00070071 CITY OF CUPERTINO -
BUnAtNc nrvtsto v , PERMIT e't. '' CONTRACTOR INFORMATION:,.
BUILDING E rum, YERMI 1'NO. -
OWNER'S DED _ _ APPLICATION SUH 5A1'1i 6
PHONE: , •` - SANITARY NO. CONTROL NO.
.40 ass. a y� -
M 0 ZO ARCHITECT/CNGINRER:,=.; r' ` - ' '> - BUILDING PERMIT INFO r
O❑ _.,rs, „,,. .- BLDG . ' HLF.CI PLUMB. MECH' '
. ¢d - .e 1 LTI CI CI f• �I
on
Z S N.` LICENSED CONTRACTORS DFCI ARAl1ON • ' f ' JOb'Deserl ti
pz c tall r :d d p Linn, 9( „PATIO' COVER p
tth5 , AIIXq fD o�Bu ': 1P f. ' Cd n_J ny l'c -e ,
3 u.to A CHITLCT S DECLARATION
O 1 J �' J yPI' shall be use p hincer us
OWNER-BUILDER DECLARATION
�
of Ill: Licensed Profession.].
as 'ar
w�11 11er,b,air...i 111' 0t1 a,fle C , , License La,f -II -. -
>y 4 fall 6 (Section 7031.5,Business' 1 P f :Code Any q ly - -
E2p wh' h g "brith.'araoir,all p decurish,or m,con,..yo. (are
a. !2 an< t , r g ' 'Ili Dano it 'he t ntainted ,1 non
hat lie licensed Purolator to the previsions r[Ile c t r. License Law(Cn p,or9, S Ft F1oorArea , a ion_
(ca b wgn Su-t 'JOOU)of D vin 3 f,h R -d P f :Cada) y . - , '
ar IM1,h n a In rcf Ih bo n ,h all 6 I npfl,Any v,olal en
afS i n]0315by ny pal' ,1 r Donn uhject:the uppl conmucivt Penally _
01 not
,of” anfive M1tmdrcd eollam(ssBn) A u Il � � � Oc aney Type "
°I r, .a P
ill 1 IM1 k nJ Ili ]044, ,2,i,T - „-
"BudP f..
Ply in lYl SpeetlOBS
I.IaaD ,yWh n n p e m Ind 1 neo if " 102 PIERS
orvah ugl his
PI y ended or
nllBelr Irl m roJn g p mf 5tldu,'In y nror . 103 — UFER :
onfriction
plf 0 nub 'IJ xillhnva th brden of Pnm ng,hm hodW nq build
`mp r p m x ors ie,) _ '= x1-].04 . —_-REHAR -
;k
El i. ,d p p ,r exclusively t t g thlicensed 05 gNCHOR Et0LT8.
ata a the prgjut(See 9044,Bl sines d P leo'anx Code)The Contractor's License Lac,does altr,TytoanawtenofarapertyWouhueds-orm,provexthereon, 106 . 'SEWER R• WATER „
and who contracts for such projects lchl ,a tagis) d p m, the '
Contractor's License La - 202 = UNDERFLOOR' PLUMBING . -
711 ion axa,npluodc Sea rc,xont 203 UNDERFLOOR MECHANICAL
Owner - WORKI:kBCOA1PDNSATI(1Nole DIiChARAI[ON �•�- '204,';— UNDERFLOOR FRAME °
Inc,ebyaM,m,unterpenal,yorp�rjury�nennhorouaw,l,ide<lamnnnx:- c05 '— 'UNDERFLOOR INSULATION ,
301 — ROUGH PLUMBING
- C lea J II' inn ' C fr l f Consent L f Wor h i'- r '
Gimp :i p Wa f by Section'3]00 r theLabor Cale for ,he
Penn nh kr ,lbah this Pronano,rated, 302 — .'TLIH' R OR SHOWER .
711 havea,Gw'nmu,tonWorker'.Canp t ,1,xlrhnce, sr�garcdbySecdan .� :. 303 •— ROUGH' MECHANICAL
9]00 or Ilio Labor'Code,for the f mm�ce.of the work for which this .o
" Per pern,ia is � '- '
x,uca MyWmkea,Ct b f Insurancerand Polrr reactor are
'304 — "ROUGH ELECTRICAL '
Cornier /�/� /eC Policy No.: a---r9-C� 305 .— . FRAME .. t
CERTIFICATION OF EXEMPTION FROM WORKERS' 7 ,306 " HDLDQWNS= "
7 COMPENSATION INSURANCE ,"'
frit . Y d tl male,d'f Ili I tin h d dd 11 >
3.07 INSULATION
!iSmH) nea.y �• 308 SHEETROCK _ • .• •`.
n�ythr 'hper nn �ikatwh'ch tM1p 1 . issued,1
309, EXTERIOR- LATH
shall nvnp any p ,ynl ner rebJect m bo Weaken!
coma , ,LawsatGI Dole1
31.0 ,— I-NTERIOR LATH
A ,I ✓ L - - '
Nmeo-amriJCA w�rlloa ong this Certificate fE.rr,dbah,yen should i r 31.1 - SCRATCH COAT. .
Z heroin mhJe a t fire W kno,Coroplar,ation pro,isitav,a,h Labor Code yen mut
�O C mann 'n Courplywi,n rohp kme,or hispora,hill ned arevo ,, n, x313 — ROOF NAIL • -
CONS fRUcriON LENDING AGENCY
H:4 Iheann Irrmtl la[ toll d 501 FINAL' ELECTRICAL- ENERGY
Y• 6 6Cy for the Performance
oflhework mrwnenaM1 arnt ini,xad(so3B9] eia.cr •
O 0 ' hall
-
. 502FINAL '
INAL ; PLUMB
Lender',Name .TNG
NG E
NERGY
.
z) z Lenaerfe503 FINAL. MECHRNICAL ENERGY
reed his edn and state chat meLbove infatuation 504' FINAL BUILDING ENERGY
.cartel g I mDly with d city and county ordinances tsa s I w ruth
U loblIIa . c,o Ili by d rcPrc a t , fill,
ll any It eto-tp 505 FINAL ELECTRICAL .
,
W theab ne r dpr pc ryf inspectionr' p p r
a (w) g t nm fr Ik pl ,m -m Cay rcpt ag l x 5& `—,'GAS TEST
L" n layer :) dg t. t 1 1 n h ty any way accrue against d 507 — FINAL PLUMBING
C,1
City
cgucnC nl,h granting of th his t, •M.; °
SOURCE
REGULATIONS.
S W WITH ALL NODI POIt.T
`
APPLICANT
UNDERSTANDS
COMPLYLNY- CU Issued by: 508 —. FINACHANICALDate
"S,gItIM m 'I i
Date, Re-roofs .
HAZARDOUS MATERIALS DISCLOSURE
Will F'I_ '
II th pphcan future bulldlny p' t fore o'ha dl n I m 'nl r Type of Roof NAL PLANNING
as defined by the Cup,offiro Municipal Core,Chapter 9.12,and tie Health not Saf'y 514 .FINAL PUBLIC WORKS .-
Code Section 25532(x). �/ 1 -• t. ,
°Y yC' All roofs shall be inspected prlor,to any roofing material being installed.
WE thespot t f, n 'buLlocation, g�p e hn' if a roof is installed withodt first obPainin inspection, I agree to remove -
Intonations conm Proof , lefncdbythe BayAnnA Q 1'ty.Mamger , g an
Di"` El Y6, �r y�No all new materials for inspection. ,Applicant understands and will comply with y
zll:non'point source'regulahons
I have ad the e :m', -nk reg,'amenk cod r Chapter fi 95 0l the
Celif,rul Health&SallyCode Seei...255052553and 25534.1 u,dexNnd,bm s.
ifthe building does not currently tr , „ht , y ...... hl'ty, notify the. ,•' bsa
occupant f the1 int c 1 it
be in a prior to issuance f a Ceriffic,ure of Occupant, QAny�'c--� l'• ' Signature of Applicant Date -
�3��
Owne edogem '/.Dasa , All;.roof covering's'to be Class;`.`
e B,' or better.
OFFICE :f