99080090 CITY OF CUPERTINO
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Bun,otNGolvtslONpFRMIT CONTRACTuORINFQRMATION:
Ile
BUILDING ADDRESS: 0( ' PERMIT NO.
111
OWNER'S A'E: - APPLICATION SUB DATE'
PHONE 1 tit PBRIEN • _ - SANITARY NO. CONTROL NO. -
q�Z ARCHIMC'GENGINEER: - - - _ BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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czNz I.heab ffn thattGncl<WuaCdRr;vEormofCnper4manlmnencn, - JobDescription -
F�tw whn Section 7Wo)Of Dej tnf he Buvineax not C nod my ' ow
G s
If in run rnKn rola nrrcd.
a z License Claw - Lic. .r -
a � Dote _ C nue , 1 3562 CONDtTSOhIED 'SGRCE, 677 GARAGE
O RCHITEM'N '
dY wale land Iny Plmx shall he uneJ m In Tic,,nada - -
�+t z p O Licari Professional - - -
°O o OWNER-BUILDER RATION '
1t I ray II that 11 front
the
Contractor's t t L I' for the
C toll ,maraca.(Scamiam 7031.5.Bostn J I marina,Colic,A Y city.,comil,
Fp wh n er,liript 'u t t h - P J I'h Pm, Y.t num
o.3� pool t t L I .h pPl' t hpe O fl g J t tmnent
(oh citgwipSect- nt7000)P.1Division3l.1 heBmiatc, 11 llewim,Cod - Sy. FC. Floor Area y Valuation ..
or that he is exempt therefrom and the basis for the alleged exempting Any violation
of Section 70315 by any applicant for a permit subjects the applicant m a civil penalty
nfrolmtom tan Eva hmtd"adolla,($5(10). APN Number 'Occupancy. pe
°1,as owner of the property,or my employees with wages us Their sole compensation,
will do theeaork,and he structure is not intended or offered for sale(Sec.7044.
Baltic's mad Profession,Code:The Crntrumar',Licence Law apex nut apply to an - Required Inspections
caner alproperty Who holld,or improve'thereon,and who docs such work anowlr
or through his own employcex.provided that such improvements arc nm intended or
offered for sale.If,however,he building or improvement is sold within one year of 101 — FOUNDATION -
connpletion,the owna,hruilder will have the harden of,coving lhat heard not habit or
improve.fmrpurro'e nfvolal. 1.02' '— PIERS
111,i s nwneref the PoTeny am exclusively contracting with licensed contractors to _ 1 03 — LIFER ,
torsional hie pn,jet',(see.7044,Baines.and Prufessior,cnaeD Toe Crimacm`P' 11714 r REDA R
License Law loco-not apply m an owner of property who hi or improves thereon, '
and who contracts Our such projects with a cont actors)licensed pursuant at The. - -
CommicmrsLiatn'elaw. 105 — ANCHOR BOLTS
,°I ant axcmpl radar Sec. .B&P Cl or this reason X1106 - SEWER R' WATER
Osunt, WORKER'S COMPENSATION DECLARATION 202 — UNDERFLOOR PLUMBING' ,
Inearby chiral nour,Penalty nrpartial owoflIn,loudwingdeew,mann.: 203 — I.IhIDER,FI_QOR MECHANIC,AL
° I hoe modwIII promah a Certificate of Coastal, to if-insure for worker:, 204 — UNDERFLOOR FRAME
Compensmmr, as.pmvided f.. Is, Section 3]0(1 of the Labor Code. fnr Ibe 205 — UNDERFLOOR TNSULATTOhI '
perfonnan®of the work tar which Ilia pcmit Ice inured. -
°1 have road will maintain Worker's Compensation Insurance.as reyuirtd by Section 301 - — ROUGH PLUMBING
3700 of the Lanor Code,for he peHomtamoc of me work fm which his pemdt is -302 — TUB R OR SHOWER
IIm'd.Mr r'x Cmnpm¢winn „utio dmicr and Policy on bar '.
carie'_ Pnli • 303 ROUGH MECHANICAL ,
'IFICA'PI :xEM ION eO�RICE"1lrs"�— 31714 — ROUGH ELECTRICAL , '
'cc PI _ "c CH -305 FRAME
OU is union a completed if the .it is for ane hundred dollars HOLDOWNS 306 „-
f51 W Itar less.) '? '
Iacht halmhepernamrneofheworktarwhichthisNounisissued,I 307 — INSULATION '
shall not employ any Person in any manner so as 4n become subject to he Worker'
CompensationLaw,nfcaffnmm.Da. 308 SHEETROCK
Ap,lwi I -
NOTICET'OAPPLICANd lidlerutuhmg his Cenifieme of Exempfog you should 309 —' EXTERIOR LATH
hecome subject to the worker's Compensation provisional ot
of the Labor Code.you m
�p C
forthwith comply with such provisiann or this scroll shot be deemed revoked, 310 INTERIOR LATH -
CONSTRUCTION LENDI NG AGENCY 311. "'— SCRATCH COAT
I herehY u0irtn that marc is a nmauuainn lending agency for the performance s
W of the work.for whicnhislwnnitisissued(See.3097.Cie.C.) 31.3 — ROOF MAIL
° A LLeoaa' AJdn, 501., — FINAL ELECTRICAL ENERGY
� z
L' G 1amity that Ihave mad this application and state that the those information is 502 — FINAL PLUMBTIVG ENERGY
F comet.Iagree tocompo,wiat all city are anllmyardmamcu'gadNntalowsrelmi"g 503 — FINAL MECHANICAL ENERGY
C.7 ,building nmmruaiom.and hernby authorize repmxentmlvcu of lhiv c'ny mena,upno
y tea wagree nedmpnr minty ndkne,lonalamam ,. 504 — FINAL BUILDING ENERGY
Qt 6 .' 'nJ fy J k cp hon de:.the Cly t C,,ta al,a aSol.,,slid� m lanStairs.t t I p many way;,,,,,,a ginxt.,a 505 —. FINRI_. ELECTRICAL ,1 i
V z Ciyol
c aft , f g nhla Pem
^ UMB4 NU
AUNUPRSTANDS ND WILL IPLY WITH AI NON ISc s � Issued by: 506 — GAS TEST Date .
s -nlmtml Dale• Re-roofs_ -' - - .
fIAn or
AISmor osu 508 •— FINAL_ MECHANICAL
x'JI he ePpftcanr nr M....building occupantCharlie,
more or handle Health a mmtdm Type of Roof - .
Cticaned by he Cupeninn Mmliclpal Gm1g cn:mter 9.12,mod the Health and Safety 509'--' 'FINAL GRADE .
Coda Suction 255321x)!
O Yca °It" - All ro0(S shall`%&ilfspectEd[lidGLtoRhjPMrii{Vrmaterial being"installed.
Will the air cotat Orhtumnnha6:d bytheByAea Air n Mice,whtn If a roof is insEalLc'aPwidh6ui.fh% obFALAft6�inblQRI6$t,Iarree' to.remove-
emilh d _: ireomatm mm sad defined by Nay c Air ar J1, vvicc,which
uall ,�
Dismay - all new materioftLor insp@0iDp:. Agplipi}g:ygdettytlijids and will comply with e
°v °Y all non-point so ce regu 1 s.
I e,ad the a m mmtrr f,rtyult nemis kinder Chaptcr 6.95 o he G �. �E BATTENS
California Health k SafelyCode.Sections35505.25533 and 25534.1 understand that 60L1.'.— ROUT' .t1N—PI11.1U ':E.S6
j1di nm currently have u nt,thm it is my msponsibiliry rat notify thee romarememtx which xl c met prior m isxu ee of Cenifn t,of
0- � Signature of Applicant ,Daten t agemt Dam All roof coverings to be Class B or better
OFFICE