01040157 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILUINGADURF S: PERMIT NO.
11b183 PARISH PL A A A FURNACE COMPA IY 010zj0157
OWNER'S NAME: APPLICATION SEE DA'1'Ii
JEFF MILLER 171.2 STONE AVE 04/30/2001
IPHON'ESAN LARY NO, CONTROL NO.
(408) 293-4717
❑z z ARCHITECT/ENGINEER: BUILDING PERMIT INTO
�++C O BLDG ELECT PLUMB MECH
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LICENSED CONTRACTORS I)ECLARAnoN Job Description
1 lherchy affirm Thal 1 am licensed under provisions at Chanmr9(commencing
�ml-� wid,See ion]IIW)01 Dlvisiun 3ottha Buxinaxnnd te„ions Code,and any license
<xl;l=a ix in lull Once an ret // G REPLACE FURNACE &
rc 2 Littn,e Cl cx k-3 el— Lic.N_ �0��
e hale �A _ — Cirrocmr- _ /_ ADD 42000 BT'IJ A/C.
R HITECI"S DECLAH ON-
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� O J 1 amd,Oumd my plana,sha11 he used as nuhlie mord,
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Licensed Professional
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OWNER-BUILDER DECLARATION
9 m 1 heresy u0irm mall 1 ani exclnnl Limn the Cnnnannr',Llmmo Law Tor the
which
re moon.(Scminn]IDES. t.alley. unci improve,
o demolish,
or Any°Sly orreame,
"'7 p which requires a permit re cones incl,pplic improve,h parm,h,lir repair any slmcmre
is. pat he isscensed Pralso
uantto me previsions o hmucnperminofile,,Law(ned smmmem
malneiocia, ei,hSacanitnm(roFDirononlot heImmucv,..,itP.l�wlcnamer9 Sq. FL Floor Area Valuation
... Ise a is rwarn Sermon]IXX3)lir Division lot he 13mincsx and ion Ai,vi tali
or Ism he is exunipt Iheml'mm andflue hums for he ullegeJ exemption,Any violntinn
of section mals by any applicant lin a permit subjects the applicant ani a civil penalty APN Number Occu a
of not more than five hundred dollars(55106 Occup
a&-9
as owner of the Pnipeny,many employees w,,It wvgcY:u Inertsole on,roaion,
will do die work,and the structure i,mit im reled or o1'rcted air,de(See.7044. 31 6zi 4 01 4 1
Business and Pmfewinn,Code:The Counaclos's License Law does nm apply to:in 'R 4• Red Inspections
ins r of progeny Who builds or improves thereon,and who does such work himself
or through his own employees,provided that such improvements are not marmic l or
m'rered or .it,,11:however,the building or impnwcinent is sold within one year oI' 301 — ROUGH PLUMBING
plia u,rhe owner-builder will have me Inerrant proving ohm he did nor mild lir
in,,-,a for paBaseof sale). 303 — ROUGH MECHANICAL
[D I.as owner of the pranenr,am exclusively contracting with licensed uimracmrs to 304 — ROUGH ELECTRICAL
Lnixliuct Inc project(see.7(m4,Business and Professions Cext The Commena's
ieene Law doe,inn apply to can owns+(if nrnpeny who build,lir ininrnvex tnmron, 505 — F I NAI_ ELECTRICAL
cclreiceucb projects who aruminations)a) Banned panamt to memm� ocontracts
Law. 507 — FINAL PLUMBING
❑
I am exempt ander Sec. .H&P C file this reagin 508 — FINAL MECHANICAL
Owner vele
WORKER'S COMPENSATION DECLARATION
I e reby;aid affil under PenaltyC.r.afi,ree Of one of the following a t...Woo
❑ I hart :uN will nwi mein u Cby Sect of Cnnmm m lid etwor a Tor I., tare
Comarmancon he pork ser for by Section 3]10 of the Iwhor Cldc, Iia the
pmfIncle r l of the wed,far which his .it is issued, `
hove the
will r Code,]'Wader'srr ncoure inn rework t ars hick M by Section
of Inc talker Cale,I'ar me Pms rance t of Ili°work Iso which mix peroral ix O
issued.My N'orbkcr�s�Cnmpcnsminn Insurance carLri�e/r and 1'nliry numk-,are:
CERI 1jijCX1 ION tdw EXEMION WORKERS
COI'r: PT '
COMPENSATION INSURANCE E
, phis section need not lie coundcied if the permit is for one hundred dollars
g1IXp or Ies,J
1 ccrudy that in the performance of the work for which this permit is Issued.I
shall not employ any peiwm in ally manner so as to bacteria subject in the Workers
Compensmion Laws of Califomiv.Date
Annlicnc
NOIICI:'I O APPLICANT:It,alley]'taking Ih Is Ccniticam n1 hxanptima,you.should
become wiNve,In mt
Inc Worker's Compcnian provisional he Labor Code,yno nom
Q O Rmhwith comply with such provision,.,,his nonoil,hall he deemed mvoAed.
F ti CONSTRUCT ION LI7N DING AGENCY
I hereby avian than there i,u snn.amninn lending agency far the Ell tamme
of the work tar which this permit is issued(Sea 3(0].Civ.C.)
L _Q lender's Name
.7 z lender',Address
V Q I ceniry mal I nnve read nix npphcutimt and state thal the armee inlmnnation is
I,. (.. came".1 agree to comply with all city and cmimy ordinances and state laws relating
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to Wilding construction.and hereby°umoriee repeaseotativn of this city In enter upon
ort above.lntnnnncd propenY ran impeniom puryoses.
y y (We)Lgrcc mx;rva inJcnmily unci kec�i hnrmloslhe City of Cupenino vgainst
y Iiabila jndgnents,cocas unci expmmn w'hmn may In uny wary aacnre ngainsr said
U ,z Cayin cnnwyuenre of me gmming of this pennate
APPAPP IWOIiRSTANpSANU WILL COMPLY WITHALL NONPOINT Issued by: / Date �O
S crR I✓191o1�s,..._ 6fL;]o��
.ig]'rare nrnnphea vcnmmcam alt Re-roofs
IIAZ\finnum MATERIALS tmom rhandl
N511meepCOwmlir futurebuildingte Chartcurtor handle Health an Sale,, Type of Roof
m defined by the Culenlno Mnnitipal Csde,CM1uptcr 9.12,and the Ilmhh and Safety
Code.Scclinn 25572p09
Dura All roofs shall be inspected prior to any rooting material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air cmttvnimann ax derated by the Hay Area Air Carl ity Mawgemem
Dixlrim all new materials for inspection. Applicant understands and will comply with
oyes `/yam,',`° all non-point source regulations.
I have road the hvrta.11 .nnumeals rtyuirements antler Chapter 6,95 of the
CAP....in liealth&Satiny Code.Scolio.,25505.25533 and 25534,1 understand he,
it rhe building Joos sur currcndy hnc a unmet,turn it 1s uny aropmn,iml'ty to near, he
sKcupanl M the m u mnnrnrs which nmm be anal prior to issuance of a Cenifeme of
1-5«° Signature of Applicant Date
o> oy—�iut �etl t / All roof coverings to be Class `B" or better
wli'r\/J OFFICE