02080036 (2) CITY DIVISION O PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10411 TONITA WY VALLEY HEATING & COOLING 02080036
OWNER'S NAME: APPLICATION SUB DATE
GLUMAC GEORGE J AND EMMY B 1171 N 4 TH ST 08/08/2002
PHONE: (408) 294-6290 SANITARY NO. CONTROL NO.
BUILDING P
p zo ARCHITECT/ENGINEER: ERMIT INFO
BLDG ELECT PLUMB MECH
to
a i LI 1...1 L-J" 17
Z v=sor i LICENSED CONTRACTOR'S DECLARATION Job Descripti
OZ_o IherebyaRnnNatIamlicensedundcrp//r/0000visionsofChaprer9(commencing FURNACE REPLACEMENT �t��LE®
with Scnion]ppp}of Division 3 of rhe Bosingspnd Pmfcssiom Cale,and my license
ae,4i is in ruB rowe]6de t. ,J�
E:.� License Clasf_ `� Lie.. 6 OCT 2 9
X o G Dare tea, Contra 2002
w 3 a to ARCHITECT'S DE RA ION
t e Oso; V 1 undersand my plans shall be used as public mere a
w=ac Licensed Professional BUILDING
a a c s OWNER-BUILDER DECLARATION
m a 1 hereby affirm that I am exempt from the Contractor's License law for rhe
F 2¢ following mason.(Section]031.5.Business and Professions Cade:Any city or county $2300
E F G which regwras a pemdr to construct.alter.improve,demolish,or repair any swcwm
a 3 sc -'pnor to its issuance.also requires rhe applicant for such Permit file a signed sta.,
That he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9mss, r 1gOr,p,�ea- t i S , Valuation
(cdm,ien5ing with Section,MOO)of Division 3 of the Business and Professions Code) (:(;11'!31,5,• 1.� li br�.•,V U,:i1i\3Nl! Ye):1'•:
or that he is exi hin thirefimm cal the basis for the alleged&Iurption.Any violation
-of Sation 7031-.5 by any applicant for a permit subjects the applicant n o civil Penalty
.of..,more than Five hundred dollar.(S5Bo). 303APNftU§H MECHANI ALP` "r- "• Occupancy Type
❑I of fire property,or my employees with wages as their sole compensation, — ROUGH RT,RrTRTCA1,
will do'due work.and the sbacmrc-s not intended or offered for sale(Sec 7013,-'
'Business and Pxdcss ons Cale The Contractor-is License Law does not apply to an 505 - FINAL E LBfl?(MII( dBpections - '' !• l•t r
owner of property Who builds or improves thereon,and who does such work himself 508 - FINAL MECHANI CAL
in through his own employees.provided that such improvements.nw intended or
offeredmonple"for sold If:howevd:the building or rden of Prov n"sold within oma year or `-- s•13:,"' '.t. CO�:.:,'1 a
improve
for Nepe.of ander will have the burden of proving Nat M did not Wild w
improve for puryou of sale.).
_ -.- .__.._._.—._...__ . ...._...... .... f____.._,.. .
conal r.pn)j propenyam Business
and mrstingw,Nlicenud contianorsm al:I l•Inr:Fc!I -,I,r�
_ License Law
does
(apps]t#3.Bareness and property
who Cudca impToeroves
Contractor's � j _v', rLf�'; � .P(I:
License Law d«s nota 1 man owner with
n who Wilds m int n vi
apply PrmPe Y w Proves ••
r
T. _and.whons License l- such.Prml<cts with a.mnuacmr(s).liccnsed.pursuant to.Ne. _.-_...._-.__-.
Comanor's License IaW. -
❑Iamexempt under Sec.`' :B&PCfor Nis rcaun iOh 11„�.,_;I.rllvn
Ow'mer.: Dade
WORKER'5 COMPENSATION DECLARATION
�. .,...1 hereby up.undel,pcnAty of perjury,onc of the following d«larations:
El have add will maintain a Cinificoe of Consent to self-insure for Wwkerb
Compensation, as provided for by Session 37W of the Laior Coda, for be
Performance of the work for.which this permit is issued.
❑1 have dot will maintain Worker'i Compensation Imrvmnci,as riquined by Section
3700 of the tabor Cale,for the performance of the work for which this permit is
' limed. MyWorker's Compeoxation Insurance carrier and Policy mkt ore: ”
7 Psnf4t* (1 , r' .Pol yNo. � m -r is I s 37re's\ Ir
s tt LCLRTIFICATION OF EXEMPT10 MWORKERS t '•1.S A lam. f4' �' 1C 9, '7 A 's i +
COMPENSATION IN RANCE ................
lThi+sectlud need not k completed'if the permit is for one hundred dollars 1 '"'" o\ r .ss ',t(';UfH.I'V•jk h: ••
(SIM'or
n
,,I certify that the pert nn iemfNodf which his permit Is i.uM,`I - I't,• h'( r `.. rs4s11 r•s. r.Iss':
/Apt - - y,lir the Workers
CII t ploy any Ptt<QQ n n any ma .t k n
Cm slgrglayfp .Ure . . _ _ .__
I PP NT alt making thisC rife t f D pato you should
- 'SY• ' -
sobj el It theW k ie Compen t nprovisions of the Labor Cade,youmum
ZO nhwnh comply with such Pro limns this permit shall k deemed revoked
" Vi - CONSTRUCTION LENDING AGENCY'
E~
41 1 hereby affirm Nat There is a con wctluo lending agency for the performance _ 111 I I`.
of'he work for which thiel perosit is issued(Sec.309],Co`:C
Lender's Name-
;D Z Ine Address
r .. ....... .. ...._.... ._.__
as z ddtl
JI a✓.'I V
U-0 I<en fy that hi a read N ppl c fell and state that the lwf rmatmn a
fail E., 'c t 1 g t comply with II city J t ordinances d state laws setting
0;V r b Id g t ea n Jh byauthpm. nm3'v fth tyt cnar upon
•�, r� 'tbe a".mernioneal p pend for indemnify
and P rpo
y,Oi liabilities
agree a save, and expeane keep h may I.the City taCupertino against
IzIZ City in cojudgments,costs and granting
of
which may yin any way accrue againm said
C.7 Z Cly scq ence'f thegr ni ng of N s C t f " `5
)) C" UNDERSTANDS AND WIILCOMPLYN'ITHALLHON:POINT Issued by: r Date
i)) Cr AEG�L"j�tn5, 'II bZ y•
na�fAlvidlea mntmctnr, ' Re-roofs /
HAZARDOUS MATERIALS DISCLOSURE -
wiltb ppl t' fi bald g p (_lister n al keaNwsmam'a1 ,Type of.Roof-...- _. -_._,,._...____......_..._.. .__.......,,._.,,,. .
a def d by th Cupen Municipal Cod Chapter 9.12 d the Health and Sat sy
'Cad S tun 2557 a) r`r' s y„•r 1” �.S'' in t. ,, ti: is
ovek •i• ` cd ', -I `'r All roofs_shall be inspected prior to-any.roofing material being installed..-,_,•-__
Will to Ppl t I rebuilding occupant se equipment devices which
[f a roof is installed without first obtammg an inspection -P agree to remove
airc tmnnt i def Jby the BayX.A Quality Mang ni
o t,0 d _all new materials for inspection. Applicant understands and will comply with _
aY " r' all non-point source regulations
I hatx read N 'Wialmn'rnimririblxsptirmoemx under Ch pt 695 of the
California Health&Safety Code.Sections 8505 25533 and 15534 I understand that
-If Ne W Idi g dyes no(currently have a be Nat Is my beeporisiolit,to notify Ne'
O -
pa _ q must k met prior to iouance of a Certificate of /�A
« t r Here cement=..nen _ Signature of pplicant Date
All roof coverings to be Class`B" or better
at or amharmd agent - ..i, Dae.
_ OFFICE -- --