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