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00020051 (2) CITY OF CUPERTINO PERMITNO. BUILDING DIVISION PERMIT (CONTRACTOR INFORMATION: OOZ.O / BU;VRESS: T VAIEZ HEATER&) INC. (] /n�/' �/ P SANITARY NO. APPLICATION SUBMITTAL DATI O N'R'SNAMF., I / Na/c`c17""` Ave NIC CONTROL# 0If ", Ha ywanv, C�j'App 9�y6-1722 ❑ ARCHITEC rENGINEER r I (510) 293-2O 1 Z BULDING PERMIT INFO px2 - 00 CLLy UU F l6^ LICENSED CONTRACTOR'S DECLARATION Job Description ZZ=p I hereby affirm Nat I am licensed under,Pr vnir ,of Chapter 9(comenencing p PyFw wiNS 1batc ,am.ivision3of NeBuinusand Rofasiom C9de,and mylicenu is QYfJ iMnfullycema m < 0 enJawa 1 # l�l/atPr Nester Repla�emPnt '40 Cq/lG� �i 5 O6Deu ISDECr D g me mall be me DECLARATION $ y I andermand my q.m shell W used ss public records H K Pro c Licensed Professional OWNER-BUILDER DECLARATION 3 Y I hereby affirm chat 1 am eaempr from she Contractors Licenu Law,for the S,x p following reason.(Section 703 IS.Bmimss and Profession.Code:Any city or county wC which requims a Permit m commoner.alcor,improve,demolish,or rtpatr any strucmrc S FL Floor Area Valuation e'3� microns i.nmence.ala ho,tims lW applicant f...ch perraino file it damen,signsu �' - /a that W is inemsed pursuant to the provisions of the Co...&.License Law,(Chapter 9 / 0(d (commencing with Sam.. ")or Division 3 of the Business and Profewaiou Core). ppN Number Occupancy wt he is eaempr therefrom we t basis for Ne afleged essmplion.Aar violation of / _ P' Y Type Section 1031.5 by any applfcm,for.pemul subjects tie applicant to a aril Penalty of a more Nen five hundred dollen(5500). T,aaawnerorthemromeny,ormremPloyen.wiNw.gaaNeiraaecompeM.tit, Required Inspections will do the work,andthe struccon is not Imendedoroffcrad for sale(Sec.1044,Business , and Pofndons Cade:The Cmuumlm's Licenu law does nor apply to an owner a propcny,who builds or improves tbemun,and who does such work himeelf or through his own employees,Provided that such improvements are not intended or offered for , ulc.If,hove sr.Nc building or improvement is sold within ane year of completion,doe cwrr-Wilda will ham de Wrden of moving the,he did not Wild a impmve for ppu- pom of rest'). 4 I,u ower of rt Sm.l l y,un s�lusively conuuung Cock:) licensed cmnuanon t. !// cmc a dProject(Sm. Businessand P who Wi Coded TW Commerce's nd nue law dines ton such to ts owner ie property who Wilds a imaa.a thereon,and whon.Lads for such projtta with a cantracra(a)licensed pursuant m the Condecror s License law. O C]I am exempr undo Sm. .B k P C for this won O Owner Dau WORKER'S COMPENSATION DECLARATION 1 hereby tufirn under pmomy of pe jury one of Ne follow,dechar mom, U I have soul will mmicam aCenifcare afComent to uhf-insure for WarkersCompen- ution,as provided for by Secuon 37M of the LaWr Code,for the performance of IW V, for which this French is issued. V,have and will maintain Worker's Compemsarion Insurmce,as mr ined by Section 3100of rhe Labor Code,for the performance of the work for which this permit is isseuyed. My Workjs�/{I C; IE I tp i nc5 crosier and Policy Wq�tber k¢:nn 1 n 1 TJ Comm:-� I]f)IV Policy No,:U ICK CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section madam,W complered Jthe permit is for.hunAcd"Ire(5100) or leu.) I certify Net in the performance of the work for which this permit is iaue4l shall nm employ my person in my manner so as to become subject m tW WorkerCooper' salion laws of California.Data Applicant NOTICE TO APPLICAM':If,after making this Cenificate of Exemption,you should become subject to On,Worker'a Compeuauon provisions of the Laou Code,you must forthwith comply with such Provisions or this permit shall W dosed mvokW. CONSTRUCTION LENDING AGENCY O I hereby often son Inca is a construction leading agency for the pcfommuee of Z. the work for which this permit is issued(Sm.3091.Civ.C.) E:, www Lenders Name �i } Leader's Addasa 1.17 1 certify that 1 have read this epPlicerion and arm, e that the move informed-is A. 0c nen.l agree to comply with all city mill county ordinances and sure laws elating to .•7 Z building consvuction,and hereby authorize uprc®natives ofthi,city to emurupon the V O above-Inemimied Property for inspection Purprom, lis I^" (We)agree to wave.indemnify and keep humlc.the City of Cane ino.gaimt O U Iiabiliria,Ptlgmcnts,cents end ea,.,which may in any way aceme.geiot said City , } f4: inconsequeuceofthegrmungof thu,ytis t" APPLICANTUNDERSTANDSAND LLLCOMPLYWI'rHALLNON-POINT V z SOURCEREGUTATIONS. P— 100 S,mmurruf AmgirmuContnc r Dau HAZARD U ATERIALS DISCLOSURE _ Wuluae,licmtorfanreBdingrccupmtmmrtarnandlebuardaaam.ar;cl Re-roofs in defined by the.penin Municipal Code.Chapter 9.12,and the HeaIN sad Safety Type Of Roof Cods.Section 25532or? .�/ Yp - ❑Yes lmO Will Ne apPI ram or roam Winding mcup.nt use ac,nipmem or devices which All roofs shall be inspected prior to any roofing material being" mitluraNmusire namirunuasdefnedbyNCBayArcaAhQualityMmagement installed. If a roof is Installed without first obtaining an inspection Ye, MN.JM10 I avee to remove all new materials for inspection. Applicant I have mall thehazard.,materials acquirenen rts ander Chapter 6.95 of the C.hi- understands and will comply wit all non point source regulations. roma Health sk Safety Code.Sections;25N5,25533 and 25534.I urtlmand that if doe Wilding duce no currently neve.morm4 Na ii i}}my rtxpoaibilirYonaifYlW acupant of de"do mems whieb mor W met 'eTissumce of a CenifceseMOrmi,ses," 1 O Signature of Applicant Date Owner or authorized,w IData All roofc verings to be Class"B"or better OFFICE