02080145 (2) CITY'OF_CUPERTINO i
i„ BunbtNGbIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
941" MILLER AV AAA FURNACE & AIR CONDITIO ING02080145
, APPLICATION SUB DATE
O
I TA'8!LZ ALBERT E AND MARY L 1712' STONE AVE 08/26/2002
1 PHONE: SANITARY NO. CONTROL NO.
+ (408) 293-4717
ARCHITECIyENGINEER BUILDING PERMIT INFO
W O ( 't BLDG ELECT PLUMB MECH
U ! fJ
Z
FF rn_ LICENSED CONTRACTOR'S DECLARATION ��j'
IZ= ,:: IhereEYaRrmNmlamlicenudunderpr°visionso(Chap[er9(commencing REPLACE WATER HEA'YE12' �'�0' ®
Fyh
with Section 7000)ofD' "ion.Lofib e Bminy1an Prafessinns Codeandmylicense
n in till fo C Cp
i Lie..
Cammmar. JAN' 0 .2:2003
itis 3 w F<n 'r ARCHITECT'S 0 O
to �' `.1 on remand my plans shall lia used m public mcoNs
Hspoo Licame,Pofe sinal BUILDING
"' OWNER-BUILDER DECLARATION
W m }1 ti mby affirmthat 1 am rapt from the Contractor's License Law for the
Z 0 foll ing re '(Section 7031 5'Business and Professions Cade My city or county
.$650
O which repairer a Permit to construct,alar,improve,demolish or repair any stiucrom
e.3� � t i uatace al responses;theapPucam fassuch Perms m fl -grrMummm
ae
that ha isbeamed Pairs ay.romeyr6aHions of the C.Mrsercy's License Law(Chapter 9 QQa�st �s���Tnnr a; Valuation
(commeniiing,with Sar n7o00)of Division 3 of Ne Bgses,adP fnsrons Code)
or that he is exempt therefrom and the basis for the alleged exemption.Any violation
of Section 7031 applicant-.5 by any applicant for a permit subjects the applicano o civil Penalty ��g..tt II�
a of not more rlwn five hundred dollars($51)(1). 502 APN C+VIQY L PLUMBING ENERGY Occupancy Type
°I.u owner of the properly,or my employees wish wages a Neu sale compensation. 506 — GAS TEST
-'will;do•the work,and the structure is not intended or o@red for sale(Seo.7044., 50 7 - FINAL PL8)I'§1r5ifeAl(gfspections' "
Bosihesi said Professions Code:The Contractor's License Low does not apply m an
owner of properly Who Wilds or improves thereon,and who does such work himself
., or through his own employee.provided that such improvements are not intended or
j'oRcrcd'for ealellC howisverdo,building or improvement is sold within one year of
Marmot,fm the owner-Wilder will have the Widen of proving that he did not Wilda r s
improro for puryose of seleJ.,
-g ._o ..___. _. ._ . ._ ... .,.-..,.... .. . .._ ..............._. ..._.._. ... ... _ _ .._
(]Istr her of the properly:am exclusively contracting with licensed contractors 's r
consweLaw oes n face:TI144;Business and ProxMy who
ills or The Ca thereon,s
.Rd wh Wes does aim apply to an owner of Property who builds or improves thereon, -
-• -_C orstat contracts fogsuch.projmu.with.e contmcwr(O.licensed pursuant to,N<.
Conracxofs pt unse Law
pmmpt
laexerrde�Sec.`- " BAPCfor this..on
Owner,i. L --NDute . ,
WORKERS COMPENSATION DECLARATION
-1 hereby affirm under p7hy of perjury one of rhe fallowing dathoodons:
=1 °14•nove'end`will Mainxain a Cenifiwte of Conscm tote](-insure for Worker's
Compensation,-as Provided for by Section 3700 of the Labor Cade, for the '
performance of the work for which this permit is issued:. -
.01 huge andwili'=''miain Worker's•Compur
cnaadan Insnss nce. rcgoired by Section
'37M of the Labor Code,for the Performance of the work for which this Permit is
iasueJ My Werke Com ns t o Imm�11aru'e comer and liI cy myrober are:
EFf (�P�������ay�^,,,�(/fpfI' ( , 'a H
�
ttIT' �1tk 4 'df• �I,I - .
t �CERTIFICAf10 'OF E%DMPIION R y'. 9 ..s. _. 1 t 1} i• f. it i� �
" COMPENSATIONINSURANCE."' ^' •''
it
virion need nor be complexed if the permit is for one hundred dollars 'li •_a ' ' - -
'(S100),orless.) .
(candy mxi nrhe Perfommnce fm okfn w1u1lith!,per;;itisiouedj -•!. I3sla I'r a ,+
ash 11 n s employ any person in any manner so is to became subject to the Workers
'Compensmian laws of Califomfa.Data '
:'iNcome subject
uj APP LICANTIL a@rmakmg rho Cenof of Camp[iomyou
O �i rice vid,co at i W chp Compensation insprovisions ll she Leber CWe you muss
.Q f rih th 'ply:with such provisions o this Permit shall ba deemed revoked,
'� VI 's t a CONSTRUC iON LENDING AGENCY,'_ -
; -` r 1 hereby,0-am Wa m orastiucxion lending agency for the pcdonnentt
-� w•a :of rue work for which mu perinn rs rssuN ISa.3097,Civ.C.1 "'
'LeMer's Name-.,
D Z •.Le dere Addrt; Y:n. a
I cenRy th r I h mad N t ppl o and tate that the above information is
tea F.a a rmn I gree m comply with all city,and county onlummu< d state laws relating
O.C.> •to Wilding wcton end hereby authorize repoesonottivesf this city to enter upon
-94 a m 7d N b9 e)m onto property save.
ind fo peel p rposes._
0•a (We)agree mfy nil le phaimlcss the City of Ctiertino.gams,
V) •lib 1't . judgments, r and xpenses which may in a y waye me agarrut said
C,7 {Cty csequence utile granting 6f the p'mit z - _
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N N. ISSuedb Date
`SOUR REGUL. IOP yi
dic
�S Iof Applicera
nf onctor+'1_.o) ate Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
h {;; Will rh aPPla n[or.f t re Wilda ag.nt store or handle haz Nous material ... :Type-0f ROOF n. .^. ro...
{;as
defined by the Cu Perl M copal a Chapter 9, Z and the Health and Safety, 1
Code Scca .8532(.) ) ',.i r '.,l t i. sl f
❑Ye: No C ; All roofs,shall be inspected prior_to,any,roofing material being installed -_ ...
Will he applicantorf tuebsuffi cepa r use eq prois device hien If a roof is installed without first obtaining an inspection; Iaagree to:reinove
earn h x m air c mm ean[s a,de by theBay Are Air Quality M...gerium
'District? , ,all new materials for inspection.„Applicant understands and will,eomply with. ,
❑res "°' all non-point source regulations ,
- - -
lnyx
. i I n He.t hC the e,,Code materials s requrrt 533 sunder Chapter 695 of roe
"California Wilding
dos Sofcry Cody.Sections ant.that
itis Brad 8534.I uy it)notify
ond xhm
rifItheiM fiaildiftherenorcurrtnrlhithhavuir Is,met
myresponsibilityCeil"au Ne`
"becdpant of the requirtmenrs which must he mm prior m issuance of a Cenificm<of
., OccupaY..
^ •'e' r : _Signature of Applicant. _ ._._ _.... _. . . ........ .. . Date
.. -
MM or eumorirN agrnt ,�d. -.r t [./ All roof coverings to be Class"B”or better:'' .
-. . ., _- OFFICE . .. _. . .. . . . .. . . _.