04070130 (2) r;CITY OF CUPERTINO
M .a3,7,7= 3I
BUILDING DIVISION PERMIT Mnumo INE
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BUILDING ADDRESS: AAA FURNACE & AIR CONDITIO "°04070130
1157 SCOTLAND DR
OWNER'S NAME: PERMIT ISSUE DATE
Alk KAZURKO HAMADA 1712 STONE AIM C)'7121 1?004
ONE: SANITARY NO. CONTROL NO.
408 293-47 17
ARCHITECTrENGINEER: BUILDING PERMIT INFO
BLDGO O PLUMB MECHO
o o LICENSED CONTRACTOR'S DECLARATION
1 hereby a nnn Met 1 am licensed Main,provision of Chapter 9 floods...las Job Description
wide Sued.7")of Division 3 orNc Basin.and Prefc ndr.Cod0.and my license Is
ormlfaae andLit 61WREPLACE FURNACE & ADIFNALM
z Z Datenea Clue Convtcmr
CHMCTSDECLAR TION
il 1 undersand my plans shell he dead As public onarda JAN �- 2005
DC
g c� Licensed Professional
3 OWNER-BUILDER DECLARATION
I hereby affirm deal I am exempt from the ComrecUrel Licrnea Law for tic
ao following wan.(Section 7831.5.Business and Professions Code:Any city ter county
$ which mquira a Ic+mii m construct.altem
r,improve,deollub,at¢pair any suucma
F- �^ pdormitsissuace,also mqumu;the applicant for such permit o file.signed moment
gggg"Zy'G that he is licensed pursuant M the provisions of Mc Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
gC�
(common Ing fro
with Section 7030)of Division 3 of the Businaaand Promadrne Code)or
X133 Mu he isin.pt Meram and dee bub for Me alleged exemption.Any vlolNon of
Section 7031.5 by any applicant for a permit subjects Me applicant in a civil penalty Of er0 0 Occupancy Type
not mom than five hundred dolbm($500). v
L,ms rofftpmpwy,mmyemployeswhhwgau Mebmleampenudw,
will do the work,and lhedldcare le nmintendell Offered forsae(Sol.7044,Buddess Required Inspections
end Profound...Cede:Tia den act Lialved Law deact apply a e an owner of (I P
property who builds m i mproes Memon,and who doessuch work torrential through his
own employes,provided Met well Improvements tee oat Intended unaltered foredo if.
however,Me building or improvemem is said within are Sus ofcompledan.dee Owner.
Wilder wilt have Me traded of proving that le did not Mid Or Improve for puryoea of
ale.).
❑1,As owner of the property,am exclusively convening with licensed commitment m
construct Uaa project(Sec.7044,Business and Profusion Cade:)The Convacmfs Ld-
ause Law does not apply w an owner of property who builds or improves deeaan,ad.
who conamm for such pmjecu with a conuacmKU licensed pursuant m Ute Comosetoh
License Law.
Ql am aoupl undo Sec .B k P C for this mason
OwnerDam
WORKER'S COMPENSATION DECLARATION
I usually alRrm under penalty of perjury one of the following declaradans:
1 haw and will malnuin a CeNftamo(Cmetm wealf-Inseam fm WarkerlCompen-
.don,u provided for by Sadw 3700.f Me Isbm Code,fm dee performance Of dee
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,As required by Section
3700 of the Labor Code,for the performance of Ute work for which this permit Is issued.
My Winter's Controlled..lusureba mien and Policy number me:
Cartier. Policy
C IFIC OMPEN ATIONiON
\% COMPENSATION INSU CE
(This section need nothe completed Rod permit Is Amore hundred do1Ws(510(0
m lace)
1 aniry Mat In the parfmmence of the work for which this permit Is issued.I shall nm
employ try person In try manner w ss a become subjml m Me Workeri Compensation
Laws of Calirwd a.Dme
Appiment
NOTICE To APPLICANT:If.after making this Certificate of Exemption,you shamld
became subjemt to Me Worker's Conformation provisions of the Labor Cndc,you must
,J O RmAwith comply with such provisions;m this Permit anall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
F+ I hereby affirm that edea is.construction lending agency for the performance of
rL the work for which this permit Is issued(Ste.3097,Co.C.)
W�Q Lender's Name
z Lender's Addw
C.)Q I cenifY that I have mad this application and rete Mn the above inf.nmadu.is
corrett 1 agree In comply with dl city and county Ordinances and ansa law misting M
rU^ building canauucuon.and beneby audeorim rtproenudws of this city manner upon the
fsd above-mentioned property for Inspection pugloeas
(WIT)agree M save,indemnify and keep harmless Me City of Cupertino against
f0.ry IIeb111Ues,judgments.cans and expense which may in any way accrue against old City
(.7 In consequence of rite granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU CE REGULATIONS.
�? Re-roofs
ppicantDate meof c. ser
HAZARDOUS MA IALS DISCLOSURE Type of Roof
Will the spplicam or future building oceupantarore ter handle haarddm material
As defined by Me Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Code,seedon1553z(.)7 �((// All roofs shall be inspected prior to any roofing material being installed.
❑Ya $Ne
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
MIL h44AN.us air cobaminents as dcMed by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes a.
(have mW the hnsNousmmdalsrequiromcnu under Chapmr6.95of Me Califon
nb HcalM&Safny Code.Sa.9mn 25505,15533 and25534.1 undersand thea ifdeo building
dors not currently new a tenant.Met It b my responsibility in badly tie occupant of the
mquiremoce which must nd met prior or issuance of a Certificate of Qcupancy. Signature Of Applicant Date
le
ter or authorized agent a All roof coverings.to be Class"B"or better