00080048 (2)COMPENSATION INSURANCE
(This wnionneed ont W completed dthc permit is fororchunAed ddinm($100)
or less.)
I cenify that in On pedo.. of the wmk for which this permit is issrd.I shall
not employ any person in Any manner to as to become wbjwuo the Workers' Compen-
wion laws of Califomie. Dam
Applicmt
NOTICE TO APPLICANT: If, afar making this Certificate of Exemption, you should
Wmme subject to dm workers compensation provisions a the labor Code. you must
Forthwith comply with such provisions m this permit stall W deemed invoked.
CONSTRUCTION LENDING AGENCY
I hereby aRtm that then is a wnsuucd.n lending agency for the perfumunce of
the, work for which this permit is iseued US.. 3097, Os. C.)
Lenders Name
[� j Uncer's Address
{yI Rectify da,1 have round Out application And.um that the JWsA information is
6, octect. I agree to comply with all city and county oedimnees And state laws mating m
s7 z building construction. And hereby authorize reprommusives of this city to enmr upon Re,
U aWv'..AmiuuM property for inspection purposes,
(We) agnse to A. idemnify and kwp humless On City of Cupertino against
l) Iubilmes,judgmenn,v. end expenses which tory in any way ..A.&. said City
;s., W in consoo Re a Ibe granting of this permit.
[— 0- APPLICANT uNDERSTANOS AND WILL COMPLY WITH At.[, NON -POINT
tjO U Z SOURCIi�Pj'UI. i NS.
/s ?�0u
sigmtun.f A,li,antl omracmr —
t H RDOUS MATERIALS DISCLOSURE
Will de applicmt or forum building ccapmt Acme or Wdie Numerous toatuW
as def sed by the Cupertino Munr ipsl Code, Chapter 9.12, And the HW N And Safety
Codc, Section M532N)7
❑Yes
Will the applicant or faun building occupant use equipment or devices which
condo haatdour air contaminants as deNmd by the Bay Ara An Quality Maougemem
DonswO
E3 Yes L— o
1 have read No hawdms materials reyuirtmcnts seder Chyxer 6.95 of Ne
fomu Heald & Safely Code, Sections 25505, 35533 and 25534.1 uncensored that If the
Re -roofs
Type of Roof
All roofs shall be inspected prior to any roofing material being
installed. If a roof is Installed without first obtaining an inspection
I agree to remove all new materials for inspection. Applicant
understands and will comply with all non point source regulations.
Signature of Applicant
OFFICE
All roof
Date
to be Class "B" or better
CITY OF CUPEMIINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
rcu"l
O O 0
BUILDINGADDRFSS:
621 LONNA LA
ALLIED AIRE SERVICE
s3'tl]E,kYN(0 1
_SUBMITTALDATt
'
ANNE M 661 SINCLAIR FRONTAGE
OWNER'S NAME:
R.08/07FTEIM
PHONC
(4.08)934-8844
ARCHITEC'IIENGINEGR
IiULDING PERMIT INFO
U
'du
,i, Qn
t- D 7
z o y MI
LICENSED CONTRACT'OR'S DECLARATION
hereby affirm Nat l am licensed under provisions of Chapter 9 (co ming
lob Description
_w
with5ation7000)ofMvision3ofdw Busimesmdpro(onion Code,asdmyliunwis
I tome A"�'7O U3�
FURNACE C/0 — 80000 BTU, ADD A/C 3 TC
veN
De¢ Cooloac
x a
ARCHITECT'S Dlci_ARATrbbi
I W mcmds
5.C
S
understand my pians ,hAl used as public
Licensed professional
OWNER DECLARATION
a a c
^_
r
-BUILDER
I from Ne Contractors License taw for the
/
t z
I hereby apron Nat un exempt
Ale
i ff o
folkuin,.. (SaUm 703 1.5, Business ard profusions Cude: Any city or rounry
au
's z
wMch nsquuca a permit to construct, attest, improve, demolish, or rapsir any summons
Sq. Ft. Floor Area
nation
prim to its inmnce, aim requites the applicant for such permit m file aligned autemem
Out he is licensed punumt to IN provisions of ibe Conreemore Liana U. (Chapin 9
2
APN Number
Occupancy
Pones Y Type
(c.rRing with Section 7000).! Division 3 ofthe Business end professions Code) re
that he is es<mpt thetvfrom and the Wais for the alkged exemption. Any violation a
Section 7031.5 by any applicwt for • permit subjects the applicant to A civil penalty of
Ant mons Nen five hundred doll. ($500).
Las ewnu of the r n y employees wi wages a
popcy,mmeml thwa utWvwlemm maden,
a Ulred Inspections
`r 4 P
will work. AM An crouddo for oak (Sec. A4, Business
clot Inmidruse,
and pmN he C.nere U to
whion. Cale: the Contnetre s License Law docs not apply w lf owner a
204 — UNDERFLOOR FRAME
propcny who buildsmimproves lberton, sed who does such words himself ordwegh
err,
his own emph yars. provided Our such impnwANAmA are Mt intended m (Rand for
301 — ROUGH PLUMBING
We. If, however. the, Wading m improvement is mid within one yearofconspleum, On
owner -builder will have she WoreenaprovingOmWdid AmWild or improve for pur-
303 — ROUGH MECHANICAL
pm<as.le.).
❑ L ...,of the pr.party, am e.charvely contracting IN licensed contractors to
304 — ROUGH ELECTRICAL
construct the project (sec. 7W, Business And professions Code:) The Contractors U.
,A.I-awdoes
505 — FINAL ELECTRICAL
mt.ppI, m An owner of pmpany wn. Wild, ne improve.x meson, and
who mn=ts fm such projacts with A 1WI ,mc(O Inentd Pursuant In tW Conuacmrs
507 — FINAL PLUMBING
License Law.
DI—c-mptmder Sec. .B&PCNeOixreason
506 — FINAL MECHANICAL
ownm Date
514 — FINAL PUBLIC WORKS
WORKER'S COMPENSATION DECLARATION
Ihcnby dorm under penalty 0f perjury one of the following dwlentiom:
❑ )have andwill maintainaCenifcam ofComentm self.insua for Woher'a Compem
Am-u provided fm by Swdon 3700 of dee Labor Code fm IW pertomurce of the
Wkf«which Nia PesachuinuW.
1 have and will maintain Waters COmR.WIm Inweem<. u rtquved by Swoon
J7fpof the labor Code, f0 eprohmen ace of the work fm which Nia permit is imued.
My Wor '.Co pE .0 so arecuwtflend Policy nmrmhrawo'i. i_.��/
Comer /mitis.. J►• hay No.:
COMPENSATION INSURANCE
(This wnionneed ont W completed dthc permit is fororchunAed ddinm($100)
or less.)
I cenify that in On pedo.. of the wmk for which this permit is issrd.I shall
not employ any person in Any manner to as to become wbjwuo the Workers' Compen-
wion laws of Califomie. Dam
Applicmt
NOTICE TO APPLICANT: If, afar making this Certificate of Exemption, you should
Wmme subject to dm workers compensation provisions a the labor Code. you must
Forthwith comply with such provisions m this permit stall W deemed invoked.
CONSTRUCTION LENDING AGENCY
I hereby aRtm that then is a wnsuucd.n lending agency for the perfumunce of
the, work for which this permit is iseued US.. 3097, Os. C.)
Lenders Name
[� j Uncer's Address
{yI Rectify da,1 have round Out application And.um that the JWsA information is
6, octect. I agree to comply with all city and county oedimnees And state laws mating m
s7 z building construction. And hereby authorize reprommusives of this city to enmr upon Re,
U aWv'..AmiuuM property for inspection purposes,
(We) agnse to A. idemnify and kwp humless On City of Cupertino against
l) Iubilmes,judgmenn,v. end expenses which tory in any way ..A.&. said City
;s., W in consoo Re a Ibe granting of this permit.
[— 0- APPLICANT uNDERSTANOS AND WILL COMPLY WITH At.[, NON -POINT
tjO U Z SOURCIi�Pj'UI. i NS.
/s ?�0u
sigmtun.f A,li,antl omracmr —
t H RDOUS MATERIALS DISCLOSURE
Will de applicmt or forum building ccapmt Acme or Wdie Numerous toatuW
as def sed by the Cupertino Munr ipsl Code, Chapter 9.12, And the HW N And Safety
Codc, Section M532N)7
❑Yes
Will the applicant or faun building occupant use equipment or devices which
condo haatdour air contaminants as deNmd by the Bay Ara An Quality Maougemem
DonswO
E3 Yes L— o
1 have read No hawdms materials reyuirtmcnts seder Chyxer 6.95 of Ne
fomu Heald & Safely Code, Sections 25505, 35533 and 25534.1 uncensored that If the
Re -roofs
Type of Roof
All roofs shall be inspected prior to any roofing material being
installed. If a roof is Installed without first obtaining an inspection
I agree to remove all new materials for inspection. Applicant
understands and will comply with all non point source regulations.
Signature of Applicant
OFFICE
All roof
Date
to be Class "B" or better