01010097 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDR&SS: PERMIT'NO.
10679 NATHANSON AV ATLAS HEATING 01010097
OWNER'S NAN117: )
PI'LICATIONSU T'
FUNK. ERNEST J TR AND DOROTHY A 155 SANLRZARO AVftlSY^23/2001
PHONE; SANITARY NO. CONTROL NO.
(408) 739-0516
QCARCIII'IP,CIAiNGINF1iR: BUILDING PERMIT INFO '
0 BLDG FLECII'LUMB MIRCH
F- I,ICF,NSEO CONTRACI OR S DECLARATION Job Descriptionhcmhy ulfimnhw ant IiecaxeJ under pmvhinm of Chapter Nnnmmncing
F=f-o with Secdas 7003)of Division 3 ofthe Business and fes,,,n,Code.and my license
axsy i,n,t11forceunitCIL V FURNACE
¢ 2 Latent C+„ Lic.p _
C
C.G nme_� Con raram .
ARCIIIFECI'S DECLNLCfI(1
C u�� 1 unJenmal nay ptanz shall M u:d m public mcnNs
Ce
to Licetwed Professional
o
ce -BUILDER DECLARATION
—m hc,'d+y,JBrm[L'A I an,exen,poh'am the CuntraRnr's Lactate Law for Ibe
]_� following mason.(Section 7331.5.Business,and Professions Axle:Any city Lor county
ce$0 which requires It permit iConsumer, Iter,inTrave.demolish, p y immature
cepdort t oho y -IM1 pylic It hpa ill II :'g J.[t nen
e. that he en:cl purmand tothe proomons oftle,C t cot f,LCemol.a (Ch pmr9 Sq. Ft. Floor Area Valuation
(Can timing will,sari....7010(1of Divi,Ion 3ofthe Budne,s,nd Profs,oa,Corel $0
or that he is exempt therefrom and the basis for the alleged exemption.Any,violation
of Semon 70315 by:try opplicnm for I,permit objects me epplicent to a civil penalty
ofnat come than me hnmmd dollar,(5500). APN Number Occupancy Type
❑I,asown crnl the pmpany.army Caaployee,will,wages a, felt>alo,c altercation. 32643072. 00
will do the work,and the amnum ix not intended or offered for sale Ste.71,14,
Business and Prumosluns Cade:The Contractor,License Law does not appy h+an Required Inspections
o,w r of propene Who build,or improve,memo a and who doe,such work himself 301 — ROUGH PLUMBING
r through his awn employees.provided that such improvements am not amended or
offeac l for,:de.Il:now t, he building or inonoveamat is told withino e yea of 303 — ROUGH MECHANICAL
ompletion.the owner-Gilder will have the burden of proving that he did urn build Lor
improve lot purpose a,ale). 304 — ROUGH ELECTRICAL
0 1,m%control property,am exclusively contracting with licensed contractors to 505 — FINAL ELECTRICAL
moue the project(Sec.7044.Business and Yrafm,ion,C,xle:)'fhe Contrunor's
iLicen,e Law doe,not apply to an owner of property wR+u amid,or httprove,memo... 507 — FINAL PLUMBING
.ad wam,`.Littow[,a. proj«t>with a commnonvl licensed ru urn,to the 508 — FINAL MECHANICAL
01 ore esempt ander Sea. .If&P C fur this ma,on
Owner [)am
WORKER'S CONI PENSA'IION DECLARAI ION ` 7
I hereby alfimn under penalty of perjury one of the following Jed /'
arwian>:
❑ 1 have and will numa Certificate of Coniston la wit-in.wre far Walker', '/
Compensation. as provided for by Section 37W of the Luba Calc, for the ^ -Ile
nl the wort for which this li,Issued. ✓�
;;�' Iald will,nnintnin Wnrkcr',Canapw,winn Ina,rance,as required by Section `
37W of the Libor C'ulc,for the performance of[he work list which this rental is
ix,ual M11 WsoyrAc w I Imamate Carrier and holes mmrMr um: 1^�
Camcr:{�/ F�i policy Na:(/I�r�/w� �`l7
ci: TwTCAnoN OP CTI:M RTIONFROM WORKERS'
COMPENSAI ION INSURANC17
(shin section I,,d nut be con..med it aha Mr nil is far one hundred dollars
($100)at lest) ,
1 cenify that in the perhm eracc of,he work I...which chi, m....it i,issued,I
shall not employ any prison in any manner sa as to become subject to the Wmka,,
Co,nlmn,olion Laws of Calllinnia.Uwe
Applicant
PILL ICE'10 APPLICANT:IL ducr narking this Comiticme of nxengaiala you,hnulJ
z acme object to the Worker',Ctm,pon ulln I pmvisiuns of the Lal Code,yo, nuns
Q half,all comply with such pr mi,iono,or this permit shall be deemed revoked.
CONSTRUCTION LENDING ACENCY s
a ' I hereby of sin[flat Nem is it construction lending:agency for the performance
of me work for which Ihi,permit Is issued(Sec.3097,Civ.C.)
G Q Lender',Name
5 z Lender',Address
VI teoily that I have mad this appliamien and slam a
that[he save information it
W tr correct.I agree ata comply will,all city and county nnllnon a,Loud Stam low,cola ing
V u+building construction.and hereby authorize representatives of this city or enter urym
r R:
cut se.ncnnated,.... Ily far In,po,inn purPo r,'
.r y (WC)agme too saee.,ndemnily and keep brainless he City el Cupenin3 against
'n ,mobilities,jtWgmmam,casts and expenses which may in any way accrue ugaina said
City in Consequence of the granting of it 'iL .,./ �sg
APPLICANT UNDCRSTANDSANDW .COMPLY WITHAL}.1�ON YI Issued by: \ Date ^v
SOURCt �ULATION' y'
Slgnu d',poreanvconnatm �[J [fare Re-roofs
IIA9ARDOU' lA'I'HR1ALS DISCLOSURE
Will lb,apphnml ar fixes Rilingmeupaat,mm ar naalm harmrdoa,matcrial Type of Roof,'
asdefined by lire Cupenim+Mu tj,d Cade.Chapter 9.12.:ad the,,mama and Safety -
Cale.Station 25532(10)7
0 yes 11No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or from,building occuand rise c9uipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
d,hamrdous air conmminunts as dcfined by the Buy Alen Air Quality Management
• uiarin'y all new materials for inspection. Applicant understands and will comply with
Cl yet 0N all non-point source regulations.
1 hose read the hazaJom tmrmrial,maircn¢no under Chapter 6.95 of the
Culifomia Heald,&Safety Gale,Sa4nn,255115.'_5533 and 25514.1 understand that
if the ailAing does sol currently hate a Ia.m.thud it is my r..po odulay,m nattily the
cupunl of the requirement,which must be met prior to issuance of a Cenifica a of
Occupancy.
Signature of Applicant Date
Owneror aamoweed Canal [)air All roof coverings to be Class "B'+ or better
OFFICE