04110163 CITY OF CUPERTINO 4
BUILDING DIVISION PERMIT CONTRA DRINFORMATIO ----- - ---^
BUE.DlNG ADDRESS: FUTURE AIR PERMrrrvo04-1-10-1-63- ---"----
OW NER'S NAME: PERMIT ISSUE DATE
JOYFUL MELODI
E:
SANITARY No. CONTROL NO.
(408) 971-6616
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG - ELECT,— "-,MECH �•
uO0 LICENSED CONDtACoR'S DECLARATION Job Description - --
C 1 hucbY a/Oro that 1 am IiamW umkr DJJoovLsiav of C6aP¢r Y(rnmmcMing p
U with tion'! )of Division3of Ne Buv'r1s516d Pmfudam Code,and mylicensc is
in full deffecIC._ ucg V 567 f� TI--ADD 2 SMOKE FIRE DAMPER
D z License
Convector _
Ze;: C ITELTS DE RA 1
Y W< "1 uMcrsund my plans shall W used es publu Ids �� -
i7yl
u 1- Licensed Professional
Gin 3 OWNER-BUILDER DECLARATION Z?
I hereby.Sect then 1 I.S.exempt rooms an the Contncmrs License law for the JJ
p 0 (showing moon.turnout
t 7113 LBusiness and Rofneio li Code:Any city Or uctury O
y$ which myuircs a permit m consumer,elmq imprnw.demolish,or repair any stmcwm
,;Orprior to its issuance.also reyrurev Ne applicant for such permit m file a signed summent
poor
that he is licensed moomant to the provisiooa of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation _
E2 W t-$ (commencing exemiNsatiaare And fDivision r the
the Business and Professions An,
Cade)or
Nat he u exempt tMrefmm and Ne baso for tM allegctl exemption.Any violation of
section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 2dH23 Nifdu'i3et0 0 Occupancy Type -
❑I.At owner of the pmisay,or my employ=with wages As their sole compensation,
will do the work.and Ne swum is not intimated or offered for side(Sec.7061,Business
and Professions Cade:The Conmctuls License Law docs not apply in in owner of Required Inspections ----------
propany who builds mimproves thereon,and whodoessuchwark himselforth rough his
own employers,provided Our such impmw.c..art not intended or offered for silo.It.
however,Ne building or improvement is sold within ane year of cmeplcuo.,the manor- - -_
builder will have Or burden of proving that he did not build or improve for purpn¢of - ' -
❑I.as owner of Ne progeny,am exclusively connecting with licensed cont.cm.us -
construct the pmjcct(Sec.7066.Business and Professions Code:)The Contracmr's Li-
mns law does not apply to an owner of pmpeny who Wilds or improves thereon.and
who contracts for such projects wish a con meho(a)licensed pursuant o the Contractor' _
License Law.
❑l am exempt under Sec. ,B&PC for this
137M
. Date -
WORKER'SCOMPENSATIONDECLARATION
1 hereby affirm under ponahy of perjury mote of Ne following declarations:
have and will maintain aC.uOcae of Consenuo self-insure for Worker's Compsm- _=A -
n,a provided for by Section 3700 of the labor Code,for the performance of the
for which this permit is issued.
• have and will maintain Worker's Compersation Insurance,As required by Section
of the Ichor Code.for the peRormanee of Ne work for which this permit's issued.
Wmkkefr-s.CCmram-.,ensu-notion loss/...carie,and Polity number am-
e,.J�rIIfZVLIN4' Policy No.: /�� 88✓'�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This xai...d o.,M cwnplevd if(be permit is format hundreddolla.(SIM)
or leu)
I Om i(y Our in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so As in become subject to the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenifieam of Exemption,you should
become subject to the Worker's Compensation provisions of use,Labor Code.you must
.JO forOwith comply with such provisions or this peroi"hall be dmmcd mwded. -
z CONSTRUCTION LENDING AGENCY
�-. I hemby affirm that Ncre is a construction lending agency I.,the perfsomame of
Cthe work for which this permit is issued(Sm.3097,Civ,C.)
LQ Q lender's Name
M Lcrulm's Address
Z
U O 1 canary Net I have read this application and state that the above information is
D.P correct.1 agree m comply with all city and county On iwttts and stale laws relating to
0U building construction.and hereby euNmrm,opeammashim of this city to enmr upon our
W about-mentioned propeny(or imeNction purposes.
6 (We)Agra to save,indemnify and keep harmless Ne City Or Cupenino against
F' rq
liabilities,judgments,costs and expenses which may in any way acme against said City
U z. mm
in
CANTcUNDE STANDStAND WILL COMPLY WITH AL NON- INT Issued by: Date
rRCEREGU GU A N . Re-roofs
Bmnvemntraemr o.mHAZARDOUS MATERIALS DISCLOSURE Type of Roof
c applicant or forum building acupnnt stem m lunatic h.udous mamriil the Cupenin Municipal Code.Chapter 9.12,and Ne Health and safety zss3zea)7 No All roofs shall be inspected prior to any roofing material being installed.
c applicant orf mm building occupant use cyuipmcnt nor Jcvices whichIf a roof is installed without first obtaining an inspection,I agree to remove
us air conumman azd rLncdbytheBayArcaAirQualityMAnagcmcnt all new materials for inspection.
1lClNu
I haw read Ne haradousmwdals mquimmcns under Chapter 6.95of thc Califor-
niaHealth&Safely Cale.Sc60mn505.25533md25536.lundmwdNat if Ivilding
docs not comenrly have a onam.Our it is my respomibility�p n m my the me t of Nc
my.immcnts which..at metpnn m eumormser acc I m Y, Signature of Applicant Date
Ow. ge atm I I All roof coverings to be Class "B" or better