99080089 CITY OF CUPERTINO '
r BUILDING DIVISION PERMIT• CONTRACTOR INFORMATION:
BUILDING A 1114&11 ` -
., , '� - PLRMI'1'ND. ,
OWNER'SNA .. •} M " ' ] ,' APPLICAI'10 D jE
PHONE: - SANITARY NO. CONTROL NO.
C C O ARCHITEC ENGINI:I:R. - - BUILDING PERMIT INFO
y1❑ 3 (• BLDG ELECT PLUMB MECH
CN
LICENSED CONTRACTOR'S DECLARATION - .
5=o I ne7any affirm that 1 am licensed under provisions m Chapter q(commencing , - 3787 COND I YYlJlVtd P�CEj 534 GARAGE
to,
Dmh Seel ]11110) fD' 1111 11Cc N.it rt,1]nJ inylcen.�'a -
nine,
..I flu dfR R
d a /GI(Jl� •l ARC�HITI—LT 5 DFC R u
CL` 11 IcaunJ my pl s.chull belled ultb r A
E�T
io C Lirenzed Professional -
Ee OWNER-BUILDER DECLARATION. ,
I numby a1Rnn dal 1 am nwnlpl Ilam Ina Comnacmr'a Licen.vr Law for the -
t�j< following reason,fSochon]0315,Ba,mess and 1'rnfesaions Cadc'Any city or county '
EFp C which"Ones.pnmil m c...mucl:uhec improve, m
deolish,m repair any slmcmrc
an priorto its issuance,also requires the applicant for such permit o file a xigram!smlerant _ GG
that he le II,mwl pursuant the powko r,of the Cori License Low(Chapter q S9, 1"i[, Floor Area illld
(cuar coda,with S.6 i 70(IB of Division 30 the Buaire,mrd 1'rolnxslons Calc)
or that he is exempt herefmm and the basis for the alleged exemption.Any violation - t
of Section 703L5 by any opIthemn fur a art,subjects the applirma s,a civil penally
of nm tnme than rive hulldred dollars($5W). APN'.Number Occupancy Type
D I l .and tray my I I y dewages e sal
will a m ark and m l l I lean Use sale rsec 7(44. 101 — FOURIpiFempections .
lass rte: roe fie Cd, The C moa r-.and w Law does t work
hit lf
nw'th rip k slow l Ie p acre d a d h kti Ir 102 — PIERS
through safe.
f, I n v the I l a n Ice l a I�"'a
t n' l m y
onefiefor sateB,ehoarier.aildelarlloan,building force bawlainoneyearn' 103 — UFER
complelinn,the owner�M1uildcr will hove the bunion of proving im be did not build� t
lap r pa,iais or le) 104 — REBAR .
IJ 1. tinhep I ty ,,oaclo,wel,comon,in,withhcranmrnrtrar in 105 - RNCHOR. BOLTS '
m a- 1 II project(Sec 71414.Basi lax,and professions Citle)The Commilor's
construct
lae se Law does nm apply m ani ,or.,pony is mild,or inlp.nve.hereon.. 106 — SEWER & WATER
and who contracts for such projects with a commemr(s)licensed pursuant m the -
p rs
Cm,tmcoa,Licemfe Law - �' 202 UNDERFLOOR PLUMBING . -
❑1 am exentpl ander Sac: H&P C lin this reason •:, - -
Owner Dale .2013 — UNDERFLOOR. MECHANICAL
WORKER'S COMPENSATION DECLARATION 204 — UNDERFLOOR FRAME - .. .
Ihereby affirinunder penalty orperjury one ofthernil„wilgdecia:aaana. - `� . 205 UNDERFLOOR •INSULATION,
❑ 1 have and will maintain a certificate of Conunf to wIf onsum for Worker% 301 — ROUGH PLUMBING
Caltlpulxmiu” as provided ro,•ray section 3700 of the Labor Cri for the
pmfmmanceonhe work I which iN pe rano is issnea. '302 - TUB & OR 'SHOWER
❑1 have and will maimain Workcr:s Compensation Insurance,as Icquned by Section - 303 — ROUGH MECHANICAL -
3100 of the Labor Cod,for the performance of the work far which this permit is - -
ixanedMy akerseamlpensum,1 ranaceama,aadllo� al a': 304 — ROUGH ELECTRICAL . .
Carden 305 —_ FRAME
E PICA'ION OF .T III K FRO WORKERS' '
M r s BON INI URA 306 — HQI_DOWNS
ri"ecttnnneedrim becon nIFof it iepemti is aeon m dollar. 307 — • INSULATION
5100) 1 308 — SHEETROCK
I certify 111.1 in me pe,rnmlmr,c of in,work for which lm4 pem,il is ia,md'I t 309 — EXTERIOR LATH
shall am employ any person in any Blamer io as n,become sobject In the W..kerv'
rnmpen.aaonLow, IC.liroron.Dme
Applicant 310 - INTERIOR LATH
-
NOT ICI:TO APPLICANT It,alle,no,lon,this Crif t fE pi y .If ld ,3311 — SCRATCH COAT '
M.co.c, hjuctmlh,, l 'C r,war,mi nmor,ot'11Labor Coro,)a11u
O ormosim co,lply with such pros s Ors in i.permit sh.h bo deemed revoked' 313 — ROOF NAIL
rip CONSTRUCTION LENDING AGENCY
F ulmml
ebyafrlhatthgneisitUm
. .Rlrtimllem
melmgagencyhuayedmarmnce 501, — FINAL ELECTRICAL ENERGY
A > mnhe work b"wbich dos ini,is i....it(Seca3119]:Co.C.),
E Lcuecr'.Name 502 _ FINAL PLIJMII I NG ENERGY
L
p z - LenAe(sAddress 503 — FINAL MECHANICAL ENERGY
(P Ir,,ilymntnavamaethis apphcatim,tlnitnio,that the bo,coftamaannis 504 — FINAL BUILDING, ENERGY
ELI mrrem.1 agree to comply with all city•and county ordinances and.tale laws relating
0 V to buildingcnna traction.a,ldherebyaahodeerrpreentative.othis eityloelmapon 505 — FINAL ELECTRICAL
me Ilamentionedp property m.pecenprym 506 — GAS TEST
FaZ IlabliticMo etlxs:v ' Jet lfY tmdkeep
Ia yin irinfless linCity
ilyy ue mengnin.gaxaJ .
V z city rte 1 ce"ln g re Bis 507, -- FINAL' PLUMBING • `
r.a gOULI, R NDE N SAND ILI OMPLYWITHAL )N 1 �' LIS02/bySOIH — FTNRI MFCHANTG ALDate VCSTklApplemUC r D e Re-roots 509 — FINAL .. - -
HAZARDOegMATERIAISUISCfOSURE 510 — FINAL PLANNING
N'1l y theCapplicant MunicipalfuttipCo e,occupantCion score nr b mB na old m Type of Roof
as drfned by 0e CI penin Cale Ch.pler 9 12,and the Health and Safety
code heellzss3zl v - 514 ,- +FINAL PUBLIC WORKS '
oYe' /_{\/Na All roofs shall 60&3 eteRfp&tcP1nyWC3Cft''1Na liW being installed.
Will the applicant in .are luildmilloccupam use component or Jevtcea which If a roof is insta�)MwithoFgffeeola#WrqE.NE§lspection, 1••agree to remove
can,h 1 air cnnt ra a 1. .derinedhy.th Bay AAir Quality Management •
Dial or. - _ , ' all new materiae'mspeR�i AeP,�u; � tca;!§s and will comply with ..
r
all non-point source regulations.
I lov d the ho. u:malar aIs mqu lemems tinder Chapter fi 95 of the
ounc.%=.inmrc
dlh&S tyCJ S Dans45511.525533 IJ 25514 I,ndeml ullht ,,, s
g does not or Ilyn diem I that t yrf5pwas M1ilty U Idy h - '• 1 "^
h' p uanfic Signature of Applicant Date
lmoudbgom Date - '. All roof coverings'to be Class "B" or better .