02110053 (2) CITY OF CUPERTINO V,
BUILDING DIVISION PERMIT "CONTRACTOR INFORMATION:
BUl11*(30&ElNORMANDY CT A & H HEATING PERMITN02110053
owTERRY CHENG 770 CHESTNUT ST APPI.IcATT1srU1V.2002
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ZONE: (408) 279-0722 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO be
BLD(: ELECT PLUMB fell
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LICENSED CONTRACTOR'S DECLARATION
1=°° h Description
w F I heresy amrm that I am beeped,oder nm�t;ton.or Chapter v mommemdmg P
<as wish linn7,0)ofDivi m3nr c uainessundPrnressionsCodc,amdon,win.Is REPLACE FURNA
Guo, m foe area err !/Y7 FUNA SO
Liscne I`ss — z as
CN m acou1Y/11
ARCHITECC ECLA AT16N FEB 1 3 2002
¢< l understand my plans shall M used as prhfic records
xoau
FLL�g Licensed Prolessiawl
OWNER-BUILDER DRCLARATION �' O'1 ®�pI/�
tali Q I hereby allirm Ihat 1 am exempt from the Contractor's License Law for the LJ L '• G?
$2000
00 Inllnwing reason.(Benin"7031.5,Business and Professions Calc:Any city ar county 4 G
as.91 which requires a Permit tit construct,alter,improve,demolish,or repair any nrumun
w—'^ pnomn its issuance.alsona,mocvhcapplieant rot such Permit o rile axigted statement
that he is licensed p..air 10 the Prnvivonsof the Contractor's Licence Lew chxpmr 9 3Sg92t9lOaA A&@ Valuation
ar° (commencing with Section 700)nr Division 3 of the Business and Processions GWe)ur
i 3 S that he is exempt Therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a pemth subjects the applicant to a civil penally of PN N6HS6vH PJIUMBiNuOccupancy Type
not morethan five hundred dollars Ds ). 303 - ROUGH MECHANICAL
❑ I.as owmaollhe pmpeny,or an,employeeswith wages as their title compensation,
will do the work,and the structure,is not intended or offend for sale(Sec.7064,Budous
and Pmfessirns Code:The Conoaclors License Law does not apply to an owner of 5 0 5 - FINAL ;CLl1On$
property who builds or improves uniform.and who dceni
ssuch work msclf m thmugh his
own employees.provided that such improvements an not intended or offered for sale.If. 507 - FINAL PLUMBING
however.me building or improvement is sold within one year of completion.the owner- 508 - FINAL MECHANICAL
builder will haw the burden of pmving Out he did not Wild or improve for purpose of
.If Y
❑1,as owner of the proper,am exclusively contracting with licensed contract...to
consumer the project(Sec.)pati,Business and Professions Code:)The Contractor's Li
croon Law tars not apply to an owner of property who Wilds or improves thereon,and
who comets for such pmjecu with a convacamod licensed pursuant to me Contractor's
License Law.
❑ I am cxcmpl under Scc. ,B&P C for this..,at
Owner Do
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penally of perjury one of the following declare umme
I have and will maintain a Calibrate of Consent to self moue for Worker's Compen-
aatinn,as provided(or by Section 3701 of the labor Code pm
(nr the fonafrow of the
work for which suis permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
3701 of me labor Code,for me Performance of the work for which this Permit is issued.
MyWnr sk•r's Compensation lnsunncc carrier enup I
,Lcy r
— POir
Q
CERTIFICATE
NNROMW ERS'
CO., TOAIINSURANCE
('This section need not he completed if[be permit is fornnc hundred dollars($100)
,it less)
I c,nify that in the Wats mance of the work for which this permit is issued,I shall for
employ any pemm in any manner an as to become subject to the Workeri Compensation
Lows of California.Date
Applicant
NOTICE TO APPLICANT:11,after making this Ceni ries¢ if Eacmption,you should
become subject to the Worker's Compenwtiun provision;of the LaMar Code,you must
OO forthwith comply with such provisions of this permit shall be doomed revoked.
z CONSTRUCTION LENDING AGENCY
I hereby aBirm that than,iaaconamsetion lending agency l is the amformanecof
ai 7 the work for which this Permit is issued(Sec.YN7,Civ.C.)
t7]Q Lender's Name
z Lender's Address
(� O 1«oily mat 1 have read this application and state that the above information is
l$. t~ come,.l agree to comply with all city and county ordinances and state laws relating to
0 U nuildiagconswcomr,and hereby xuthorim mpresematives of miacity to enter Open the
,r lk1 aMwc-mentioned property for fn;pcdinn purposes.
t1 (We)agree to save,indemnify and keep harmless the City of Copeninu against
tF—t In hataloice,judgmenu.costs,and exNases which may in any wayaccmc againsisaid City
U z in consequence of me granting of this Permit ,/ v
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /
SOURCEfEGULALIONS, e /
17 Re-roofs
SignatureLZARr','�',J,
pplicanl/Contraclnr Dvte
I IAZARDOUS MATERIALS DISCLOSU RE Type of Roof
Wapplicant or future building Occupant store or handle hvarduus material
as definedhe Cupenino Municipal CnJc.Chapter 9.12,and the Ileallh and gaiety
Code.se25532(x)'' All roofs shall be inspected prior to any roofing material being installed.
0Nn
We aPPlicam nr fuwrc building rwcupam um cyuipmcm or devices whichIf a roof is installed without first obtaining an inspection, I agree to remove
mil ha ,air contaminants as defined by the Bay Arca Air Quably Management all new materials for inspection.
Uidria7❑ QI ad me becesdnusamwislsnmmi cma unJerChapmrfi95ufmc Cuba,piaHalmfely Chd,Stttinnx 25915.25533and155311undertwmlNatifmebuilding
docs not ntly have a w mourn.mat it is my responsibility Ot notily the Occupant or me
teyrifommrnmrubemetpnor an,enrac,nir,arorqpane. Signature of Applicant Date
All roof coverings to be Class "B" or better
net oinwd agent Dar