02080134 (2)CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS
19507 HOWARD CT.
OWNE�TOR
SNAME
VI WOO
PHONE
ARCHITECT/ENGINEER: ,
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (cournamm"'ll
with Section 7") of Division 3 of the Business and Professions Code, and my licarcim
is in full force and effect.
License Class - Lac. #
Date Contractor
ARCHITECT'S DECLARATION
I understand my pins shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby offirm that I am exempt from the Contractor's License Law fur the
following reason. (Section 70315, Business and Professions Code: Any city or county
which requires a fampit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such Permit to rile a filleted statement.
that he is licelikal mrsularl to ilii bobvisions of the Committees Lice. Law (Clamber 9
-of Section 7031.5 by any applicant for a permt subjects the applicant in a civil penalty
f of not more than five hundred dollars ($500).
C1 1, on owner of she P.,art, or my employees with .,an as Outline emonamsaham,
will do the wolix'Ard the structure if no, intended or offered for t.1c (Sect 700.1:
4 Business and Professions Coale: The Contractor's License Low deal not apply to an
owner of property Who Wilds or improves themon, and who does such work himself
.1 through his own employees. parmaidsvi that such improvements sum not intended or
offered fmsal x. If, however, the building or improvement is within one year of
completion, the owner -budder will have the burden of proving that he did not Wild or
improve for Purpose of twin').
11
- an tnto
ias owner of the proper; am exaTtus nljaonm�jinj with iia,nied n I
_;aW
swot the pruitext (See 704,t, Business and limitations Code) The Contractor's
License Law docs not apply to an owner of property who Wilds or improves dommi,
am exempt under Sec. ''.B`& P C for this mason
W
nel-Maa;e
WORKER*S COMPENSATION DECLARATION
I hiretry all,. an&, natty of Pudinry one of the following dealarations:
EI I have and will maintain . Cmiflarve of Consent to self insure for Worker's
I Compensation, as provided for by Section 3700 of the Labor Code. for On
performance of the work fur which this permit is issued
M I have and will maintain Worker's Courripmraikin insurance, as rkaimd by kiietion
37M of the Labor Code. for the Performance of the work for which this permit is
issued. My Worker's Compensation into ancif cattier and Policy number am:
Policy No.
U't 1 f CERTIFICATION OF EXEMPTION FROM WORKERS%
COMPENSATION INSURANCES"-''
MIS union need no, be completed if On permit is for one hundred dollars
which t his Par
init is issued: I
0 ZI MOMCSUDJWIOInCWOTKersCom�n�tionpmvisionsotimuwrCwe.)
Z forthwith cmnPI1 with such Ponsimmus or this parraft shall be, deemed revoker
CONSTRUCTION LENDING AGENCY
a.7""
7;of the I I herebyherebyaffirm that thice iiia
work for which Ok Permit is
M Lender a Name'- '--""
Z
❑
Lender'sAddress
carnicL1111 a fy hot I hall acad Oil
ag to antraplyiffi .111
Valuation
fob �fdjh annitz.fion, and thereby
Occupancy Type
Ll
a a I!au, for in
="Yenicif
C6
(Wei agme to
FINAL ELECTRICAL ENERGY
liabilities, judgments, calls and as,
FINAL -PLUMBING ENERGY
City in amoseclausica, of the Arantiall
APPLICANT UNDERS pA Dsr AN
FINAL MECHANICAL ENERGY
IRC j A,ATION
---,-,FINAL-- ELECTRICAE
fitibuture mAppitcant/Contract or
FINAL PLUMBING
HAZARDOUS
Will the appleant or furft'ti la.
hen ser
he1;
0 yzx�
WII the
emit hazardous air contaminants as
Di",
- in"Ib Yes
I has, mail he hazardous
California Health & Safety Code, 5
ed stai. 3W7, Civ. C.) ' `
. C'
icat ion and state that the abrove information is
and county ordinances and state laws misting
onze raimesehmatives offlus city to enter upon
bon purposes.,
d keep hationless in. Ciij ofCiqzenin. against
ci which may in any way same tipaima said
CONTRACTOR INFORMATION:
CUNNINGHAM'S AIR SYSTEMS
1125 PANDOLFI PL
(408)926-2879
02080134
APPLICATION SUB DATE
08/23/2002
SANITARY NO. CONTROL NO,
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l= I I-- I Li -I L__j
Job Description
INSTALL A/C CONDENSOR
FINALED
OCT 0 8 2002
D WILL COMPLY WITINON-POINT' Issued by :l Date
te
Dale Re -roots
AATERIALS DISCLOSURE I . ,
ildhol; occupare, store or nvWk harallous material
T3
al Code. Chapter 9.12. and Om Health and Safe,,-'kiikf./
.
roofs shall be inspected -prior, to, any roofing material being, installed..
jildia, occupant ti,a equipment of devices which if a roof is irstalied'without first obtaining an inspectiofiill agree t6.remove
thfired by the Bay Am Air Quality Management
all new materials for inspection. _Ap_ ant understands and will comply,,�yith
a non plic, . ......
11 -point source regulations.
, �j
.Us' he ma lition,
Qm, or authorized agent' i
he
of
Signature -of Applicant ' D
_ate
All roof coverings to be Class "B" or better
. .... . -OFFICE,
CON I
Valuation
3 0 1APN kTMIrSH PLUMBINif:
303 - ROUGH MECIZN
Occupancy Type
Ll
304
- ROUGH ElfliqMR341APctions
501
FINAL ELECTRICAL ENERGY
502
FINAL -PLUMBING ENERGY
503
FINAL MECHANICAL ENERGY
---- -- --- -- 5 05
---,-,FINAL-- ELECTRICAE
507
FINAL PLUMBING
D WILL COMPLY WITINON-POINT' Issued by :l Date
te
Dale Re -roots
AATERIALS DISCLOSURE I . ,
ildhol; occupare, store or nvWk harallous material
T3
al Code. Chapter 9.12. and Om Health and Safe,,-'kiikf./
.
roofs shall be inspected -prior, to, any roofing material being, installed..
jildia, occupant ti,a equipment of devices which if a roof is irstalied'without first obtaining an inspectiofiill agree t6.remove
thfired by the Bay Am Air Quality Management
all new materials for inspection. _Ap_ ant understands and will comply,,�yith
a non plic, . ......
11 -point source regulations.
, �j
.Us' he ma lition,
Qm, or authorized agent' i
he
of
Signature -of Applicant ' D
_ate
All roof coverings to be Class "B" or better
. .... . -OFFICE,