01020114 CITY OF CUPERTINO'• I -. ..
BUILDING DIVISION'`:l ' , PERMIT CONTRACTOR'INEORMAT.ION:~ _
BUILDINGADIIRESS',. • `t PERMIT.NO' .
OWNER'S NAM11 - HEATINg
APPLICATION SUB DATE_
2" 02i9`11 /20011
PHONE. SANITARY NO. CONTROL NO.
G e4Z ARCHITECTIENGINIiER: - - BUILDING PERMIT INFO
BLDG ° ELECT .!PLUMB MUCH
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•2 F,� LICENSPD CONTRACTOR S DECLARATION * • - - Job Desction
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°a LL y Dm 2= c ,tors p _ ly R &R 100, 000 BTU'. FURNACE
F Oe AR IIIT[U SDI CLANA IOIV .
J I d t J ypl1 IIb 1 'p hl' V.
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aaoo ee s'l Professional
S m OWNER BUILDER DECLARATION -
u�l I hiltirby affion II`1 1 nor pocalle from fail C I I License Law for the
� d 'foll g (Section 7031.5.Ball,ince,andl f:`-.Cd AYft ly
f O which retlaires A proulnt .t t IIo,improve,shniolsh,or repairystucure '
ec^m .Pr t t y ' d pal tt hp ',I fl 6 d th em
It. that lie is licensed pet [lie provisions ofA Contractor's LL (Cmarr9- - i
mo,men�,gwmseadh,moB)oroei: 3ofineB,aae aP rrs,ih„eode� s9• FI. Floor Area Valuation _or that he pt thercfron and the basis feaffic alle,d]w,emnion A y vieloo6o i t
if' ttionahrvmafiehad...Hdiunr(S500).t object,'",ppl tt elpea,lty APNNumberOccupancy ype -
cw ❑Las ,wneruflhepropany.orniyemployee,wilh wuyes LLS lheinole mmpen stum.
will do the work,and the soucwre is not intended or oBead bur Bale(Sec,7044.
Business and Probes......Code The Comma....a License Lawdoesnot apply to nn, • R 9 iced Inspections', i
owner f p p ry Whobuilds p (h rc n,andwhish,,. h Oak himself, -
Or ffirmi,lahi o c Il y .p ddunit such rap..eecraos are ansintended Or t
- nlTerulforin,it.howeverthe hu'IJI,g provcnwnis-soldwthin,a, carif F 204 — UNDERFLOOR FRAME.
ranmpleorn,the,owner-nonderwill have the burdennrpmyingthathedidhotbuildor 301 — ROUGH PLUMBING'
p P 1
EllflheproPerro d , IyI' t' g threensencontractors 1. 303 — ROUGH' MECHANICAL
oa,lmal the pr meal(See 9094,Basin, nil Fine os Code)The Contractors ;
Lawrse Law does hof apply to an owner ofproNrly who hailds Or tortoises thereon, 304 '— ROUGH ELECTRICAL
nod who controls Nor such Pmjetl,wllh,a contract (d licensed puram,m m the .
Compactors Llecnse Law. 505 — FINAL. ELECTRICAL
❑Iran exempt under sec.' � .B&P C for this reason
507 - FINAL PLUMBING
Owner Data WOR KER'SCOMFF,NSATION DECLARATION Is SOB. — FINAL. MECHANICAL -
J
` Inerenyan d �plly lip i > nnefollowing a r t : 514,. FINAL. PUBLIC ;WORKS
e •:❑ Ihave, d II maintain it Cc
nfcat fControl mself-insurefor Worker's
Co p paha„as pmvdul for ty section 3700 of the Luber C de, for the
performance of the work for which this permit i,InHcd. - .f s - -
❑1 have and will maintain Walker',Comperoofine hOaahnce,u,rcyuired by Section
3700 of the Labor Code,for the performance or the wed;for which this peril is -
issued.My Workers Cnnpensnun
o (,surearner
and Potty mummmer are. � - h '
Carter 1VB Poli,No.:N1ll� (J.. .
CERI'l1aICA'I'[ON OP EXEMPTION FROM WORKERS:' sCOMPENSATION INSURANCE
(This section need not he completed if the permit is for one handrail dollar,
(MOMOr len.), w ” •i•i' a� .r - - .. ..t'
I ecdify(hill in the pedonnance of the work for which this parmil is ismed,I -
shall not employ any person in any manner so as to technic subject to the Woken
CompenLaws h
emion Lf Califomla.One n
Applicant
_
NOTICE f0 APPLICANT if, O k ,oil,Chrlifi,ificofFeamplan. you O W
bee l a theWalker C ,w o, p rthe Lob oalsorc le,you _ y '
Q Q ,fed llcourtly w all such junivineiv.or IIs On an(shall be decal revoked.
CONSTRUCTION[.ENDING AGENCY
a > v i hereby ifffinal that lane is a inandpation lead ag age my for lie safnmwno, - - s ••
W ofthe wark for which mispermils iss,ed(Sec3197,Ci,.C.) ..
(� Lender,Name
Trader',Address
V ( lcavity Out hits itan ala W ' that the M f t
I gree n comply II d ordinances d Int I . l
uti- gc) 6rbuile gcenrnLaid hemtycoh, prseuudw rl lh,cp mea,'upunheab mentioned
-
- 7 t •m -
pmpeny for inspection purpLac,.•
-a
liabilities*
ande pen...kcephumyin the Cityofau(teninr against -
V] 'Chitin amal 4parCes,ane uJ expenses which-mot in any way acerae ngnin,l.aid' - a
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City in y f0 counting DWIfir, I.
APPLICANTRRGULERSTAND ND WILL COMPLY WITH AL'LNON-POINT' , Issued by: Date
•sOU FRECULATIONs � Y• .
w
Sn"natmep5tnin Ca`,4aat . DateC Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Y
Will Type'of'Roof ' .,
as d0land by the Calfunno N,pal Code,Chapter 0.12,,Old It,Health and 5 l 1,
_ Coto,Suction 2552(vJ - - . -
OY " All roofs shall be inspected prior to any roofing material being installed.
Will the ppl' t future h 'I- of e I 7u i, t 1 , h'ch . If a roof is installed without first obtaining an inspection,'I agree to remove
email d11s�rcom , 'a,Jelned to,the Buy Arcu'Ai,Quality Mmag meat
Distill ( ' 'all new materials for inspection.. Applicant understands and will comply with.
r
� . t,deoy� '` "° all non-point source regulations., - - • '
I have read the bCodes Sections
2 rcynl25533 a under Chapter 6 9 of the
Cul,hoil Health ffi Site,_Cod S tion mm,that
it kn amd25534 1 understand that _ '
ifdmbu'I(iaEF cal rat whicly h
Grid be flhatts tnyrcuance bltymnrl'su the -
occupam mf the rcyuircmmpts which mux(be met prior m issuance of a CcdiB'wle of
p y '� `Signature of Applicant - Da'
UV-O All roof coverings to be Class"B" or better
Ow ninonzed agent Dale g
• A , y
'OFFICE
•