02110052 (2) CI'T'Y OF CUPN RTINO
BUILDING DIVISION PERMIT CMNTRACTOR,INFORMATION:.
Y.
BUII;)bWydDRNgWCASTLE DR A & H HEATING PERMIT NO 2 1100 52
occMEHMET NALBANT 770 CHESTNUT ST APPLICAT11n1SNIUtY2002
IONS: 408 279-0722 SANITARY NO. CONTROL NO.
ARCIII'niCr/ENGINEER: BUILDING PERMIT INFO
RLDG ELECr PLUMB MECII
0 0 0 0
00 LICENSED CONTRACTOR'S DECLARATION
IInchyadfimrthat lam) ro
crowdtinderpvionsoPm
Chapter REPLACE FURNAC bDescription
Gw with Sttlinn 7lXXB til DivixionJof NC llusi sant Prnfcssinns Gdc.send myli[cn¢is rr�f�
�<y in full lupylnJ effect
icg '?)X,9 e—(L-
�z Liccnm GTi6 Z L , xes t�
�y�p Dal —LI�Cnttl�cl
r^<—� ARCIIIlliCI A AI'I N
C 1 Q I nndestind my plans shall k uxcd as publiC u,C°rds DEC 0 5 2002
Dau
�LLO� Licensed Professional
g OWNER-BUILDER DECLARATION
in
u1 hereby affirm Ihal I am exempt from the Contractor's License Law[or the BUILDING $2700
i—00 following rcaam.(Section 7031.5,Business and Prnfcasions Code:Any city or county
X$ff which rc4vires a pnrmii m construct.almt,improve.demolish,or repair any structure
1°
—r prior In mi
its also requires the applicant for such perl m Glc aligned statement '�r�'
d—�< that he is licensed LOJWLMuo the provisions of the Comment Lice rte Law(Chapter 9 3*6110Mot18A@I) Valuation
CFn (commencing with Section 700)of Division 3 of the Business and Professions Code)or
a that he is exempt therefrom and Ne basis for Ne alleged exemption.Any violation of
Se. Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of 3 JAPN N Occupancy Type
am more than I.hundred chAlma(S500L 303 - ROUGH MECHANICAL
1,as owner of plc progeny.or my employes with wages as Noir redo Compensation,
will do the work,and the structure is not intended or offered for sale(Sec.70,14,Business
and Pmca.,tons Code:The Convectors License Law Nes not apply m an owner of 505 — FINAL ; GLtbnS
property who builds Or improves thereon,and who dons such work himself or through his
Sun employees.provided that such improwminls etc not handed or offered for ale.If. 507 — FINAL PLUMBING
nnwevcr.the budding Or improvement in within mrr your of Completion.the owner. 508 — FINAL MECHANICAL
builder will bare Ne burden of proving that he did not build or improve for initiative of
side.I
❑ I,as owner of the property.am exelosivdy contracting with licensed convanurs to
construct the project(See.7144,Business and Professions Code:)The Contractors Li-
Came taw does not apply to an owner of property who Wilds or improves thereon,and.
who contracts for such projects with a contracsor(s)licensed pursuant to the Contra mel-I
License Law.
❑l am carotid under Sec. B A P C fOrlbixrcaem
o r DateWORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury one Of the following declarations:
,./ I have and will maintain a Certificate of Comers aself name for Worker
oti 's Cnmpen- .
lon,ss provided for by Section J7(XI of the labor Code,for Ne performance of the
work for which Nis permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37k)in Ne Labor Cade,for the vedurmanct,of Nc work for which this permit is issued.
My Worker's Compcnsatinn Insurance carrier and Policy you etc:
Cy�c 11 U� I Kai�J Policy NO /
r( CERTIFICATE OFEXEMPTIO WORKERS'
COMPENSATION INSCIPANCE
T thus saxtlon nemmot be completed if tlepermll is foronc hundred dollars(SIkB
or Lela)
I certify that in the performance of the work for which this permit is issued.I sholl not
employ any person in any manner m m to become subject o the Workere Compensation
Laws Of Cahfurnia.Datc
Applicant
NOTICE TO APPLICANT:If.after making this Cent fettle of Exemption,you should
became Subject to the Worker's Compensation provisions of the Labor Code,you must
OZ forthwith comply with such provisions or this permit shall he deemed revoked.
z O CONSTRUCTION LENDING AGENCY
F" h I berehy affirm that there is a eormvetion lending agency lot the performance of
7 Ne work for which this permit is issued(Sm.31197.Civ.C.)
{[7 Q Lender's Name
a Lcndcr's Address
U p 1 Certify Nat I have read this application and swot that the above information ix
LL F., correct.l agree to comply with all city and county ordinances and stale laws relating to
O U building construction,and hereby authorice representatives Of Nis city or coder uqm the
r W shove-mentioned property for inspection purposes.
a. (We)agree save,indemnify and keep harmless the City of Cupertino against
.U-d m Z inconieq judgmentse costsand cxpcnmsmit. may in any way accmc against said City
Uz in consequence judg ethe granting ofthis urs which
L
'+ APPLICANT UNDERSTANDS AN WILL COMPLY W I ALL NON-POINT Issued by: Date
SOURCE GULATIONS.
r(� DL Re-roofs
gnaturc of Applic OALARDOUSMATERIALSDI.SCLOSURE Date Type of Roof
Will Ne applicant or future building tccupan lnum or handle hasaNuus matenal
as defined by Nc Cupertino Municipal Code.Chapter 9.12.and the IlcalN and Safety
Code.Secdom 25532(a)r — All roofs shall be inspected prior to any roofing material being installed.
Vex
Will thelicannufumrc M1uilJin mgsee p+pm nalmuevmeswMch B a roof is installed without first obtaining an inspection, 1 agree to remove
PP g Occup' 4
emit harartout air contaminant.a defined bythe Bay Arca Air Quality Management all new materials for inspection.
DlstriCL7
❑Yea ErN�11
I have mail the hasardous materials requirements under Chapter fi 95 of the Califon
.in llcalNSSafety Code.Sections 25A15.25533 and 25534.1 un&.it the if tk building
dors or cu.rllybascawnam.Natitismyrcspotnibilityurnodfytkoampamuf Nc
mgaf nntswmm�maslk Pdvdnisanancenra rim aforcnIt Signature ofApplicanl Date
moot norhanrm'gen, Date All roof coverings to be Class "B" or better