01020043 (2) CITY OF CUPERTINO
CONTRACTOR INFORMATION:nun.DlNc DIVISION � PERMIT
RmLDING AnDRE56: PERMIT NO.
7635 HOLLANDERRY PL ATLAS HEATING 01020043
OWNER'S NAME: APPLICATION SUR DATE
JANNING ROBERT J JR AND PATRIC 155 SAN LAZARO AV17 022/09/2001
PHONIE SANITARY NO. CONTROL NO.
(408)739-0516
nt0� nRCHI'OiLT/ENGINEER: BUILDING PERMIT INFO
w BLDG- ELECT PLUME MEC
yF
Oy= LICENSED CONTRACTOR'S DECLARATION Job Description
Z_ hereby nMen that 1 fat liavnwil ruler provisions of Ch ins,9(oommenei.g
iS With Sell to 700(roff Dlvisio.3 fthe eusirm,,in 1'ndexoara,CCoodd+�a.mood§/lJ.uy license
ast se 3 a sin full e I. t)' a ✓V-
m, sense Cl r� Lias_ FURNACE REPLACEMENT AND RELOCATION
Q a D Dalc _ / Cnnlmclor_
t O ARCHITECT'S❑ECLARA!AlION
g 1 undenlnnd my plans shall be rued a,public records s
MY
Mp O Licensed Poduxronul
OWNER-R amptEk DECLARATION
L=w I hammy.(lion that 11, ucmpt firm the Conememr's LicenseAOc law for the
L a following reoxni.ISeminn 70115,Ilusiness and pndesrions Cmtc:Any city or(seventy
S pl p which rcqulren a"mil lu....o rues,alts,Improve,demolish,or repair any structs '
prior ill its issuance,also requires the applicant for such Permit 3o file v signed statement
(hat he is licensed pursuant m the provisions of the Contractors License Law(Chapter 9 S Ft. Floor Area _
(Commencing with Sectio 7ollp of Division 3 of the Roof less anti Professions Code) q' Valuation
or that he is exentp immirom and the basis for the alleged ex.Inpdon.Any violation qs 1
trisection 7011.5 by any applicant fora permit subjects the applicant to v civil penalty
of a.'more than nee hundred dollars($5000. APN Number Occupancy Type
Cl,snwner it the pn.party,Lir my employees with will us their srde<nml,ensminn,t 36226068. 00
will do the work,and the stmcwrc is net intended or offered for safe(Sec.70W, -
Business and Proessmns Cooll The Contractors License Law sees not apply or an Required Inspections
owner f propary Who hrrdd�or;ogrmvee rbcreon,and who)does such work h;mwlf
or lot his awn employees.prwhled Ihill such;mprnvemerb,are ne,intended m 301 — ROUGH PLUMBING .
91fiemd for side.If,however. he baildmgm intprwnnem to old within...year 9r 03 — ROUGH MECHANICAL
ontplaoo..the owner-buimcr will hthe h
have e omer of p,,,, h
.,( ilt he did not build X
or ..r
mopnweforpurisweofsale.). 304 ROUGH ELECTRICAL
CLoxoart oflhe lamprey,am exclusively commuting with licensed contractors l" 505 — FINAL ELECTRICAL
construct the project(Sec,76,T Business rand Professlons Cm1c)'Cm Contact's
License Law dwo ram apply to ran owner of property who build,est intpnwes(hereon. 507 — FINAL PLUMBING
and who contracts for suchNJts
pecwith a ammamnns)licensed punuom to the - '
cner:m tor+rSacnm Tont,Sro 508 — FINAL MECHANICAL
Chace,Liendetsou E&VClobo.raves.
Owner Das
WORKIte'S ally ofNSA'ryti DIfCLARA', irg
I hereby utlirm under penalty of perjury one of the following Jeclumtions:
❑ t have andwill U' C orf m f 11 . r h f Worker'she's
Compensation.1' p VII t f 1,1 s 1 3 71111 tit Ie f11 d
pert nee fth rkl 'h 1 tit'.R tisiwared,
ElThaveand,will t W ke C pe. 1 Itt q r Ihy se fon
3701 if the 1 tour Code,1,11 Ile ,firment, ,I the work f 'h h Itisyyyceryy/ icy O /O
issued. Wor C pansution Insumnre eatnery dPolv:y sitijntlrary , ` /
carrier: �_Pouay Nn.:�� ( O 1 0
I:I(" rICA LUN UI'l"R MPrION I;ROM WORKERS'
COMPENSATION INSURANCE
Crhis e,,f need-1111 he cmnplemd 11 the permit is for enc hundred dollars
(SHMR tit ons.) -
1 army Iia(in the perfan
ormce of the work tit,which this permit is issued.1
'shall nal it ho,rnry,pen...in any manner n,as to become subject an the Walk,,,'
Compensation Laws of California,Date
Applicant
NOTICE TO AI'PLLCANT If.after making this Certificate of Exemption,you should
laconic h]eci rt the War ker's Compensation pm,vi... of the Error Cole,you mus(
0 Q fonhwilh comply with .all provisions or Iris parch shall he decmcN revokad.
C~ CONSTRUCTION LENDINO AGENCY
a ' I hereby aRrm that there is aconswclin 0 lending agency for the perlinmmer
of the work for which this permit is issuold(Sec.3W7,Civ.C.)
(� Lender's Name
.� Z. Lender's Address
C.7 I acidly thin l have mad this application and state thin the abases information is
W F. correct,I agree m comply with all city and county ordinances and state laws refuting
0 f,) to building cmiaruminn,and hereby niffirm c'alre...taIves of oh lx coy to cmc r.pun
} •ray the ahrvommptionedpn,,.'v for inspection purpose..
0. (We).8.tosmx,indemnify and keep harmless the City of Cupertino against
h liabi li ries,judgments,011ie.,and expenses witch may in any wily factor n,ainn said
V ► City in consequence elR the granling ill this permit. p_ —
APPLICAREGULARSTANDS DWILL COMPLY WITH ALLN NP INT —�—�/
SOU REGULATIONS. � ��� Issued by: Date
ignaanm of AppwanJCar nm Ude Re-roofs
HAY DOUS MATERIALS DISCLOSURE
Will the appRea future hording occupant store or handle hazardous material Type of Roof
as tlwircd by the Caper ton Mende l)al Code,Chapmr 9,12.and the Health and Safely
Cotte,Section 25532(a)P
°YrOhm
All roofs shall be inspected prior to any roofing material being installed.
will the appharrtm home haddiagtwapfnl a,e atmi can 9rdt.....which If a roof is installed without first obtaining an inspection, I agree to remove
nail h.urdnus lir conmminanis as defined by the Ray Area Air Quality Monagemam
D;,ede0 all new materials for inspection. Applicant understands and will comply with
°Y °"" all non-point source regulations.
1 have lead the hvardous nrt2na6 mquimmenm under Chapter 6.95 of he
California Health&Safety Code.Sea tis 25505,2551,1 and 25533.1 understand that
i f the on ild,ng dtms not currently have termor,mal 11 Liany nespnn,Intl fly .notify Rha- -
Oupm of We",airenu•.I,whic last he rect prior to issuance of a eni cute of
Occur ay J Signature of Applicant Date
'nrt'rauthndaadagem -ale - - All roof coverings to be Class `B"or better
OFFICE