02060058 CI
BUILDING upnsio1NPERMIT CONTRACTOR INFORMATION:
Bg"gigNcy3AD1IMTHERWOOD DR A PERFECT CLIMATE PERMIT NO. 02060058
TMVIAHATT 10570 S DEANZA BLVD T9'J -17702
PHONE: (408) 861-9545 SANITARY NO. CONTROL NO.
O O ARCHITECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION 61,�e.`s p 1�
hereby.nBrm that l am licensed under provisions of Chapter 9(commencing REPLACE FURNACElJ ADUcrAPf�°
to with Section 7000)of Division 3 of the Business and Professions Code,end my license
f is in full force node c
c C< License CI ss Licit M
LL a Dal[ -20
Contractor
CHITECf'S DECLARAMN
}g 1 underntantl mY Plans shall he uses es public records
7 i O O Licensed Professional
o OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the $4588
?a following most .(Section 7031.5,Business and Professions Code:Any city or county
D
which requires a Permit to construct.alter,imprdemolish,or repair any structure
so prior to itsissuance.also requires the ppl ant for such Permit o file a signed statement ---- - ------- - ---
that InFis Iissfused ptmadh{to the proisions of Ne Continuators License Law(Chapter 9 _ ,3 f.���,(-6t�a.-rtt Valuation
(commencing with Section]IXX)of Division 3 of the Buamass and Professmns Code) \ ',. i )s 'ss'+ 1. .L.n I '
or tom he it exempt therefrom and the basis for Ne.[]aged esemrymn.Any violation `
of Section-703]3 by carry.,,[aeon,for a pemd,subjects Ne applicant m.civil pnmlly P Y
of not marc thnors
en five hundred do (5500). 303ki"N IO MISE MECHANI AL:a.:.: .. Occu ane TYP e
❑I.a6 owner of the pmpeny,or my employees with wages a6 Neir sale compensation, 304 - ROUGH ELECTRI AL
- -will'do'the work:and due'stmctum is not int,M,d or offned'for sale(Sec.70,4,
'Business and Professions Code:The Contracmr's License Law does not apply roe [tons'
owner of progeny Who builds or improves Nercon,end who dos such work him M I C L
or Nmuggh his own employees,provided Nat such improvcmems am not intend r _
-:ofered'forsa[e:If,tiowever,She Wildin & - __ ttssold within one a f - -- - - -- - ` --- -- ---- -- - ---- :--- -- -
colnInion,theoimery the
fpn y „�,,., _
p builder will have the burden of proving Net he did not buil
improve for Purpose of sale.).
exclusively._. .. ._.___...._.. __.. c ..._ ..
_ con;asowner ofthe p(Secny,em Buinssand Pmfeingwi Coicensed k,)The Climtno ._J!•i,:�, ' t•
- _
construct w does
(Sec.]044,Business and Professions Cade:)mpr Contac
License Law does not apply man owner of property who builds teimprove thereon'
F _and who conwnseL wch.projens.wiN.e conwnor(s).licenud pursuenrm Ne _. _. ..... ... .... .. ...__._ _ ..... _..1___...-.__...__...-,_.-. . . ...____ .____ ..._.-..
Ell.o atarriors xcense Law._
❑lam exempt antler sec, - ,4,B&PCfor this reason .'.l Ct %•11•Il
o'vineF'' „��I - Dam
"WORKER'S COMPENSATION DECLARATION
1 hereby from under pcndry of perjury one of the following declarations:
❑ I have and will maintain a dai0cnte'of Consent to self-insure for Worker's
Compensation, az provided for by Section 37W of the Labor Code, for the
perfarmince of the work for which this permit is issued.
_ ❑1 have and will on
WorYsr's Com'pcnsation Into.,az rcquirtd by Section
37001of the Labor Code,for the performance of the work for which this permit is
issued.MMyy'W Workers Co pe ' ton Insure 'der,.and
/Policy
/number
ars;
1v I ,
Cemert-T�AN .AIhC�t Pol e)'No.:1:�" i Atz;V .. . --._.
•_)_i •, .tail:
tI CERTIFICATION OF EXEMPTION WRKERs':
COMPENSATION INSURAMs, '• 1 .+
"�^"(vlhii'unfon need at be completed if the Permit is for cote hundred dollars �'"• --
(SI)0)Or 1[56.).
,. .. - ��_._ ...+. _ ..
1 cempl Nati the n in any ma n the wa 1 for o mh thio petit.nose,, J In:
I i
shall not employ any person in any mender'w'az is become subject m the Worken' '
Applicant nsntion Incas of California.Dan',"
Applicant ..
If,
NOTICE TO APPLICANT:Workers
Compensation
this 0sinsofcate of Labor on.de,you muld
st -
O � become subject the Workers Compensation provisions of the Labor Cale,you must
forth nA comply with such provisions or this Permit shall bedeemed revoked
oa
fir]
CON eTRUCTu LENDING
he b ff�that Cagency farNe pc form n
of for which i omit is (S 3M7, C)
-
._."...___A def s Name
1.
Lenders Addrat,
G'Q 1 c ri agree
that[have with al application and orate that the above laws n is /J
fzac F correct 1 g e to comply he b city and acountympar ordinances and state taws enter
open 5
DSV rob Id gcantumail on and hereby-auctionpeprcu mtivc (N rymenter upon
W Ne bo e e .tea,to pmpeny f inspection
p rpou
y. es.j agree to save, andarroulyexpenses
and keep hm may,.
an City of Cupertino against 1
_h Cry io ci judgments,costs end expenses whrth may in any way eccrve.geffit said
Cary in canuquence ofthe greening of this'petiC '
SPRCA : ER$TAND$'ANDWILLCOMPLYWITH' ' 'NONPOIN Issued by: rAY� Date
siossfA,phFimt1C.HtJts - Re-roofs
,.HAZARDOUS MATERIALS DISCLOSURE '
W[d Ne tilt'h am or fuwre bdldieg occupant store or hand,hSraidaus material .Type Of ROOF _
es def no ed by the Cupen Mumnpal Cade Chapter 9 12 and the Health and Safety
CtiBe O no 25532a)+ No
1- ^s I
4 1 . --1,;. r_ All roofs shall be.inspected,pnoc to any roofing material being installed.
WJIN[aPpltant or future buildng occupam use equipment or devices which If a roof is installed without first obtaining an inspection;I agree to-remove
n herarEoss air contaminants as defined i Ne Biy Area Air Quality Management
D tnctt?, ' ' q Nn all new materials for inspection. Applicant understands_and will_comply with ..
all non=point"source egulattons: , „.;:.
1 have eod the haurdoue materials rx,tdpepnrmlsder Chapter 6.95 of the
Cohforre Health&Safety Code,Se tion un
25505 25533 and 25534 I understand that
if lhpbulldmg da es not cunently have a tenant that it s my responsibility to notify,the -1'-
• poo q p or to isw.nee of a Cenifeme of / 'ems
t of the i[ oven rets which musrbefd n
... . O u tn
nay.
nature of Applicant Date
o r r.atnnria,a.gpnrnot U
All roof coverings to be Class "B" or better
. . . -OFFICE .