01040085 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
RUI LIIING ADDRESS: PERMIT NO.
7390 RAINBOW DR ATLAS HEATING 010400AS
OWNER'S NAME: APPLICATION SUR DATE
PHONE. SANITARY NO. CONTROL NO.
O��O ARCIII"IIiCI'll!NGINMIR: BUIIDINGPERMITINFO
131.DG ELECT PLUMB MIaC
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6
z N LICENSED CONTRACIOR'S AFCLARAI ION Job Description
I Lerch,:dano ohm 1 um licenwd ,ad,,porvi,innt oI Chios 9 tconnucncing
��m^F twit with Se,tinn 9q o m Division Sot"the lluvinee.,and 11 te,sions Code,undnty(wrens,
y`,, i.infnlllir`camlysjly.yt � REPLACE FURNACE
K d 2 hiccnnc�/ ppGZC) Lic.N fW4 67
O i O Date y�/'��Pr C armor /J
3 u h ARCHI'IF.CI'S DECLARATION a
yI understand my Plan,shall IN,used as public records
sY
u a p Sp I,iccnw•d Professional
OWNER-BUILDER DECLARATION
w=w 1 hereby off nn thin I mn esemP,from he Commemr's License law for the
N Z< folhwing reaw,n.(Section](UIS,Bos nes and Professions Cada:Any city fir comm,
E x e which rivalries a permit to construct alter.improve,demolish,or repair any sameare
u, prior ohs iswance.also mgrac'maapplicant fursuch penia mama signed%fanner,
mat he is licensed pursuanno the provision,of the Cemmenr's License low(Chapmr 9 Sq. Ft. Floor Area Valuation
(Commencing with Section 7NXI)(i(Diviono 3 of the Business anti Pron,own,Code)
ar her he is e`e npi mc,efrom and m,basis for the alleged Csca ,ion.Any vdolmion
of sector 70315 by tiny applwam Inr a permit subjects the applicant w a civil malty
of Colt more Corot file hundred dollars(55M). APN Number Occupancy Type
Cl,a olaw, ,Lyn rty .u,I.... wtmwa ,collie,ane cnmpenamimr,
1) do old 11 ..:,v Inc rcnme it oat intended or tiered In."ur a(Sec.main. .
Bonin,,.,amt erne Wain.ccs or iia Cornell Lie,m,Law,ansa not npyly w an . Required Inspections
w r firh his o won Humes or impnwcs mown,and wen own,such work(ted or
,it through els own it-cvc,.e,. building
matsuch hen,ovem,ms arc s„ire yesrm 204 — UNDERFLOOR FRAME
clamed tor sale.of hawuilde the nuiave t fir imnrwawmt is xrdd within one year of -
i,n,petwn.me owner-Load,,will Linoem,bumen of pradmg that mind nm bairn or 301 — ROUGH PLUMBING
mpmvc Inr purp„se of sulc.l.
Ousownnfthenn,ncoy.amex,wmmmw
,ivelycontractingwihceenraetnr to 303 — ROUGH MECHANICAL
Lw
nnttmet the proje t(See.7Iw.Boo..and Pm(c„inn,CWC:)'rne Cnwraem a 304 — ROUGH ELECTRICAL
license Law dor,nm apply loan owns of propeny won builds or impmvc,thereon.
and who contnu't,for such Ili with a commchoP)licensed pursuant m me 505 — FINAL ELECTRICAL
ITinme.cmptonJr Sc'. .II&PC(o,hismaw,n 507 — FINAL PLUMBING
Owns, out, 508 — FINAL MECHANICAL
WORKERS COMPENSATION DECLARATION 514 — FINAL PUBLIC WORKS
1. here',amore order pommy ofperjury m,e of m,following dedromicna:Cl I hove land will moinmin u Certilicara of Consent Ilivell:inanre for Worker's .
Coo,punsmi...l Its provided fnr 'y seed 3700 of the Labor Code, Iia the
,sedore of otowark Inrleach oris croll is i.creed
Cl I terve and will mnimalo woke,',Comp,nsmia i I,wnnee,as C,ur,d by Section
3900 of the Labor Code 101;the pCrfornrnce m aleee ww�ork I'or which this permit is
orker
Pit C,mon
Can My WCERfIpICATInwNO (IF EXF.M�ION IRO7IiRS,arc
COMPENSAr10N INSURANCE ^
Oris section need not be completed if the permit is for ore hundred dollars MAY I/ 200
D
ISIo(p or Ie".)
L verify that in,he performance of the work for which this permit i,ismed,I D
shall nut anplo,e any fiction in any manner situ'
as to bome,object to the Workers /A/A
Compensation Lows nfcnlifraii.Date �r■�r�1
Applicant
NOI'ICI;'f0 APVLICA N 11;after making this Cendwate of INcinption,you should
bccnnm subject onthe Worker's Compensation provisions til the Lnb,r Code,Ynu onto
0 fonbwit,Comply wi0t-old,povi,iuns or this penult mall fie deenud revoked.
FCONS T RUCTION LENDING AGENCY
a ' I horcby atlirm m:r d,co,is n eno,bunnit lending agency for he pe ornuancc
or work I”wh'mh(his Imnnit is issued Nee.3097.Ci¢C.,
Q Lcuda't Naim -
.7 z Lcuder's Address
U C I certify that I have reed this application and state that the aM,ve information is
W. '. emmct.1 agree n,comply all all city and army ordinances and,tate laws relating _
f, to building construction.and hereby aurhnriaerepresentatives of match,b,carer upon
the above-mentioned property for inspection purposes.
0. (WC)agree to save.indemnify and keep lmraless the City of Cupcnino against
to liabilities,judgrtmms,co,n and expenws%4y may in Cop way avenue ugain.n said
U Z City in conwluencc of the granting of oho tit.
APPLICA 'I'UNDERSTANDS AND L COMPLY WI'm ALL Nf.-POI r Issuedb , Date /e
SOU ifiULAfil Z///
li%n,nIns �1110/. Re-roofs
Z IN) fATERIALS DISCLOSURI:
Will me apnli,mI r l ilding«capant ani or handle h:,ml material Type of oaf
is defined by the Cre .fun ipul Coda.Chan¢'212,n id the IEeahb and Safety -
Code.Section 255321;07
0W, No All ro fs shall be inspected prior to any roofing material being installed.
Will lie a,fl".letmmmmbuffing 0,cnpam alecgrdpnam m ceedscsweill, If it roof is installed without first obtaining an inspection, I agree to remove
Call b:vanlnux air Conumanunts is def red by the Bay Area An puAk,y Mamusmmem
Darned all new materials for inspection. Applicant understands and will comply with
El Yes ElNo all non-point source regulations.
1 have read the huaadam materials requirenmmv under Chapter A 95 of the
Calilinam Health&Safety Code,Senior 25505.2553)and 25531 1 understand that
if the building dins not currently have a tenant,that it is my marymslblllry nu notify the
occupant of the n'quilements which must be met prior In issuuaa,of a Cenifcate of
Occupancy. Signature of Applicant Date
Owner is,..Iliiced agent Date All roof coverings to be Class"B" or better
OFFICE