02080146 (2) CI BUILDF c RTOYNO
DIVISION
PERMIT CONTRACTOR INFORMATION: .
BUILDING ADDRESS: PERMIT N0.
943 MILLER AVE AAA FURNACE & AIR CONDITIO ING02080146
APPLICATION UB DATE
Awk 69ff&Z ALBERT E AND MARY L 1712 STONE AVE 08/26/2002
I PHONE:
p (408) 293-4717 SAMTARY NO. CONTROL NO.
O O ARCHITECTMNGINEER: a BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a i 9 L3 LJ =1L.7
�yZH
LICENSED CONTRACTOR'S DECLARATION lob Description
QZ_ ebony KP.fDlorm simu3tI am udheBundssandPronsoion,Crn.andmmencing REPLACE WATER HEATER 130 GAL)
rr:t with Section 0000)raf Division l of the Business and Professirans Code,and my licenss
Y is i till orae en ffl ty S[
O u Lie CI sap Li
J9 Conti tar !�
3 a to.�f/ CHITECT'S D[C I11
c
C`u��0 0 g 1 underssond my plans shall he uud as is records Ft N A L C
Q o Licenutl Processional
6p
Rfz OWNER-BUILDER DECLARATION JAN 0.2 2003
-' I hereby option Nm at 1 aexempt from the Contractor's License Law for the
w
I-Z a followingre nation.Permit
t 7031,5.Business and Re,de on.Code Any city or county $630
p
which requires o Perm t t construct,t alcor, reprove h pia
h repair any steatite
$ .-th r t ,sirs «,also req theapplicant for sucContratm a signedw(Cha mint - - - - -
°• - tWthellicensed:pu ymtorh-PrtiviainnsofNeContmcm License lawlcnaptm9 364 1049orplpea Valuation
(com=n'ng 4th SwOon]000)of Divri on Jmf the Buvnes.and P[olesuom Cale) �. 1.. x +. a 4 •, lft �:rbi-i .Iia 4:
or Nat he is exempt thercfmm and the basis for Ne alleged execiptiA Any violation
of Sectio.7031.5 by any applicant for a permit subjects the applicant to a civil pemalty-
.of not marc than five hundred doll vs(SSW). 502APNP�2N.baqE PLUM13IN ENERGY Occupancy Type
01,as owner of the progeny,or my employees with wages as their sole compensation„ 506 GAS TEST
will do the'wmk,'anJ the'structure'is nor intended or offered'for sale'(See:'7041', SO7 - FINAL PL ns,.�n�
Business and Professions Code:The Contractor's License Low does not apply to im �fY11'iaG tspections,i` ` 1
owner of property Who builds or improves thereon,and who does such work himself
or through his own employees.provided that such improvements an not intended or --
...
`offeredto, 1 ICer thebuilding; rtrapn ofpsotn sold he did rete year of
improve for the owner Wilder will hm'<the burden of proving that he did not build or
improve for purpose of side.).
it �ensed...--._-_..-
of the
cm ownerpnjer property.7 n exclusively and Profeisi n.Coeef The Cmn contractors to q:`.e�:•v
License theoescn Tapp.7041.Business indene who b Cod=:)Thevesteaor's
License law tract nm apply tooj owner th pmpeny who builds se improves thereon, ,
and.who.rontreca.for such.Projects..with.u.cunmacmrlO licensed pursumt to.the. ..... _ _prop.-._ ..._.......___. ._prop_ ..._.._........._____,..._.._...._...._._. .............__.prop
' _ Conoanols Liam Law., _ .,.f• ---_ ---
_ ❑I am exempt under Sec. ,B&PC for this reason n _
Owner'
are
` t;
_ WORKER'S COMPENSATION DECLARATION
-'t I hereby arms under penalty of perjury one ofthe following decimations: -
0 1 have and will maintain'a Ccrtincnte of Conscnib self-insure for Worker's
Contpenuu., as provided for by Section 3700 of the Labor Cale.for the
performance of the work for which this permit is issued.
01 have and'will maintain Warns',Compensation Insarania as reyvircC by Section
- - 9700 of be Lzdmr Cole,far the performance of the work for which this permit is
issued i.My WorkcLsCm attar lnsumnc cam and Policy number ere:
.anter' tPsl yN.•.
l Ir
Or N PE%CMI!TI MW K RS' i
,,-..:. .,-.COM
COMPENSATION IN. R_NCE'tl._.1 -„ -.-..... .-.___________.__._-..........................._..._.__............__.__..prop _._...-..._.._._......._....__
'IThis section need bot b,completed if the permit is for one hundred dollar
ISI00)or lear.l '
T Le wy that in
the erson too any tra fthe,s rkfor which drspeto be issued,'1 ,t,,, .1 , �ql ,j'u
'shell'not employ any person'n any mannei w as to hecome suM13ed m the Workers
Applca rat LawsCompensation f California' .Dae l
. .... .. ,. . ....prop prop _... _. .._ ... _.-.....
-Ncome s bjec'mLICANT IL after mu,.t,.n s Certificate f Exemption,lvard, .a auld •,
' became sob en to the Wrarker'sCom
J P,fruits
provisions of the Labor Cate,you must
z O forthwith comply with such pmvisiom or this permit shall M deemed revoked.
4 t CONSTRUCTION LENDING AGENCY,
> 1 h by M. hot there' a con wct - ding agency for the Kantor anee
'L rad -work
for s, thisperms issued 15 3097 Civ.C.)
W r certify ._
`pyy❑r' ofth kfwhich
0 I t 1 have read this application and state that the above infommuon is )
L*s�[r -partici.1 agree m comply with all city and county national and state laws relating
(„) t to Wilding construction.and hereby authorize representatives of this city to enter upon
.r W 'th W entinnerrproperty forinspection purposss. -
(Wei agree to sae mm
dent fy and keep harmless the City of Cupertino against t1/
Lr y liabilities,pal,naers.cars"and expenses which may in any way can against said
V
City ue
y in...ntnce of the g (ng of this permit
'APPLN' VT UYDENSTA\DS AND WILL COMPLY WITH ALL N NT
MH z_ REG/1TI v ��� Issued by', Date
lure ofApplica'nUComracts Date' Re-roofs
HAZARDO S MATERIALS DISCLOSURE.
wNm= ppbe t rte Wddmg as pant store tar hasMle horudoas nowenal _ .Type o1 Roof-. ... .. _ . . . .. .-.. —-- __: _-
a deft edby the Cupmmo Mon cipal C haps 9 12 J the Nesbit and Softy p s
'Code sectionO25532(a) t tr'y3' I 1' r :as rigs •<13Vi
.r
t if
roof is installed a,
]l be ispected pr or to ray roofing materia being install d
Wrath rpa=ntorft nide t owey 'p fi deviceswn=n installed without first obtaining an mspecti6h,il•agreeto.reinove
= t h ab arc t rants as Jef y the Bay Are A Quality Management
District _ - _ all new materials for inspection. Applicantunderstandsand will comply with
Dyes �� - - all non-point source regulations. -
- ° 1 have'find the hazer a materials requirements under Chapter 695 of the '
�Cslifomin Health&Sof ode.Sections25505.25533 and 25534.1 understand that _
.. _... . . prop .- ... _._ ... ....-. -_.
,tf thebuilding doesmrn rtently have a tenant,that it is'my responsibility tonotify the -- 1
oecup t f th- reyt rcme i hmh tar v bd t p',r to' unre mf a Cemticate of
Uy
' . _o P n/hls�a�. .. -.. . _ aD�Z .Signature of Applicant _ _ _. .. Date„
'obi«m arta . A`',`/" G— ate All roof coverings to be Class "B"or better
_.d, ., ..:,__,....'.,.•.__'.. prop ...-- - --._ . ...-.. ._ .. - -' 0 --. - _. _ -- - ------ -...prop ._.-.-- ---- -----
- -- -
FFICE - -