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HomeMy WebLinkAbout01020092 (2) CITY OF•CUPERTINO '" ,a •• suu,OmcptvtstOr PERMIT: CONTRACTOR'INE ORIVIATION.'' p/—/ BUILDING ADDRESS: } ."i PERMITNO.' MICCII"HI` "MASONRY 0102QtLr9E OWNER'S NAME: - APPLICATION SUB DATE •BEL, 02I 16/2001 . PHONE:- -AIR - SANITARY NO. CONTROL NO, r —5964 ANC/{IELCTIENGINf:BR'. BUILDING PERMIT INFO-s ` BLDG ELECT PLUMB, MECTJ at'< e, F LICENSED CONTRACTOS DECLARATION - - Description- r •Job o� c i nny ftot] Jdpnk I Cape,3( g tw WithSet on, " 700.. rD 3 fineBn adP 1 i ,Gale,and myl s -,. - I`ic ur and et,:L�LL L ` y© ' CHIMNEY. RPRIR . Dat -- ' Contractor - - F' ARCHITEC'T'S DECLARAI N , } --}`. - 1 Jconand my pl .:hall be adaw prafic we as 5r� } a o0 LicensedPrf.."nl Pd_ OWNER HUII DCR ANION - , 1 hereby fl II t 1 pt f .In The C Ca I t Intense' 1 r for the 1- �Z�O a ;e hI 6 (Section JIl31 5 H d P 1 , rt C,d Any IY nanly- which equ masa pecroul to Construct,ahc pave Je nr beh r-parany-mmeme - a3 price to its issuance,alsoq the applicarelsuch p l Isignedstat statement mean licensedpursuant l the{ of the Contractors License L (Chapter 9 Sq Ft Floor Area Valuation (oo m 6 da Section 7000) I D' 3 f tl B : d Profession,fe Code) - I or that he :exempt th f d The basis for the Ilgd exemption.Any aktlo. _ :)'• '$0 - • of5 n' any Y PPI' ttf p a t subject,the enpr u tovcivlp Iry• ' nrna re than fivehndreddnuars($5od) �APN.Nuinb,er •OccupancyTy'pe ' ❑I•atawnmofffit ,penr,nrrrymod",<,.wlln wasps nFtticmeorocompamfiamn - v o Biu J m k d ne I t .e nor o ,Lided .erre a r aSeepply it,a n- ,Required Inspections ' 3048 Bus' J eProfession,Code II Gml un L e L, d .apply l l an OWmrnf men Who builds or improvesit sucnandwendoesrushn an,nrdor , mupn nig emnmyeeF.pinvitedtalking Ior saee'iervnt is of OIC nal inert'er nr 0 L — FOUNAAT ION 'offered fur sale,m ar,t it r;Ina ve or Inapnnement r sold within one year or - lompmdon,thenoeotsale.),will nose the bnrdaa nrpro.mg that ne din nn,nava or � 31E, — CHIMNEY REB,AR R', STRAPS " m[! f 0 lose nf'I ). q . - 01 ndemppiy •xelaasivly conarectin,with licensed contractor. t, '514 — FINAL- PUBLIC �WORN.S man.......he p,,G(See,71AW,Business and Professions Cased)The Cn.mamr's License Law Line, I apply.o an u.'anof,aroperty who builds mpr a itheric and who contracts 0 scrollp j tswiffi.a councractoths)licensed pm la h . , Contractors License La t ❑I'. I 'npl order Sol, 9&PCfor this rmc , Owner Dene NORIUN S COMPENIAI ION/DECLARATION - • - 11 ny aft n nd pe Ily t pepury one of the toll g J lam. e' - ... ° Iha li arainnarin a Cc.f A. of Consent t If' for Worker's Cmin,draidum, asinvited for by Section 3708 f the [..hot Code for he .. pert f The A f winch thisp I' d. a + v p Olhave and will maintain Worker's Compensation Insinuate,arequired by Section _ 3410 of the Labor Code,for the performance of the work for which this permit is ) -' coed.My Worker's Compensalion Inwrence carrier and Policy nwnner urs: - ' • carrier: lAfil— PnleyNn: . t�UdTO$.•D( _ ' � •,� CERTIFICATION EXEMPTION FROM WORKERS � • }-- ' COMPENSATION INSURANCE .. - (This vection need not he aumplared it the permit is for one hmtdral dollars ' I eanif)that in the peri mance of(he work for chich in,p ,it is issued;I :{ shall not employ any person in any manner so as to become subject to the Workers'. " Compensation Laws of California Data _ x A,heral' NOUCETOAPPLICANi If ader analcm,mis L plc tc rEve tpinn you should >_ ^ Z bee lj a th W k C p t n p fthe 1 ahoy Code•you mus. Z fool with comply with hall Proaimmon or In s Pennd shall be deemed acroked FZ"Fw .f. 4 - CONSTRUCTION LENDING AGENCY+ ' a ' > I hereby offirion that there is a ionsurrietionleading agency for ane perfnormar.e ,. r wniJa le,Perot s .w.cd(Sw 309'!,C'v.C) - W Q Lantei's Name t V z Lean Address - .. 0 1 ceirifi that lhave dthis application and... that The h f ciiaa I u t I ag p, d, II city J p d - d t 1i i ll ' r Q V tab Id,corna...her and hereby remaintop rv'carouse,ofthsep In dnlenupon ° rS] ,ahc b e t d Property forinspectionp rp t 4, (W) g 1 'ty nI k p l I:.Ili Cty I Cup rd nb'alnet jJ ¢ c .. rad xpe swhah nay is ray Y - eganet send U z City a,, once nlhe hamfny of of s"unit. ,m • - `n APP 1 A UNDBRST S AND WILL COMPLY WIT ALL N �-POINT s I .Gu ryry Issued by — — Date d i` Sifulfrm4t AplIanoth-houucmr - f- Data - Re-roofs• HAZARDOUS MATERIALS DISCLOSURE : - t Will the npplca in f1 bu1A - 'ng p LI M1 II k . I meant. Type Of Roof, - avdcllaeJM1ynaecanen' M pd CalClplr9.12•.nl me Bacilli and Safety f - •; Code: mcTia 255t2(a)Dyes '. C All roofs shall be inspected prior to any roofing material being installed. wH Ine nrI' t r? b IId s p l . q pn , e ae wnlce If a'roof is installed without first obtaining an inspection,I agree to remove - carc h d oomaman nt 1 f J by the Pny Acca A r Q I'ty M nuge n \� District? - W aTnew materials for Inspection. Applicant understands and will comply with' : °r No, all non-point source'regulations. 11 xad men d nmol: y to an A,- 695 of ale , - Cnlit Bashi,&Saty Code,S linos 25505,25533 and 255341 undcrsaaddat 'fah l b dnbd s a,,[turnmally have a account,that it mya, blay poorlylie e -.a �. t �t sea'''��f t ft q n -th mhad alp' rmxs.' f/ C tlwl f yawn— ) Sigoature,ofApplicant}: �.` Date - aam erred ri Da.e. All roof coverings;to be Class "B'•or better -'- t'. 0FFICE