02090023 (2) CITY OF CUPERTINO
'BUILDING DMSION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS PERM IT NO.
10341 PHAR -LAP DR CONDITIONED AIR 02090023
Am 09IT6WGEORGE B JR AND ALICE A 1701 LITTLE ORCHARD ST APPLICA`69�'MA 0 0 2
PHONE: - SANITARY NO. CONTROL NO.
(408) 291-2220
QWZ ARCHITECTIENGINEER: I WJILD[ PERMW INV)
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on JV-G %.�LtCT PLUN2 I MISCH
8 Z' LICENSED CONTRACTOR'S DECLARATION 0 e ption
O� I thereby iffirm than I on licensed aside,luminions of chapter 9(stonsommairig
with Section 7000).fDbv,i..3.f,ha B.0's and P I as Code-and my license REPLACE FURNACE
lLsi f c el cl,,-,
ra,. em
Lic.
Oust cauaeA AAA�d KA&Afl
a. -
ARCHITECT'S D- ATION
0 1 itude stand try plans shall be used as public,remod,
,,W�x Licensed Professional
a. 0 0
to E! � OWNER-BUILDERDECLARATION
. I hereby affiran thal'I am exempt from the Contractor's Limma Law for the
followingumant(Section 703t.5,Businessand!Pix,fiessionsCorl citymccunty $3600
X.0 which efitures is peranit 1.c...later, he,,inalmovc,demolish..,repair say structure
in 1-2
prior to ita isitiance,alit)requires the split!Cant forauch Penn![to file a signed Statement
�att�tii1ima4idpr���httd�'pmOsionsofffieCon�tor'sLimnin Law(Chapterl? Valuation
(comrnu�cm9u4hSEcdon 7")ofDivision 3ofthelburinessard Pronficatiomi a,.-,-,- I lk'IN AlIX �PfMATIGN
or that be Is atiarripo therelmin and the basis for the alleged ciialpfitti.Any violation
lofnistrousuctranflychundualchollars($50i 301APNNUWIRN PLUMBIN ii, on, i Occupancy Type
[11, a owner of the property.or my employees with wages as their sole compensation, 303 - ROUGH MECHAN 3AL
will do the W.&: ad the moncture is nor intended or offered for sale 3-04
Busincisriaid Nifiessions;Castle:The Contractor's License Law does hent apply to ars - ROUGH EL:KQ'1FeA(" ctions'
wancrof,ofteny Mo builds or improves thereon,and who does such work himself 505 - FINAL EEE�!T CAt
or though his own employees.provided that such inaprovesicin,ara,�ma_imend,dor *
507 FINAL�-PLUMBING--." '-
offica6cf1brit blissevir.the haddiall-6y imirrovirmat is sold within one yearof t
iompfccion,the owner-builder will have the burden of posiving that he did nor build or
inulponse forIar,oin.f sale.). 508 FINAL MECHANICAL
CI 1;..cavats,a the prcipsulry�..atchusively emuse,firg wish licensed comirossucas a.
construct the proyser(Sac�7011.Business and Professions Cedc:)The Contractor's
License Law does not apply to an owner of proferty,who builds or impooas thereon.
and.who.cormacts for such.projects with.a.ciamortuarts) licemed.purstont to he. ----------
Cionoracuor',LicemeLaw.
C]In.
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c B&P C far this...a
a'an, �,ahu Se
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tire
WORKER SCOMPENSATIONDECLARATION
FONALED
0 1 have imid will randinuitin Cmifisale of Cmraml�.se,fi-innoe for Worker's
Compensation. .-provided for by Section 3700 of the Labor Code, f the SEP 10 2002
performance of the ml,far which this mot is issued.
0 1 have and will rarsuntLi.iMalker's Compitustitiont lostimace, �nurtured by Section
3700 m1he Lothar c6de,fiw�the perfikirouria,of he work for which this Permit is BUILDING
issued.My Worker's Compearatio I s ne nfincram:
A&UkW!%N[,soner and Policy-no
AFIC PTION FROM.WORKEM�
)rori - t In,
P I
COM EINSATION INSURANCE. a
i'' abi,oictionAcedrotbe ..unple
SI 00)or I red iffire nai,is for one loodred dollars
T
to i
,L]l irto employ miyLpccs�m in any ra�,aw, in he a a.,�hjcc,to the Worken'
Carrojehanum Laws of Calificarms Otto
Appla,con
NOTICE TO APPLICANT If,after making tlfi�Certificate ot Exemption,you should t
z beimireiritij,v Code, .a most
0 forthwith compl�with inch pravisions or this fiction shall be ifiernev!revoked.
z2 .,- - -----
M r 'CONSTRUCTION LENDING AGEN&
of the week fcr`%�hich this Permit is insuied(Sic.RED.Cim C
Landc,Adicincis
0
., nil,fliat I lave-ad lhi�application and state that the above information is
correv,%ce rar,l,wifib all toy and vot 1,onfiron,c.,and ,are hot, chum,
officem to
U ilding construction:and hereby authomic repocitcrim6cs ofthiscity to entartapon
is
;hwlaw.-finhoumni hurimpeclum Imponal..-
t,91. twe)allove i. . comify ad it.,h.I;Li the Ciiy,.f ci,'P�oinc p.mil
Z) liabilities judgments,costs and expenses which may in any way oCoWe aptiam aid
U-1 z Cit�in comenpuence ofthe granting ofthis paromi,
APPLI��NTUNDER�AND$A)D�VILLCO.�IPLY�'�HkI NOZP0\7
so��IGUL T Issued by;A#"A&2W Date
10
Signature.1 Appit foue Re-roofs
IAZARDOUS MATERIALS DISCLOSURE
wl,�l�,t�.P"Plicantorfutur�buildiniwcupants,6morh=dl�ha�ousmtc6aI Type.of Roof._
v ver defined by tbe Cupertino Municipal Code.Chapter 9.12.and the Health and Safety 12, t
Cuba.Section 25532 'cot— ". . I �. -'s,'1'�I
. , 1 , �-. F _, I ,
-.--All Lroofs.shall..be inspected.prior.to any.roofing.matefial being instal
applicar, ��\.:t �
a mfixibire If a without first obtaining an inspection�,Fagln& to rdmove
roof is i�ifalldd'
r�.�'aii�.t,.d�fi��b,,h�B.yA..Ai,Q-.IityM....ement
nor cf? all new materials for inspection. Applicant understands,and will comply-with
all n6iI-Ooirit regu ations;-.`,,;._1�L 1.:
I have read he infixt,..ran.I rectiturenters,under Chapter 6.95 of the
cidifunria Health&,Safety Coca.Scoiso,25505:25533 and 25534 1 anderstord than
if he building does mo tionsamly have.famon.that it is my responsibility uo"ivutkf�fire 7,
.sicupom of'he acluirenscrits which must be rinct poor to issuance'af a Cenificate of AA4�1 , 4:�
caffisrus, Date
0
.�ignature of Appocant
Date
Owncrwravoh?riz� ;;a, All roof coverings to be Class"B" oi better
----'OFFICE