00120086CITY OF DIVISION
I ISIONNo
I ' PERMIT
CONTRACTOR INFORMATION:
B1111.DING AI U H'S'
ESTATES DR
ATLAS HEATING
PERMIT NO.
00720086
OWNER'S NAME:
SPARKS JACK I_ ARID MARIE E7.55
SAN'I_AZ.ARO AVE
APPLICATION SUB DATE.
12/14/2000
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SANITARY NO. CONTROL. NO. - -
(408)739-0516
7AR=CHITFqTffiNGl
BUILDING PERMIT INFO
BLDG HLECr- PLUMB MECH
1=1 7
z LICCNSEDCONTRACIOR'SDECIARAI'[ON
1 hereby aBima that 1 am licensed under Provisions of Chapter 9 (commencing
Job Description
u widl ScctionlIXXhol Division3of the BuSinc,R utut l'n,l'csriona Coda and mylia'me
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Eialltlui+reeand te,Zv „
Q License Class_
REPLACE FURNACE AND ADD A/C
Date Com.,far as
�j DECLARATION
arder:aund m"ARCHII'I=S
I lmr,hall to used m pnhlie records
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Lmensw rmre55tnnal
i OWNER-HUILDIiNDECe
I hereby almaContractor's
11. exempt Gam the Conicon,CS Lianve Law for the
on Busitessand city ormunty
reres.a
wfollowingi
ernal tn'IO7LS,
orrery
] which requires n permit fv construct, alter, improve. demoli,h, nr repair any smuontn
nionoc. demolish,
-
prdIleisvinuunx,also lbcuppllwnrhn ed
mlilmw
ve:(.the Contrucam La.
a len"9
- tholbeislicc sedwith
pursuant mlbe p f Division a se theHashavR andPelnw...Co e)
he ing Smtion Cole)
Bgeedl
St. Ft. Floor Area
1
Valuation
or that s exempt efrm(nd teburson3 flits
and the basis for Ibe alleged exemption. Any violation
exemption.yvi
or that he in exempt th.y
_.
$ 4000
of ration, 3 1 ldafn subjects the applicum nucivil penalty
than vanydreddollrs($50rmit
of nm more than five olio+area nnurtr, tssln).
APN NumberOccupancy
Type
❑ Ltis owner of the pmpery, or my employees %;th w' ages as their Rule onmpensaron,
3691 3,1274-9. 00
will do the wmk, end the structure is not intended nr olrered for Role (Sec. ]Baa,
Required
Required Inspections
Business and Professions Gude: Ile Cornmam's Liaeme Laxdotes not apply u, an
ocaner ohi
f pmpeny Who builds or inaprosev thereon, and who does such work himself'
through his own employers. provided than such improvements are nor intended or
7G 1 — ROUGH P LUMPING
mfered 1,11 11. B. however, tie hni dan,,,im"asemem IS Sold within one year of
completion, the owner-builder will base the burden nr proving that he did not build or
`�
703 — ROUGH MECHANIC' I CRI.
improve for purpose of sale.).
304 — ROUGH ELECTRICAL -
asuum the pmjecl tope. IMa, Rnsmcss Old m11,ling with
❑noIt' owor' -I the pmpctSam "cleBusinesalycomoll"I eCralle l Hw mmaam°Is'
Cndea ed Contra... to
License Law dust
S05 — FIhIAL. ELECTRICAI.
mor apply to an aw net of prosody who hands m i taproves merear,
who contracts for Such Pwject5 with a contmcnr(s) licensed ponuam m the
enntoueve Lheense''ws
❑Iamcxemplunser
507 — FINAL PLUMBING
508 — FINAL MECHANICAL qZ0
Sec. ,B&PCfor his renwn
Owner Dare
WORKER'S COMPENSATION DLCLANA'OON
1 hereby aRnn under penally of perjury one of rhe following decimeters:
^ 1 have :rod will maintain x Cenilielac of Consent b+ selginaure for Walk,,',,r.mupeneminn,
Ise provided for by Section 991111 of the Luher Code, fur the
pertinno,rae of the wo k In, each Ibis permit is iswed.
❑ 1 have and will maintain worker's Compensalinn Insurance, as required by Sermon
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3700 of the Labor Code, for the permor ance of the work for which this pewit is
issued. My Cunion lnwrance carrier and PalcY number are:
Gvrivn_�WorkerS
_ Policy Na.:(��f j,/�•
CLRTII�CA OOPKI,1.1WW
COMPENSATION INSURANCE
('Phis section need not be completed if the permit is for one hundred dollars
($ 1011) or las.)
1 cenif, that in IIle performance of the work for which his permit is issued. 1
shall not employ any person in any manner .w as or become subject [..he Workers
Cumpenation Laws of Califomia. Date
Applicant
NOI'ICIi TOAPPLICANI'.I[ulrermakingthis Cenilicme of lixennption, You SboulJ
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becmre whjen to the Worker's Cnnapcnsoion provisions of the LuMr Code, you must
fonhwinn cumply with such provision, nr Ihis permit shall be, Jeemcd revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affin;r that there is a entdwction lending agency for the perfonnunce
of the work for which Ihis permit Is issncvl (Sec. 91197, Civ. C.)
,ad,, , Name
Lender', Address
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I certify than I have read his application and Rn. Nat the those information is
corrtwl. 1 agree m comply with sell city and county onlinunees and stain laws renting
ra huddling connrtit nn, and hereby rmnhnrlze re,w,ramlve, of this city to enter upm
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the uhsw'e-mentioned property for inspection purposes
(We) agree b+Save, indemnify mal keep harmless the City of Cupertino against
liabilities, judgments, ends and expenses which may in any way accrue against Raid
City in ..sequence of the graming of Nix pemait.
APPLIC iDIT UNDERSTANDSANI WILL COMPLY WITH ALL N P INT
s OR
Issued by. �
t 1y1. 1 S. �. O-�
Date ����
- f�
signatere nr Applic:rmlconmc Ie
Re-roofs
IIA'LARDO s MATERIALS DISCLOSURE:
Wtu the nPPfcnnt or lu re bonding oscupaut .store or handle hazardous nmrcdal
Type of Roof
asddinalbythe Cupculnn unlelpNCudc,Chapmr9. 12,rodllmllechiland Safely
Crile, Section 15532(a)f
❑Yes 0 No
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building oecopam use e,i ipmem or device. which
emir huaidau5:ir cmeaminanu a5 dehned by the any Ana Air Qnul lay Management
If a roof is installed without first obtainin an inspection, I agree to remove
g p g
Didtidr
°Ye'' 0N
all new materials for inspection. Applicant understands and will comply with
P y
all non-point source regulations.
I hese read the huallous behind, nquiremcms under Chapter 6.95 of the
Celifomis H-11h d Safay Code, Sections 255115, 25533 tad 255311 understand that
if the holding does not currently have a Icnant, that h is my responsibility ,, na dy the
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ecu, I of the requlrcn cuts which onset he men prinr In issmmer of a Cci ilicme of
Oceapamy.
Signature of Applicant Date '
All roof coverings to be Class "B" or better
ownermamnnn.edagent Date
OFFICE