00070124 CITY OF CUPERTINo - -
BUILDINCDIyt3ION -PERMIT ° CONTRACTOR INFORMATION-
BUILDING
I1jDW34 DEMPSTER AV COMFORT: SYSTEMS . PHRMG N000070124
• OWNIIR'r5 NAME�F � � " APPLIC1'I'ION SUI3 DATE '
MARTIN 6570' FIFEWOOD ur.� 07/20/2000
,11111111110 k
J
c SANITARY NO. - CONTROL NO.
(409)927-0560
C O 2O 'ARCHITECT/I?NGINEEIi; '•{ " BUILDING PliRMI'IINFO
m❑ . s - BLDG ELECT PLUMB MECH
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LICENSED COfRACTORS QUCARAION5
Job Description
F% hereby afnnatamcensepr nsopl commencng
with section 7000)of Division lnf lheR , es, dP fess :Cd nd my bell r - '
9�� i-feerurlaas_ rRa c eN J4-73 AC
real LL F Dal 7_.y. n. C IraCl—or�`y , -
C C, ARCHOl S OF LARAT - ,y•a,
1 t�mnd m ons sMdl I , d as public rl s
z t-,,ch
1 ��cIJ Pro esniout LWN'EISI1l1ILUllli DF.CLARXT1ONt,ereby afliran for I am exempt front the Comracmrs License Law for theowing sawn.(Section 7031.5,Business and Professions Cole:Any city or county
reporr,a permit of clientele,itim, p I f,h e real,a., loolum y
6fa pr 't 1 at re,life applicant ape ill ll (,td aleteal
55 ntatn ':1 •dp anti thprovisiumfLheC(inimil-iL.aw(Chapter9 S 'Ft. Floor Area Valuation
(ct g with5 fi n7") (D' l fth R dP .f - Cidc) q'
nr
thin hu is enc to flurelmon a the ha,i,far the alleged sciantor.An,v'uwron - v - b
of Scctin 17031.5 by ally upPLenm for a"perful.subjects the:y,preanl to a civil penally
.,factfamemnnfivehundreddollarels5wl. � AP_NNumber : OccupancyType
oL as ownan nr me pn'ranr,or my emplaycea why wnsea n.mai"ol,e.,miscom nn. 326480^e9. 0@
will J Ib A and II structure, sintended r offered f air(S7(PW Business and Profession,Code:The Coll License Law does not apph,a,an Required Inspections ^ ih
owner(if r perry Who nWilds or imposes thercon, ind who discsknoself 30?- — . ROUGH ROUGH MECHANICAL
or Inn'ugh If,own employees.i nv ded thw ouch' lin tents use lot mmde
� d or '
offered for role.If,howeverthe budding ,,improvement is.rod within one year of 304 ROUGH -ELECTRICAL .
companion.me owner-builder will have be harden of Pru,ing mat W did bol bund or .. - .
hi forpurPnsenraale.l.'t+ '' 505 — FINAL ELECTRICAL'
01.isowner ohne pmpeny.'mescw,iecly central is his Eeensedcoracmrs to 509 — FINAL MECHANICAL- .
concoct the project(sec.70-14.Business and Professions Cief The Contractor's
Licelne Luw dons inn apply to rot owner of property who builds or ilnprnves'thereon - - -
and who contracts for alwh projects with a coumemr(d)licensed pursuant at the
Council License Law. _
❑I out exemia toner Sec. 1{&P C for this reason
Owner Date
WORKER'S COMPENSA'T'ION DECLARATION
p
I hereby affirm under penalty of perjury,one of the following decluratiom: - QO
J I have and will maintain a Certificate of Cmtsent in sclbimnrc for Worker's _
compensation, as provided for by Section 3700 of the Labor Core, for The' _
performance of me work for which this Permit is issued. -
❑1 have ad vvill faitfin W k -:Comp "( Inove,or,all rcyJ rod by Section
370o f 1 L M Cad f 11 a pe f n ntt f thework for which this Permit is
issu d,My�N1orwes -�aCompe t 1 cti is ce caI and Policy not�ntner am: t"
ar �1�I �nln
,CERTIFICATION OIC f EMI'TION PRON WORKERS'
COMPGNSATION INSURANCE. t
Cl his sedan need not be completed if the pentyl I's for nna horded Jollnrs
'ISIWI or less)
"I certify Ihnl In the in anmencaof the work for which his penitis is lssnc.l.1
ons employ any pen"
many manner so as to become
subject at Ilse Worers'
'mmpensmion Laws" C
Califnmia.Date -
�NOTICH'I'O API'hICANT:It:alter making this
Ccnilicale of ExcmPonn,you sbnulJ - '
corm subjecnn the W'orkcri Compnnmsion prorinions of the tenor Cnle,you roily
zQ O fomhwim comply with such p.......is or Thin permit shall We will
rcnked.
CONSTRUCTION L17NDING AGENCY t ' ' -
ai 7 1 hereby fi irm that there is a construction lending agency for the Performance
of the work for which this lentil is Issoad Sl,.3097,Civ.C.) - -
aY (� Lrnder'a Nome
z. Lead .Add "
U 0 - 1 certify lb lJl..c e.d lhY.ppl'cn'i aund slate theudo,above ill reli as - - - a
comert. gee to comply with all city and county ordinances and state laws mining - s '
0 U to Wilding construction,and hereby nathoriu representatives of city it)enter upon
�!a W the aboeo-o,mi...If proper,for inspemmr amicus.
'ri CL
(We)worse if sam
line.indeni fy unit keeptarmfi
le, e,Cilyof Cupertinuagndln - s
h piabililies•judgment•,,costs and ealemi which may in any wry uccme against said
UI.ig
Cil in cause u ce of lbs mmm of this mit. '
4 cn H
Per n
PLICANT UNDERs SAND ILL COMPLY WITH ALL TN-PO T
uR R cu o s. e� Issued by:
Li
. 77
,
alarem'Appb[a AZARrDOU - Dao Re-roofs HA%ARDC US MATERIALS UISCLOSURUwnmeurpueantorfutureWilding.,.PamaumorhandlehaimJrounenm • Type of Roofs defined by the Cupenino Municipal Cale.Chapter 9.12,and the Health and Safely - -
Code,Somlon 25532my?' - -
�Y" ' . 0 N All roofs sh I be inspected prior to any roofing material being installed.
Wil the applicant of home Wifdmg occupant use equipmept or devices which If a roof is installed without first obtaining an inspection, I agree lo'remove
tis has;udous'air contnnti tants us dull netl by the Bny Area Aar Quality Mnnagemem
.Ides • - all new materials for inspection. Applicant understands and will comply with
❑Yea - . , ❑Nn all non-point source regulations. .
7 1 have read the hazardous materials requirements under Chapter 6.95 of the _
California Health&Sanely Code.Sections 25505.25533 and 25534.1 mider,tand that `
it be Ifiringd net currently h tenant that Y.toy rep n:'b'flyt city the - , •'
tv<ypy Ithn I is mugb tp ririss f Clific:ncof Signature of Applicant •Date
mon tried ag ut �/—ate / All roof coverings to be Class "B" (;r-better
OFFICE '