00070083 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINO ADDRESS: PERMIT No.
20601 MC CLELLAN RD ALTON AIR CONDITIONI G & HTGO0070083
OWNER'S NAME; APPLICATION SUIT DIM
LEE JEN S AND JA—LIH 45300 INDUSTRIAL DR t4 07/14/2000
ONE SANITARY NO. CONTROL NO
(510) 490-5655
C as m ARCH[TRUPENG NEER: NUILDINC PERM]IINTO
00
&& ❑❑ In.ur ItLltc'r PLUMB MIECH
natio I_I �I I= 17 1
<a
Fy LICIiNMIUCONI'ed midr pr UECLA of Chat Job DCSCI'IptlOn
Z✓+O 1herebya0irtnthvl1 am ofthe bander prod poll of..Code96mnmcnese
p v_,^tai with Sall panlfwagofec ':- 3ofthe business and 1'mfcssions Cooly,and my license
- i.iter°"f°r<°°^r '« _ 9C REPLACE FURNACE/DUCTING
s W a License Class
o y V ualC //i� • cnmmeIA .
go G nxcHrrt,cl•s ul:chARAnI
I�i m I nnderstand my Awns shall be wed as pahii<ree:EPI
Liccnud Ill nnal
OWNER-exempt-BUILDER DECLARATION
I M1erehY affirm dealOW I am exempt fmtn the Candrenor's Liaenm Lew hdr IM1e
F% fold°aving maroon fsecllon flULS,Bmimzs and Po dicso m Cale:nny oily ter county -
5 i d which requires a Permit iconsume, Iter, p demolish, repair ano omasum
asti
3 prior to t.issuance,alsomq thePortant) hpc ilt IHesigned.element
mtM1 r lit ,anod ,hp ,.n lthe c 1 ter',License Law Ichlpmr9 Sy. Ft. Floor Area Vanation
Iconmmn ing with Semon 7bhO)of Division 3 of the Rmaacxs fill I'nrwssiom Coded
m that he is exempt Ihomirom and the httsix fnr the 01,,11 exenlpr:,lt,Any va,wdon $9800
of savon 7031.1 by ally xppl;canl En Il it lefja a,the upplieent b,a civil pcnaay
of m a risme then live hundred dollars f$500u. APN Number Occupancy Type
01,as owner of the property.or an,employees with wages as their sole compcnsai°n.
will do the work,and the swcwre is not intended or offered fnr sale sat.70,W.
Business and Professions Code:The Contractor's License Law does not apply to an Required Inspections
owner of proper Who builds or improves Ihennn,and who does such work himself
..O,h his own coodal pollheat such bnponetnenn are nal intended or 204 — UNDERFLOOR FRAME
9 l aced for sale.IL hnwcver,the hu;lding ter arpmvnnenl is snld within one ycu of
, pwtion.theowm,-Ia.Ider wtu one the bunlml ter proving than hedld all bond or 301 — ROUGH PLUMBING
nmnprsa
ovela"it"'cof 'e.) 303 — ROUGH MECHANICAL
01.as owner orthe propenY.am exclusively contracting with licensed contractors to 304 — ROUGH ELECTRICAL
construed the project(See.701L Business and Professions Cade:)The Contractor's
License Law does not apply to an owner of property who builds or improves thereon, -
and who contracts for such projects with a eontractons)licensed parstand to the 505 — FINAL ELECTRICAL
Commetor,Lieeme Law. 507 — FINAL PLUMBING
❑I atm exempt ander sec. It m I'C lar Ills reason .
Owader Date 508 — FINAL MECHANICAL '
WORKER'S COMPEN'SA'TION DP,CLARA'I'ION 514 — FINAL PUBLIC WORKS
Ib
vlEnn under penally of perjury one of the following declarations:
1 hove and rill maintain a Certificate of Caused to self-insun for Worker's
kCi mponsminn, nx provided fur by Secnon 3780 of the L.Kur Codefor the
pad arms cot the wk fur whi,h Iiia pennil is Is,Ool ,
have tend rill mn..fou Worker's Cnnpnasmiun Imunume,us replircd by Section
3700 of the Luhnr Cole,to,We ped°mta,un of the wort:lar which this lermit in
issued.My Worker`s CCon,cowlion Insurance canter and police notnMr are:
Cumeel/.e�y�r�/v—+ folic"No.: � � ,6
I(��.'KIl19CATION OF For EMPTION FROM WORKERS'
COMPENSATION INSURANCE
('Phis wiakin peel mol be enndplaed if d.,mor is lin nuc hundred dollars
IS I lull ar Icss,1
1 ernity Ilan in the wriurnal of the work for which this Peron is issued.1
shall not employ any person in any ne net ,,as to become subject w the Workers'
Compensation Laws of Cnifomla.Date
Applicant
NfITICE TIJ APPLICANT:IL ager making this Ccnidlcam of Esmnptinn,you should
become subject m the Worker's Compensation provisions of the let"n Code,you must
Q O forthwith comply with such provisions or this permh shall he dplanual revoked. -
tiC'ONSTRUC'TION LENDING AGENCY
I hereby alien that then is a consa elian lending agency lir the perlamance
of the work far which this pennil is issued(sec 3097.Civ.C.1
6. Q Lender's Name
7 'L lenders Address
t.7 0 I comfy that l have mad this application and state that the above information is
a tea I agree it,comply with all city and county ordinances and.sone laws nlanng
Q V e,building c000runinn,and bembytathonm repress, ative—I this city ,,ender upon
�1 the ubo-m
ovanti...<d In'openy for inspection Parallellir y p9Oa,mcu.wve,Indemnify and lose,a,.^tloslhc City if Cupertino agviml
lin huhifins',judgnenls,toss and expenses which may in any nay aecnte against said
U z City in consequence of the granting of this r"'nn;l.
APPLICANT UNDIiRSTAIr�a'tt SA ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU ;EIB71 ai
signatare I nrp mticommanr rate
Re-roofs
IIA%ARDOUS MATHRIALS DISCLOSURE
ume,q,Hdeamt Or rmuclafking oeetpam store or hands, loadams mall Type ofRoof
o deluded by the CuIll Mat;dp,d Code.Chaptx+9.12,and the Health amf Sarety
Code,Section
oYcs 255321sT? 0N
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building reception use equipment ordcxiaxwhich If a roof is installed without first obtaining an inspection, I agree to remove
emit baadi air cantaminana m dofdned by the Bay Area Air Orality Madmgemcnl
;•frict+ all'new materials for inspection. Applicant understands and will comply with
Yes 0N^ all non-point source regulations.
1h""'read the ha,uohm,m.aetak mrvbe^d^nts dmder Chanter 6 95 of the
California Heath k sut'cly Code.Sccnons 25505,2553)and 2557;.H nndcostand ohm
if the building docs all currently haven coup.that it Is my rmry,nuhilfly hh notify the
upanl of the reyu^i ^s which must le net prier to issuance of a Cen;ficam Of
iccxeupan<r W `l' Signature of Applicant Date
S.?_
act car ori"d agent L! Date All roof coverings to be Class "B" or better