02010078 (2) CITYILDING DPERTO^NO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10456 STOKES AV UNITED AIR COMFORT 02010078
OWNER'S NAME: APPLICATION SUB DATE.
LEE EUGENE C AND CHAN-LEE WI N 5819 N ANDREWS WAY 01/18/2002
/
4 V9
0NE: (408) 771-8967 SANITARY NO. CONTROL NO,
1
O n z ARCHITEC(ENGINEER: BUILDING PERMIT INFO
O O BLDG ELECT PLUMB MECH
r u u I_I L—I L._l L__I
LICENSED)CONTRACTOR'S DECLARATION
5�? Job Description
z- hereby affirm mat 1 it heensed ander mad P lie oor,Coer,i Iealnmenemg FURNACE - Iis BTU
w{_; with Section 7(NIBI of DivlsinnJof the Business nnJ l`rnfe»,ora Cade.and myli¢nse
in full force a and�s��t a Licenu Clas lie ZO Lic.M 2S 7S Q 7
O ac O Doc �O= DECLARATION i u u.t ARCHITECT 5 used
DECLARATION
ud 4 1 understand my plans shall M used as public records
iEa-+-
S O O Licensed Pmfe.aional
OWNER-BUILDERIm DECLARATION
y I hereby n(Gnn Nut atIran exempt from the lcs6mam o e:Any c Law for the
01 z a meowing massa.(arson monitr t.ade. and improve.
demolish,
Code:Any city or County $2195
01 E F❑ which its iisu n permit re enres Chet,aper,improve,dentNish,or repair any our
i3� 'P!ionoirsissuance.also myuircsthe applicant forsuch permiuoRleasigned smmment -- -- -------��- - -
thal ac is licensed puryuant to the pi r,wbv s of the Contractors License Law(Chapter9t. Valuation
com
( mns]fNp)
encing with Sectioof Division 3 ohne Business a ad RaGssions Code) I -3 6k7ld2SAI'l7. ,t
m that he is exempt thertfmm and the basis for the alleged cern ion.Any violation '
of Se dian 7031.5 by any applicant far a permit subjects the applicant to a civil penalty 7�{a, �,�
of not mom than five hundred dollars U6500). 30,`PN NRTt1SH PLUMBIG - Occupancy Type
peny,
❑1,as owner of the pmser my employees with rages as their sole compensation, 303 - ROUGH MEMIA AT,
will do the work:and the nIracmam is not intended to offered for .In(sec:7044:
Ravidese and Professions Code:The Contractor.License Law does not apply In an 304 - ROUGH ERiRJ(flMR LQfthions ...
owner 505 - FINAL ELECTRICAL
nr iced fo his own anpmer, providedbuilding
that men cescon meol art not intended anmar or
completion,
for ache.IC enbuil r,the l have
d' - t n sola within one f - --- - - - - - - '
°r,ropy"v<men yeas 507 - FINAL PLUMBING - •'^
oprove font the uric of
will have N<burden of proving that he Did not buil)or
�mPr°"= purposes 508 - FINAL MECHANICAL
_ h.. . c
❑1,a owner of Ne proem%am Businessa comrxdng with lieenaTheonuaaors to _ ... . .
omwct the does
project(Stt. to a Business and Professions Code:)The improves
Contractor's .
License Law noes oat apply man owner of property who builds si improves thereon.
and who contracts for such pmje<ta with a commaor(s)licensul-pursuam to Ne
Contractors Licence Law.
Olnm exempt unser sec B&PCfor his reason
_
owne, Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under pcnahy of perjury one of the following dmlamtions:
•] 1 have and will maintain a Certiftcae of Consent to self-insom for Worker's /
y Compcnmtion, as provided for by Seaman 37M of the labor Cade, for the
Performance of the work for which this Permit is issued.,
vrJ.I base and will arairmin Weaker',Conapeareirlion,Insurance,as required by Section
9700 of the I-Lbor Code for the Performance Of the work,dowhich this permit is
sued My Wo ke Coy f 1 rant d P licy M re:
6terven1QB./ t
n.CERTIFICATIONNO EX@.1PnON FROM WORKERS' -
I'
COMPENSATION INSURANCE,"- '`... __... __. .... _..._. __...,_ ._. ------.....
finis urian need not be comVle(cd if permit is for one hundred dallaa
1$1RB or less.)
I cenify that in er,perfonny..an the, ark for which this permit e issued,lacer I (,
shall pent employ any person in any manner zn sea m nccamdsubject m he Wnrkem'
ComApplpensation'on Laws of Culi liimia.Dam
NOTICE
subject
OAPPLhe Worker
aftermCompensation
this Certificate F:xemption:you ou auld '
becomeeh comp y the Worker's Compensation Permit shaof the Lahr Code,you must
O � rannxam comply with men vro"ismns or Nis Permit shall x dames rcvak<a.
.. _ _ ..
CONSTRUCTION LENDING AGENCY'
C ' 1 hereby aRrm that there is a'2nnktiaclon lending agency for the performance
ti
al the wink for which this permit is'issued(Sec.3097,Civ.C.)
0. Q Lender's Name' ., . . .... s .. _ .._. __..... -
z z Lender's Address
I cenify thea1 have r<ad this application and late Ihat the above informaion is '
correct.1 agree to comply with all city and county ordinances and state laws relating
U to building construction,and hereby authorize representatives of this city to enter upon
W the above-mationW property for inspection purpose}.
F' IL (W.)time I.onJc.indemnify and kap harmless the Cir,of Cupcnino against
,h liabilities,judgments,costs and expenus`which may i"any way accrue against said
C.7 z City in consequence of the gmming of n..pgrmit.
APPLICANT UNDERSTANDS ,5? .L COME
SOURCE
NO f.PO ' Of�
SOURCE REGULATTONS, '� Issued by: Date
. Signature of Applicanl/Coomacar°, p.m- Re-roofs /
HAZARDOUS'MATERIALS DISCLOSURE' "
"
Will'the,applicant or future Wilding occurount store or handle histandous material Type.of Roofas d=fined by the Cupertino Municipal Code.Chapter 9.12,ami the Heald and Safety -
Code Section 25532(a)7,
sues '- •`tom,,," .s'r;- ._All.roofs shall be inspected.prior to any roofing.material being installed..--._
Will the applicant or future Wilding Occupant use equipmento de ces which If a roof is installed without first obtaining ars inspection, I�agree.m remove
mit hazardous air . .contaminants tdefned by the Bay Arc Air Q 1 ty Management
emit � all new materials for inspection Applicant understand_s and will complgwith
�Y. .:, - all non-point source regulahons,., -
1 have'read the h zardous maer celsrequirements under Chapter Ii 95 df the -
CalifomiaHealth&Safety Cotler Sections 25505,25533 and 255]4.l understand Nat
if the building does not currently have a tenant,that's is my responsibility to notify the
occupied of me iequiremen' pith mu. be ma poor w issuena of a C, ica of
�J�/ Signature of Applicant Date
Game,co.a�nori:e �g<nt � � Al] roof coverings to be Class "B"or better
ci ,... - -' . .. . :.,. ... . . OFFICE- .. . .. ...