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01040052 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 2176'2 LOMITA AVE. A A A FURNACE COMP' NY 01040052 OWNER'S NAME. APPI.ICA'I'ION SUB DA'I'11 GARY I_Ehl 1712 STONE AVE 04/7.2/2001 PHONE: SANITARY NO. CONI KOL NO. (408)293-4717 - µ1 we Zp ARCHITEC(ENGINEER: BUILDING PERMIT INFO ❑❑ BLDG ELECT PLUMB MUCH aW ISI CI 1SI 1SI h LICIiNS1iD CON'I'RACIUk'S OfiCLARAr1ON Job Description 1 hereby aflirin Ilial IInt I leenwd um ler pnwivimoof Chirac 9 b, alocncing oz. ce with Scoinn 7("))of Devirinn 3 of lire Business and Profession.,Cod,mdnty It,. .¢ M nRd ytak , , hp ADD A/c 48000 HTU. K d Liccnsc Y�5 I.ie.N "2'_/ a u )at._ fv i� Conlnctor 3 u.I-n ARCI111'ECr'S UIiCLARATION tO g I undesis I my plan,,ntdl he used it,public lean& �so ise Liaatsed Proh,"inn:d 6 e OWNER-BUILDER DIiCLARATION u"3 1 hereby anion mut 1 nln eieatpl t.mri the C..mrsemre L s Lncen.cw for the m C?!e fawing reason.(Seninn 7031.5.Itusiness and Professions Cents:Any city or county {2p slid 1 -, flo"ononoO,' p I', P ,shroame a 3 es prior in its4 the MI a t felt such perrin to life g I t nem that he is licensed Frott the provisions ofineConfiscates License Law yChapter Sq. Ft. Floor Area Valuation tett . tgw hSe"i 7n(XdofDv,�tt3moeBm to aidlrsre. n,Ctde) $,5118 of Thal he i,exempt Iherelimn and am Devi,for the alleged exemption.Any vodation of Section 7031.5 IDI any applicam Ibr a pemtit subjecu the uPPlicanl eta civil pcnahy ,if moo man five ntmdred dneaf,($510). APN Number Occupancy Type 01,as owner of the prepeny,or my employees with wage,as their sole compensation. 3571.8039. 00 will do the work,and fhe nowt re is not inner hsl nr offered file yule(Sec.7444, Bushes and Professions Cos.:The Cmarneal,,Lmeme I.aw does stet apply ,,an Required Inspections owner ofppenyWhohaam morimprovesemon.andwhodoessuchworkhimself 304 — ROUGH ELECTRICAL r m rough his own employees.provided mat such m imprnveems are not intended nt enter!it,, le.IlL however,me holding or improvemnnf is lots within rote year of 501. — FINAL ELECTRICAL ENERGY completion,the owner-builder will have the burden of proving tad he did not build nr int"'we fn Propose of,els,')' 505 — FINAL ELECTRICAL 01,as awmr of We proPeny.am call u...el,emarn,ting with licensed conlraamr,to construct the project(Sec.70IW,flus and Prmfcs ,Cade:)The Core Iia eweov xtt upPly ,,I,, eoI ,openy who s Laboildsur lmproes thereof, and who continues file such project,with a contractor(,)licemed immumn to the Cor mcmrn Lweroe law. 0 do exempt ander See. .Ba 1'C for this reason Owner Date FINALED WORKER'S COMPBNSArION DECLARATION I hereby dT t under penalty or perjury,mail the following declarations: MAY sr� . 0 1 have :utd x:ill maintain a Certificate of C'nn,eal m x211-insure lin Wolket', 0 0011 Cooper anxim, ii, provided for by Section 370X1 of he Labor Club. for the perfonnunce(,title work ler which this permit is issued. P[nnrc and will nmiand.Worker,Compenmtiun Insurance,as yell ired by Section - BUILDING 00 of the IaMle Code.for he perfoaancc of the work for which this permit in omod.M�{,Wmkcr'ti'Cron n tion lauurnncc cxriicr,ot 1t'nnr`li,,attmhcr urns Carrie ffAT�1',II N OF I XEMPI ION I•ROh1 WORKERS' COMPENSATION INSURANCE ('Ili„ectloa recd not he cn[npleted It the worn I,for one hundred dollxrx (5100,or less.) I esrtity on in the permanuanee.d'the work for which this permit is issued.I shill not employ any Person in any muoner ,us In beomne subject Io the Workers Compvmation Laws of Calirnmia.Ode Applicant N Well. .•bj APPLICANT:Jr,of ism prolong Inn mi,ime m of Escmphna,yen uum. ruld hcrthtrcsunjme,the,such o amen,,,this provisionsII the ,owd Code.you nmet Q O forthwith entnply with weM1 provision,nr this Penni shall be deemed revoked. - F Zi CONS'FROM]ON LENDING AGENCY 1 hereby affirm that there is a cot tmclmn lending agency for the perli,rmance of the work lin siren his crano is issued(See.91197.Civ.C.) lender:None .7 7 Lender',Address V Q 1 certify Out I have read this application and score In., he$Mme information is [L E. correct.I agree to comply with all city and county'ordinances and state law,relating to taildon, :f tout i.and1 huo that pr eI'NJF Ith city to mer upon he M' nu tri rode y dot P P ti C (W je g t sec ole fy keepdha it"i moy wy fCupea oagaaid V] City i J q f.,....t' f . pv c, 1 h y any way gain,said V z ChyinnANT UNDERSTANDS of theNDS AND p<•CO � APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued e— /"'Tw�JwCJCv Sun �BREG tLp ) S. � �L Y Date it" nduremAPPrtcant/Comm n nate Re-roofs HALARI OUS MATIIRLALS DISCLOSURE wh the appfieant m toore brooding a:capion, loort,handle haenmlon.material Type of Roof' . an defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety Calc.Section 25532(x)! Cl ye, :r<_ All roofs shall be inspected prior to any roofing material being installed. Will the Tpheuntm Bathe huilA;c cupunt use component or dcvices which If a roof is installed without first obtaining an inspection, I agree to remove unit hv:udouv Bir canuur'umnts u, by mu Buy Area nit Quality Manasatttem District? all new materials for inspection. Applicant understands and will comply with oyes 0 N all non-point source regulations. 1 nave real the Imeardom materials requirements under Chapter 6.95 of the Californi a!leapt,&Safety Cole.Sectitms255(15,25533am125534.I undo bndmat if Iia huilJing doc,not cumotty nave a¢runt,than if iv my to.ponsihiruy to nobly the tecupunl of the reauiremm,o which am.o be met prior m issuance of x Cenifcde of kcuc. y L- Signature of Applicant ate -d ages /-"— f All root coverings to be Class "B"or better uner it,atalhu � at OFFICE