Loading...
04120026CITY OF CUPERTINO q CONTRACT,y INFORMATION - - ------ -- -- BUILDING DIVISION PERIVIIT Y:� .P [%✓moi.'.-F,`aiY..$tlxwA�Flr 1X .fieri' BUIL DING ADDRESS: SAN JOSE AIR CONDITIONING Pa" "'10412OO26 15717 AMHERST DR OWNER'S NAME: PERMIT ISSUE DATE JAMES KEATING 880 N T NE: SANITARY NO. CONTROL NO. - (408)286-2047 ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTR S DECLARATION Job De i 1 M. i u;dcr IMI 1 am Itcenscd under provisoes 0r Chapter 9 (commencingI, wills Section 7 ) of Divi¢ion lof the Business atb Profusions Code. end my license is and in rase fame Ones erfrc �[Lim.{' REPLACE FURNACE Dames des Conlnctar_,SQ O ARCHITECTS DECLARATION - DEC'} tt'1 C 2004 I understand my plans shall be used as public records BBpBl��� p n Ig H II Licensed tonal OWNER-BUILDER DECLARATION - B I 1 hereby exempt from Ilse Conunnoos License law for the encs Nat 1 IIIItlfN'I pry!! followingmemon. . sac 1. Profasons Code: Any city orcounty ](131.5, t. aitasand t0 construct. alter. Improve, demolish which mqus a (anion or repair any surinatmstatement e. also Permit t u priorwits issuance,alsorequitra po applicantthe Cohpermin0t Ieasigned eummcnl those Sq. F[. Floor Area Valuation (comma cccnsedpursuan 7fNepmvisiovofof cBummriLi¢nselaw(CMpmr9 (commencing of the vi Code) of Business and Profeson. ]0o0)the Deal( . pt thomeon Nat Meu tempt Oemfmm ale IK Ease for Ih slcgcd exrsnpuan. My violation of r alleged M on Semmi 7031.5 by my applicant for a permit subjects the applicant to s civil penally of 3 3P&X$Qffi*cr0 0 Occupancy e P not mole Nan 0n hundred dollars (1500). y •J P ❑ 1. as owner of the property, or my employees with wages m their sole compensation, will do the work end Ne trema is not intended or offered for side (Sec. 4041. Rumbas and Pmreadoes Code: The Commcors License Law does not apply in an Owner Of Required Inspections proper he Wilds Ortmprovesthermn,end whadociauchw«khimseuor Nsough his ' own employes, provided Jwsuch improvements art not intended oroffered for sale If. however. Ne Wilding or improvement iamld within one year ofemopletion. one builder will have she bunden of Proving IMI M did not Wild or improve for purpose of - " - .It.). Q 1, as owner of IM pmpcnY, am exclusively convening with licensed mnumlors or construct the project (Sec 70a 1, Business and Professions Code:) The Contractor's U. " cards law dura not apply to an owner of pwpeny who builds or uniform thereon, and - who concocts for such projects with a cantsacmor(s) licensed Pursues w tM Contractors License Law. ❑ I am esempt under Sec. . B & P C for thea reason ' Owner Date WORKER'S COMPENSATION DECLARATION 1 Mreby &Man under penslly of perjury one of the following declarations: I ham and will mutual a Cenoam of Conscnl w self-insure for Wmkei sCompen- satton, as provided for by Section 3700 of this labor Code, for Ne pesfmcconce of in, work for which this permit is issued. ❑ 1 M and will maintain Workers Compensation Insurance, as me uhad by Second 37000 Ne labor Cmarortheperfarm aflo, rk for which this permit is issued. W rmes mPensalion Insurenm mrin miryroma ran: Ca Ncy No.: CERTIFICATE OFEXEMPTION FROMWO KERS' COMPENSATION INSURANCE Mi¢ section need not he completed time permit Is foronc hundred dollars (SIM) or tess.) I certify that in the Performance of the work for which this permit I$ issued. I mall not employ any parson in any manmrm u or become subject to the Workeri Compensiden Laws of California. Data Applicant , NOTICE TO APPLICANT: It. after making this Cmi0cae of E¢mption, you soul amino subject to the WOr bcri Compensation previsions of IM labor Code. you must moh-ith comply with such proem s On hid Permit shall W ducmcd revoked. CONSTRUCTION LENDING AGENCY 1 hereby of ina that them is a conswciinn lending agency for the perfmmance, or tho fur which Nu perrnil is issued (Sea 309]. Civ. C.) Lenders Namez Lwork (.enders Address 1 certify that 1 have std this application and slam that the above infommiun is correct I agree to comply wish all city and county unbalances and mute laws testing to Wilding cansuuction, and hereby authorize repraaentaovra of this city 10 enter upon the above-mentioned properly for imKcuonpurlwsec (We) acts to save, indemnify and keep harmless the City of Cupertino against 0abilidu,judgmcn6, costa and cxmnses which may in any way Ocean agatnstsaid City in this Permit. CANieU APPL NDE STANDSWILL COMPLY WITH ALL NON-POINTIssued by: Dale SOURCE REG A N . Re-roofs ' Sig ApplicanUCanRDO Date HAZARDOUS MATERIALS DISCLOS Type of Roof II applicator (mune or handle material Ca c, Chanumrc y t Heanaw as defined by the Cupertino Munitlryl COM, Chapter 9.12. and the Health and Safety Municipal ode, Section 25532(a)? [_]Y. o All roofs shall be inspected prior to any roofing material being installed. .... Will the applicant or future building Occupant rte equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove mil hazannus air contaminants in de0ned by the Bay Area Air Quality Management all new materials for inspection. DislriaP [D Y., N"teESU I have rent the hxzannas materialsrc,tudements under Chapter 6.95 ofthe Califoo niaHca10&SafctyCode,Sed.25505,25533and25534.1undcrsmndthuifde Wilding leas not currently ha qle i, Nal it s mmaponsiM1ility m rodly Its occupant of Ne m immen which a b p 0 1 eofaCemrc��upaney„-' / i Signature of Applicant Date All roof coverings to be Class "B" or better / owner or authmiced agent Date T CITY OF �UPEI�TINO M. Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department PERMIT # I am not using any subcontrac • �— L� Signature Date Please check applicable subcontractors and complete the following information -- -v Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile -- -v Date