03030120 CITY OF CUPERTINO . r iyA�s« w c' �" «_' '
BUILDING DIVISION PERMIT C(SNTR�CT®R�INFORMATI0,N:
rA'
BUILDING ADDRESS: - PERMITNO. -
A PERFECT CLIMATE
OWNER' A - PCP
10570 S DEANZA. BLVD 1>ERMIT�
NE: - SANITARY 1 12 OL NO.
(408') 861-9545 '
ARCHITEC IENGINBER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u o o LICENSED CONTRACTOR'S DECLARATION
d 1 herby a rm that 1 em licensed under provisions of Chapter 9(commencing lob Descrl tion
with Section 7llfq or i 'ion�of atm Buslneuaed Profr Wm Code andmylimnseb - �'�INA
ICD
in fullf and Y A E
i5� o:m° cenu.nar D NEW A/C
tillCrR DEDu MAR 2'4 2003
I u d aril my plans shell M used u puhlRadcoNa -
w0 Licensed PnNeninnat
OWNER-BUILDER DECLARATION BUILDING
<I 1 masa .(Sect on 11. exempt from the Cssion Code:
:Any c Law far the
ma off, following uires a permit
t 70 o1.6,Business and Prome.de nm Cade:Any city or county
which requires Issuance.pctmit re enm.the epee improve,de ermit t fi repair any laructure
prior wned loment
FZSn thathe slicenalW myalrtNnovisioeenl for sucCo mon'Wicense Law(Chapter
FF <
(common
co he blkendpumuam7 the of Dielooe 3the the
Common'sLicense (Chapter9 SQ.Ft.Floor Area V Ion
dale[ (cam a Is'emgwphherefrom and
the
bssbf a Bar al egad me end m.Anynmcadc)ur 3 6�J
Net io b exempt therefrom sed., anis for bj Waged mnmpmn,Any vlolabon of -
genion tanf ny mydred dont for a pemtll subjecU the applicanno.tivll penally of
to mnrc N.t five hundred ammm(s500). 3-0 bTPbtBlIer00 Occupancy Type
❑I,an;owner orthe property,or my employees with wages as that,sole compensation,
will do the work and the sunnum is not intended or offemA I...R(Sce.]044,Busineu -
and Profession,Code The Conusctm's License Law docs not apply m 301 ROUGH an owner of Wh�00 INFtctlons
propenywhobuildwrireprovesthewn.and whodoeumhworkbimself or through hit 303 - ROUGH MECHANICAL
own employees,provided that such lciamn, ncou ere not intended mortared for uta If,
bovenmr,the Wilding or improwment issold within one year ofcompledon.the owner. 304 ROUGH ELECTRICAL
builder will have the burden of proving that the AE not Wild or improve for purpose of 505 . FINAL ELECTRICAL
. sale.).
❑I,as owner of the property.am exclusively contracting with licensed eonmemn to 507 - FINAL PLUMBING
convect the project(Sea.HN4,Business and Professions Code)The ContramesU. 508 - FINAL MECHANICAL "
"me law dma not apply to an owner f property who Wilds or improve Hewn,and.
who contracts rat such projects with a camranco(l)liunud pu nsam to the Conu¢Wfa
License Law.
❑I are exempt under Sec. ,B A PC for this moon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby elftrm under Nosily of perjury one of the following daluatlom:
Ih.w and will mommin a Cedificam of Consent to self-insum for Worker's Compen.
Ion,u provided for by Seaton 3810 of the ebur Code,for the Performance of the
work for which this permit is issued. -
❑1 haw and will maintain Worhees Compensation Imuran,u required by Section -
3700nf the labor Coda for to Performance of the work for which this recruit b issued.
ME�V�N
rtier end Policy n
Co.:PF:�RlION INSURANCE
(Tab section need not bccompleted if to permit Is fnromehundm4 doll.(SIM) '
or lms.) -
•- I certify that In the performance of the work for which this permit is Issued,l shall not - - - -
employ any person In any manner so as in hmomesubjmtlo the Workers'Compensallon "
Laws of California.Date
Applicant
NOTICE TO APPLICAND If.army making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of use Labor Code,you must
z fonhwi in comply with such provlsinm or this Pencil shall be deemed ranked. - -
zCONSTRUCTION LENDING AGENCY -
PIWrcby alfrtm Net thercha comtratinn lending egcney for the perfurmenceof
W
14
7 the work for which this permit Is Issued(Ser.3097,Ch,C.)
W0 Lattices NameIS,
z Lender'sAddrtas - ..
C)Q I certify that 1 have read this application and stem that the soon lefmmalion Is _
LU P conte[.l agree to comply with all city and county ordinances and emus laws mining in - -
p U building construction,and hereby nmhorirs mpresenmdws of this chy to enter upon me
fs7 .hove-mentioned property for inspeedon purposes.
(We)egme m owe,indemnify and kap hssmlen the City of Cupertino against
ra/1 Imbilities,Judgmenu,cmu and expemu which may In any weYettme agatnn said City
V 7 In coney rise of the Snout this Permit.
r7 APPLIC NT NDERST D AND WILL COMPLY THA ON-PD1 Issued by: Date
SO RC R ULA ONS.
Re-roofs
Sigmtumo A IiunUConuacmr Oete
e HAZARDOUS MATERI DISCLOSURE Type of Roof
WII me applicant or fume[building n ant norm handle huodoos material -
n dcfmned by the Cupenimo Mun IMI Code,Chapter 9.13,and the Health and Safety
code,Sccdut 25533an
❑Yes All roofs shall be inspected prior to any roofing material being installed.
u
Will the applicant or fuwm ilding occupant um cyuipmenl ar lawless which If a roof is installed without first obtaining an inspection,I agree to remove
It hmardom air coneran ants cfired by the Bay Arm Air Quality Management all new materials for inspection.
smlct9
❑Yea n -
I haw roW the huraNnm memriabmyulmmcnm undcrCMpmf the Caldio:
1�i.HaiLhfl.fctyC.dc,Swd-25305.25533.d25534,1��ftifftWildin:me Willing -
s no`i c/Jtp rally he s mnen Nn h b my expansibility m notify the occupant of me
ulmmcn whigh-m ibc e�+non 1st ora eNfmamof°ccy a Signature of Applicant Dale
owner err seri road spent pm. All roof coverings to be Class"B"or better