02040135 ct of cuPE
BU DIVISION INFORMATION:
aun,otnc v[SION sto` PERMIT
BUILDING ADDRESS: PERMIT N0.
1532 ASTER CT A B S HEATING & AIR COND 02040135
OWNER'S NAME: APPLICATION SUB DATE
YIP 334 SHAMROCK DR 04/24/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 238-7178
❑WWW ARCHITF.CT/ENGINEER: BUILDING PERMIT INTO
a ce G BLDG ELECT PLUMB MECH
mea C� C1 —1J U
LICENSED CONTRACTOR'S DECLARATION
5 y n I herebyfirm ma.I.m I cd un« Job Description
e p provisions or Chapmr 9(commencing
�wFni with fill ,0o0)ofOi'ion3of the Busi�css anJ ProfessionsCode.and mylicense REPLACE FURNACE & A/C
re in Secrroea ra �++
o ia«� �( Lienn,a<mrr V 1 40
�p1e C
?LL O Jl ARCHITECT'S DEC
LA 'ION
�1.,Luntlgn,apd mJTlgn>shall be used as p cords
i d p O Licensed Professionsl
OWNER-BUILDER DECLARATION
w R a' I hereby affims thus 11. ,Business
from she Conon Co :Any cence ty o fordia
my
F i a following ream..(Semon)W,,m Busing and Pmfd...h Code:Any city or county
s
to F O which t requires n Penni,re casrme pplic improve,demolish, fit"
repair any stmmon $2500
e. prior s Isorequires_fo applicant for mchPerron ctors im Law(Chapter
_. ._.._..._. _. ._._._.__ . .
thorn licensed p tra0 po - amuse Ce Business and
Ia C«9 F r Valuation
or e g mlS co ]raga of Do is 3orthe Bgra dProfession,Code) "CN'T13
or Sham be rs 31.5 b ,hercrrom and.a basis for the ct the cxempuon.Any 1penalty -
-°f Section]831.5 by any applicant(nr a permit subjects the apphicam to a civil penalty '
of not mom than five hundred dollars g500). 301 APN 1 r"-1 PLUMBING Occupancy Type
°1,as owner of the propcny,or an,amployeas with.,as as mei,sale compensation,
will ne the work:and the T structure is n tractor a<d or offered for aalenon apply to an 3 04 - ROUGH E1�9VIIR�LnA&etions
Business d Professions Code, in Contractor t L' L d t I mart
t o owneror property hisow em l ee provided
n d h d b k need lf
or
oro for a]&: ply p dnmt nimprovementsimen&Suof _" 505 - FINAL-ELECTRICAL,:,
core
offered tele.Iw.erevderw balding r"pr We proving that
wmid one)ear or .. -.._.._ _ . ..-_._._ . _completion,rhe owner-builder will have she burden of proving mm M1a did not build or 507 - FINAL PLUMBING '
improve for purpose of sale.). 508 - FINAL MECHANICAL
- ❑I owner of the ProPenY,am exclusively contracting with licensed contraction to
onsvua the Project(Sec 7041,Business and Professions Code:)The Contractor's t
License Law,does not apply to an owner of property who builds or improves thereon,
L and who caimans for such projects wim.a cominnor(s)licened.amsunnt to.me...
Ccurrhowmex License Law.See
❑lamexeaempt under See � ,B&PCfor this reason � � tr .�
Owner Data
N' X ��,WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the following declarations: �®
° I have and will maintain . Certificate or Consent to self-insure for Worker's AUG 14
V Compensation: as provided for by Section 37W of me-Labor Code, for the [oo�
performance of the work for which this Permit is issued.
0I have and will mammin worker's Compenanrion Insurance,as required by Section BUIL pr1VG
37W of the Labor Code,for the perfmmanee of the work for which this permit is
ossa
J.My Workers Compenem on Insumn c and Policy b rc
�4NsU ( _C6�EegOnirH012SbS t7U z 1> t +
ERTIFlCATION OF EXF.MPfION FROM WORKERS
_;:_COMPENSATION INSURANCE
. - .... ...-.r.,. _.__....__.__.._._.
(This similar raid not be rompleod if the permit is for one hundred Jolla.
(SI00)or lcss) '
mor th i m th refforrource of m work for which'th s - .t .. _ - .. _... ... .. _
pc small I
shall nm employ any p n,n anymanner so as m become tabled to the Workers'- - •. u .
Compa.sation Laws of Calif raii.Data
"
i
Applicant ..
,NOTICE TO APP LICANT:If,rs of"mmaking This visional of Exemption,You should
st
bhome h comp(o the Worker's Compensation Provisionsofthe lamer Code,you must
� foithwith comply with such provision:or this permit shall be deemed revoked.
1
CONSTRUCTIONemisaconstruction lending
AGENCY -
" 1 hcoby:(firth that team is,.2obswaion lending y.C.) for she pertoimance
A, of rfier s Name which this permit is issued(Sec J09].Crv.C.)
11 —Lender's Name",. ._�... ._... _.. ..... ...... ... _ ..__... ... . _. . -. ., ._ _ _... .._... .i._. . - ..___ ._. ._.. __.
��� Landcr's Address
I rectify that I have read this application and state that the above information is
U conga.I agrcc to comply with all all,and c..my ordinances and arm,how,relining
U to alfarva-meng naonaion.and er ,fora auection upresematives of this city man¢r upon
tri the ahu(We)agianed propsom ndemify, and kephaZlrp s.,
F., (,0 (We)dgree I.save,and expe and keep harmless the City of Cupertino sr aid
W liabilities,judgmems,coats and,pontes which may in any way¢ecus¢against said
at
C.) ti
City in comequcncc of the gmming or this p t.
'APPLICA' U 'DERST KIDS���'A��N�D�W�I ;C"'"OMP�LYWITH ALL NON-POINT -
uRt 1—`F/� 9° IDL Issued by: Date
1
Signature,,,AppbContrit
cHtrAZARDOUS MATERIALS DISCLOSURE � "! Re-roofs
Will me applicant refivarce building occupant store or handle haamicar,material ..Type of Roof .
as refined!by he C pen n M p I Coca Chapter 9.12.and me Health and Safety
Chda.S<aonZ1532(al _- - - ( : t; yji.
ear
_.. °Y '° t _ All roofs shall be inspected prior to any roofing material being Installed.
Alm 1 prat building a nl sequipment devices.mmh
Area A Quality M gem nt If a roof is instald without firs[obtaining an inspection;'I agree to removeeaarIohepthi ey
DLtr r all new materials for inspection. Applicant understands and will coo I with
❑Yes 'J1 No- t - P Y..
all non-point source regulations'.
1 have read the h rdous mammal q.25533¢under Chapter 6.95 of the
If the iH«hh s Safety Code Sections 25505,dical itis and 25534.I understand that
';(thebuilding at i,nothre I himvcaon t me,
t' In smai 'bl CardErm the -
oc<up 1 of the quiremem hbh must be t p'or to issm c f C7�nif/cpo�of
oe p..y7 I(oto Signature of A. " _ ... Date..
PP.(meant
owinar or out...a agent . . Data All roof coverings to be Class "B" or better
a
... .... .. .._ .. .. :. ._. .__. . .. . .. ._. OFFICE .. . .. .