02120079 (2) CITY OF CUPFRTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: ATLAS HEATING PERMrrNO.
22347 MC CLELLAN RD 02120079
OWNER'S NAME: 155 SAN LAZARO AVE APPLICATION SUB GAT 17
HITESH PATEL 12/18/2002
41 IONS: 4O8 739-0516 SANITARY NO, CONTROLNO,
ARCHITEC'VENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
wpa LICENSED CONTRACTOR'S DECLARATION C7 O O O
.-1= I hereby affirm that l am licensed under Provisions of Chapter 9(commencing Job Description
`zu with section IDlX)of Division 3 of the Basl sx and Professions awe.and my license is
iltlrul��t� yyyyyy!!!d" CE& A/C
AZ Li
m
of—o Da 'li r vwtnr
E'=1-to A CIIIT[CT LAR
as a I unJcrvand my plam shall he used as uhlic records
,�3wN Licensed Pmle'xional
—'per OW NI:R-BUILDI:R DECLARATION
op! 1 hereby altirm that Ions exempt Gam the Commennr's License law for da,lu i 00 following 0.,..n,(Section 71131.5.Business and Pmfeavinns Code:Any city or county
d K$� which mottoes a permit e,cnnxvun,alter,improve,demolkli.or repair any IrUclure
to—'^ poor its issuance.also requires the applicant frt osuch Permit to file a signed'mmmenl
Ela that he is licensed pursuantuotheprovisionsoftheContractohLicenseLawlChnp¢n9 Sy. Ft. Floor Area $49flGbtion
�$ (commencing with Section 74XX))of Division 3 of the Business and Professions Code)or
y
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of be Occupancy Type
not mom Than five hundred dollars(5500).
I,as owner of the property,or my employees with wages m their sole compensation,
will do Ne work,and the structure is not intended or offered for sale(Sec.70q BusinessRi
R�Q(,f
and Professions Code:The Conuactor's License Law docs not apply In an owner of 3 03 - ROUGH &A(tions
property who builds or improves daemon,and who arcs such work himself or through his
own employees,provided mat such impmvemcmc are nor intended or ofered for aide.It, 304 — ROUGH ELECTRICAL
however.the building or improvement is mid within one year of completion,the owner- 505 — FINAL ELECTRICAL
builder will have the burden of proving but he did not Wild or improve for purpose of
sale.). 507 - FINAL PLUMBING
0 I,as owrcr of the property,am exclusively contracting with licensed contractors Ir 508 - FINAL MECHANICAL
construct me project(Sea 704,Business and Professions Code:)The Contractor's Li-
cense law does not apply to an owner of properly who builds or impmvex thereon,and DEC 2 'G
who contracts Inn such projects with a ennlractor(s)licensed pursuant the Contractors 2002
License Law.
1 am exempt under So. .B&P C for this mason
Own,, Dam BUILDING
WORKER'S COMPENSATION DECLARATION
1 hereby aRnn under penalty of perjury one of the following declarations:
I have and will maintain a Cm-ificam un of Consent alf-insua for WorkersCumpen-
sation,as provided for by Section 371X1 of the labor Code,for the pen i m ow of the
work for which this permit is issued.
❑1 haus and will maintain Workers Compensation Insurance,az required by Section
3781 of the Whnr Code,for the performance of the work for which this Permit is issued.
My Wnk Compensation toxo camcr an ticy1a��/Wr/!he���[�a�s����/�
Ca cr' r(/Jn,�,.�L i Nnt"�lGL1.tL110/
.�s� C�fIFI 'rE ON FE%EM FROM WORKERS'
COMPENSATION INSURANCE
(fhi'.acdnn need not be completed if the permit Is torose modncd Jollan(S lUO
or less.)
1 certify that in the performance of the work for which this permit is issued,l shall not
employ any Person in any manner m as to become subject o the Workeri Compensation
Law'of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this CeA Eeae of Exemption.You should
become Subject no the Worker's Compensation provisions of the Labor Code,you must
O z forthwith comply with such provisions or this permit shall be deemed invoked.
z O CONSTRUCTION LENDING AGENCY
t-. Z' I hereby affirm that mere is a construction lendi ng agency 0tr the Performance of
ai 7 the work for which his Permit Is issued(Sec.3097,Civ.C.)
la1Q Lender's Namc
M Under's Address
J 0 1 cattily Nat I have read this application and auto that tbe three information is
G. t"' correct.1 agree to comply with all city and county ordinances and mute laws refining to
0 U building construction.and hereby authorim mpmacnhtocs of this city to enter upon the
about-mentioned property for impection purposes.
(Wee)agree to save,indemnify and keep harmless the City of Correction against
iliabilities,judgments,costs and expenses which may in any way swore against mid City
U in consequence of the granting of this permit.
'^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL NO DINT Issued by: Date
SDURC I UI.A ON'
Re-roofs
nature or ArplmandCmnranor
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occurrent store in handle harardous material
m defined by the Cupertino Municipal Code.Chapter 9.L2,and the llcalh and Safety
Code.Section 2553S(a)'! N/ All roofs shall be inspected prior to any roofing material being installed.
p secs
Will the airphec m or future buildin,ocrtipant use equipment nr devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hamlous air ronmminsim as defined by the Bay Arca Air Quality Management all new materials for inspection.
Uislria7
Yes
I have read the harardouv materials requirements undo Chaper 6.95 of the.adlfor-
ma Ilealth&Safety Code.Sections 2551)5,25533 and 25534.1 undersund Nan if the building
docs sol cu By hast a tenant mat it IS my responsihilptw?
quire n¢ hchmu. bens rissuanccofw ignature of Applicant Date
nor or auhoriaJ agent All roof coverings to be Class "B" or better