municipal Cade Chapter 9 12 an
[I Yes 11th I : t a4 -' I n ;;7
I
All roofs.shall_be mspected_prlor.to.any roofing.material being installed.__
N.I tit ppf tort l eb 'Id cu I .... ._...
If e all I a ea nen If a roof Is installed Without first obtaining an inspectiofi, Pagree.to'remove
it h aN all commitments as refined by the Bay Arca Am Quality Manngemem
at
Diam I ... ..all new materials for inspection. Applicant understands and will comply with
❑Ye ❑No_ all non-point source regulations. - -111-16 read the M1 tl u materialsrequirements- and
Chapter 6.95 of the
Calif. Health&SafetyCd Sedco,25505;25539 and 25'5'341 understand that
oithbinding doe,not curenlly hale a mnant that it I,ny resp hTrym notify the
If the buddi
Oce punl:y.'the reyu rc armi which must be met Prior to issuance of a Cenificam of
a - 7 Signature of Applicant . Date.
not 0 at All roof coverings to be Class."B" of better
. !._ -. .. . OFFICE . .