01040144 (2) CITY OF CUPERTINO '' "" - -
euu,Dwc DIVISION PERMIT CONTRACTOR INFORMATIii-
BUILDING ADDRESS: PERMIT NO. '
7523 'DE LA FARCE DR SOIJTH 13AY REFRIGE ATION 010401.44 .
OWNER'S NAME: - APPLICATION SUR DATE
, I
COLEMAN: JAMES I ' ,V hl 46:1.•. .PERRYMOhIT 04/26/2001
IONS: y SANITARY NO. -CONTROL NO.
r2
79-191-1
g O ZO AIiC111TEC1'IENGINEER _ - S ' 'BUILDING PERMIT INFO
m BLDG ELECT PLUAfB MECH
a�`�Fj
�Z LCI: SE)CONTRAC'TOR'S DECLARATION '
o y^ rnee.n error mat l alit licensed amen provisions orcha ret 9 aonnnendri Job Description -
-OZ—� Yu provis P 6
Q_t J welt Nlhr 7tR101 fUl nt lith.Bu nc'. ndln(e.cions Gdc.and mylicense - p_ '
HO" I:a . I �-� �. 'REPLACE EXISTING. FURIVACE WITH 60000 BT
3 < Da -��.( �T S UI CLAR , .
C a J I n a=mend my pl nc rhall healed as publi dv
Llecnsed rrolkwo,ltw
OWNER-BUILDER DECLARATION - ' -
u"1 1 patchy aRml Ibm 1 am exempt faith the Commeor's License Law(err the _
C ze¢ rnllawing rens...(Scanlan 7031 S,,I3timor s and Proresslnns Cde:Any city nr cnumy
$rt Ow wIih j p II t Iah p I I',h P. 'nY 'lastute
6�3F pr I I I requires theapplicant for such peen t t Elf, signed orientation
e, main licensed p tt thep -of c tract r' I ><La (Chapter9 .. - - '
- comme,.aswnSeaonno
gxuftn
Divi or the ..
dlrrc: geode) $q, FL Floor Area - . . Valuation,
a ma he is u,a,pl dla,crran amt the basis Ea Inn mmged excmprion.Any AnIatiol0
of Section 7031S by any applicant for a permit subjects the applicant In a civil penalty
or not mere than Five n..deed dollars($500). APN Number' _ - Occupancy Type
will
d the onneprolleny,ortturelis not swide wagesaaweb.,,mle(Seasnron. ��•
wall da the work,sad the add: Ili is not in.1,Lie e I a. t.ails(Sec. In it -
Business and .y Profession,Calc:The coahamar.License law d«.not apply to err Required Inspections -
r of pmpeny Who huildr err improves Ihercon,anJ bodocs such walk himself
o,huashhis u nanpm,tac,poweledthat.ueh do,ow,carsOne aolmtvtdedor 301 I4OUG14`PLUMBING
united for sale.It,hisses.,in,handing or hrtpmvemanl is sold within one year of '
unpletion,the owner-Iwilder rill have the hurden of proving that he did not build or 303 — ROUGH MECHANICAL
Office,for purpose of.vale.).
0La,twna,nnIn,propanyI,an.sra%ively comroming with licensed contractors.to 304 — ROUGR ELECTRICAL.
Instruct the project(See.70,14.Badrone
Badness and Pcion,Cade:)The contractors s 505 — F I NAI_ ELECTRICAL -
License Law does not apply to an owner of property who builds(ie improves thereon,
andmwho sandoas for etch project,vl...bnam(,)licerecd.panaaat l,, he 507 F INAI_-,.PLUMBINGJ
r
Cmadc,s,License Law. '
❑I am elan,..wader See. Bm Pc fm this ,on 50.8 7 FINAL MECHANICAL _
O vocr Date
WORKER'S COMPENSATION DECLARATION
I hereby affimt under penalty of asrjury"dee of the fallowing declarations: � r
J have and will muinlao a Cenificme if Consent io self-inwle for W..let's - 'FINALED • '
Culnpcnvulnd, ns provided For by Stenon 3700 of the Luber Coda, for the
perfnrmnnce of the work for which this permit is issued. - JUL
t/� -
❑I have and w'ill'mainlain Worker's Cnmpcnvution Insumncc,as n, had by ScanlanV L n J 0 2 2001 '
371,of IM Labor Cede.Idr •Pat I'orinunc'e.of the work for which mi,,Iwl'Inil h
island.My Wmkere ca one'a nn Insurance artier and Po cypyfl into l .v
CaR,.r: & PalicYNo,: C-✓ '(\/••�( L �••/ BUILDING
CIi Ri'I411ATlO 1FIiXEM1'I'IIOsan WoWoRKFRLY ,
COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred della
ISI(ID)or lcsx.l -
i
' 1 cranny that in the performance of the work for which this peintit Works,l '
shall not employ any peelali in any manw,ner as io become sohjen to the Workers'
Compensation Lows of Califamia.Dale
A,dusnNCHICnTo r
NOIrhe subject
to Work If,Compensation
is Cenons of of Labor at.
youshould
Mhwithcjen,NeparoCom is Iionsennit provisions LaMa Cala You main
/0. O forthwith comply with such prnvisinne nr this permit ahWl I+e deemed rcvnACA, • - - , - '
^F 4 -CONSTRUCTION LENDING AGENCY
a > _1 hereby infirm that there is a conabu,non lending agency for the perfnnnene, ,
.,the work rnr which This permit is issued(Sec AN7,Civ.C.). -
S Q, fennel's Nunle
z Lucia's Address -
V 0 II ii,r lha l hmo a ith allx vtrplicaion and amc thunhe above infonnainn iv -
We.1 mrte.L 1 agree to a,mPly with all city and noun Y nnlinnnce.v and slut.Inw-v ralnOng' -
>a O then 't-rovnsratedg.andncl'enyaurellon enmllvn of Ihis clay to mnul'upsm
>I then P e ny for insponion eprsen.
nl'c)agree m' vet indnnni%and kef(hannlav the City of Cup.ninn against
co) liabilities,jud,alFGnI meta and exp ones uch only in any way ncrne again,,.„aid
V z CityilC;A)r,,K5 arlhe gmm'm•,'thi LCO
APPLICApr 1 ' ERSTA COMPLY WITH ALL NO -POINT
aces r ' nDN. - �� Issued by: Date �Z
sismll p Icanlrcllrl—o ale— 'Re-roofs '
HAZARDOUS MATER CLOSURE
Wiu the applicant a far.,,building n.crtlwm.rare or hand),hia,u wn,radicdal Type of Roof. .
.,defined ny rbc Cup.ninn Municipal Code Chapter 9.12,and the Healthand Safety, -' r
Cale,Semen 25531(a)P + ,
ora.. -❑w. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or furore building-eupanl use equipment or devices which If a roof is installed without first obtaining,an inspection, I agree to remove
mit hazardous air contnndnlmli as defined by the Bay Area Air Qualify Management -
'Ltdcla e all new materials for inspection. Applicant understands and will comply with
ore,, ❑No all non-point_source regulations.
1 h ,ad he � B u a-,roll 'nuo meal.,code,Claque,695 nl the - •, - . _
-Calif aH'Im&S. 1 ,al S Inn,,22�155(15 5511 nd 25514,1 uW :Iandlhut
It the hild gdoesn c By huca tcrl6n(Int is my rc'po.hllyt nify me
'reentrant of Ih j i it,wh' \nus n t prior
cum issuance of u C ileac of - -
Ocp'a.y. ', / Signature of Applicant Date
Fowner, i n ag=nl Dai= All roof coverings to be Class"B” or better
OFFICE'