00050179CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING AD _ .
PERMI'I'NO,
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OWNER'SNAAVHN WAKEFIELD
APPLICATION SUB DATE
HONE:
SANITARY NO. CONTROL NO.
Z ARCHITECl/ENGI AER:
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BUILDING PERIMI INFO
BLDG LLIiCI' PLUMB MIACII
I=1 I_I IJ I_1
mmli am under
Job Description
I hereby affno en.sed powiolmaf Coupe, 91eomrawmang
jwith Section 700(d (it Division 3 of the 13 usincss Land Professions Cole. andmlicense
y licee
is in full Bares and effect.
LI<ensc Clxs, Lic M
Dare Contractor
ARCHITECTS DECLARATION
— I understand my plans shall M used as public rtnnJs
2405
LIVING SP. 420 GARAGE
Licenced Professional
a OWNER-BI111.DER DECLARATION
1 herehy afflict the, 1 at,, escmPt Both the Cmaranm x License law for the
a following rcavoo (Section 7031.5. Bmsinvw and Prnfivownc Ctale: Any bit n
��
which require%. iscri a, cmuwct, alter improve, demoli"ly,�yiu(Q'�� �$t.
jA
prior,,it, i ... rare. also mquire"he applicant tech of tpMrt tcmam
O� Sq. Ft. Floor Area
Valuati(�p
W242832
I be is ]]caved Puts...I to the prom. of the Conauch, . 1 echptar9
(commencing with Section 700(4 of Division 3 of the Btninms and Pr CC((yy11U
mat he ix exempt tbercfmm unU ma baxi%f r the ullegW mxamp in ac,
rt
of Section 7031,5 by any applicant for a permit subjects the applicant t vt penalty
of am mnedem eve hundred dnnar,(s50(d.�.
APyflJ�I�flftPiy7. 00
Occupancy Type
10 i, as ownerof me progeny, m t„y employees wish wage. as theirr sole e�ppE,h*
��
Required Inspections
w II J tit A d lit t t m l t d J Re d f I Ffyhl..
Bus d 11 I ao ; Coca: The C... on,in, Li,mov, Law does ran apply in an
f p Who n Id improves thereon, J ho 1 n
hm.r
'perty ... id
r
.wlmndaf
through b. npl y p J d that hinitiative
affected for If M1 u c the I IJ ng improvement is IJ lti are year of
ve the lamdnd prnviny that he did no, huddar
complchnn. theowner•bmlder will have m
1.01. —
FOUNDATION
improve wrn,seofole.).
1.02 —
PIERS
❑ I, as owner of the pmpeny, am exclusively counseling with licensed contractors a,
he 7(st Buaoeas Ponrc%, Cuda:) The Cm.nowln
103 —
UFER
mnaet indIce, (See. and as a
License Law Joos not apply a, an owner of prof ny who build, or improves themon,
and who contracts list such prnjectx with a ecntmctonx) licensed mosam,t nn the
104 —
REBAR
Common', Laser c Low.
❑ I am exempt ander See. . B& P Chn this onxm1
1.05 —
ANCHOR BOLTS
Owaet Dane
106 —
SEWER & WATER
WORKER'S COMPENSATION DECLARATION
202 —
UNDERFLOOR PLUMBING
Inerehyaffirm under Penalty ofierjuryuneofthe following declarations :
203 —
UNDERFLOOR MECHANICAL
1 have and will maintain a cenificate of Consent to mlf-insure for Worker,
by Sec,inn on oe Libor Codu, for 'he
Con,indowamn. Lar provided lin Pf W
204 —
UNDERFLOOR FRAME
performance of the work far which his Fconit is issued.
205 —
UNDERFLOOR INSULATION
O 1 have and will nainmin Worker Compensation Insurance, as required by Section
3@ 1 —
ROUGH PLUMBING
Its work roe which this mmit is
371m of the lahnr Code, tin nhc p,rf nnn,r,, of nhp
,ued.MyWorkers"CompenxationInsurancecarrierandPolicynumberare:
302 —
TUB & OR SHOWER
Ci i== PalicyNO:
303 —
ROUGH MECHANICAL
CIiR I'linCA'rION OF ESTX1iMPiTN FROM WORKERS'
COMPENSATION INSURANCE
304 —
ROUGH ELECTRICAL
Cutis section need not be completed if the permit is for one hundred dollar%
305 —
FRAME
(S lud or Icss.)
3@6 —
HOEDOWNS
I eenify than in the performance of the work for which this Penmil is issued. I
shall not employ any person in any manner w, m to heemac subject a, the Worker:
307 —
INSULATION '—
Cmlicantup'nonlmiLwx
aurCannsr°1st DateArpne l
308 —
SHEETROCK D
NOI ICE'10APPLICANT. (Calor making obis cenificate of Exmnplion. yon should
bceneve subject to the Workers Con,penmtion provisions of the Labor code. you must
309 —
EXTERIOR LRT
fmthwm, cmnply with %Lien provoion, or dak permit shall be deemed revoker.
310 —
INTERIOR LAT
CONSTRUCON LENDING AGENCY
3 PIIhereby anirintthercisamnonfiction lending agency Far the performance
311 —
SCRATCH COA a Q�
y� 0
of work for which do, permll is issued (Sce.3097, Cie. C.)
31.3 —ROOF
NAIL,
Lender's Name
L,rd„%ndatess
501 —
FINRL ELECTRICAL ENERGY
I tinily that i have read this implication ant] static that the above information is
I laws
5@2 —
FINAL PLUMBING ENERGY
agree to comply with all city and squinty ordinances and state relating
j correct. nlundingcm,%tmafmaaddhotelsyauthoai,eremesentative.softhiscitytoenterupmn
svmm
• the aMc entioned pPeny, for inspection purposes.
5@3 —
-
FINAL MECHANICAL ENERGY '
(We)agreeit, ,anc.indemnifyandkeep harni heCilyofCulcnlnnagainst
0 liabilities judgments, casts and expenses which may in any way accrue again,( said
clty in perant.50�
504 —
FINAL BUILDING ENERGY
ennsequena of gnu,ang of
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT
NAL ELECTRICAL S 27 B ( J
SOURCE REGULATIONS.
Issued b
Y'
Date
_
Signatumof Applicanhconnr:mlcr Date
Re -roofs 507 —
FINAL PLUMBING
HAZARDOUS MATERIALS DISCLOSURL
Will one applicant Lir froom luUding Occupant store militaristic ha.amm�, material
Type of Roof308 —
FINAL MECHANICAL
as def nal by the Cupertino Municipal Code, Chapter 9.12, and the Ileulth and Socny
Code. Seefon 2553201?
❑Ycs ON.
9. —
All roofs sh• in e)cp
F I NNqqL R
gp(lor being installed.
Win the applicat or mmre building occupant use equi Pnuut Lir deviees whrl,
If rof Is I t Sed wi h t I Jqfin�rnaterial
30•s eetion, I agree to remove
,mi n hanrdom air conmmin:mts an defnted by the Bay Arca Air Quality Manegemenl
''��4hh%`U1et,
all new mate s foTinU
�ir. Ii Pun i(i�s and will comply with
re, ❑Nu
all non -poi 6WceTe ISPLYWOOD NAIL
1 have read the hamrdous (amenia requirements under Chapter 6.95 or he
% 603 —
ROOF BATTENS
Culiromia Hcahh & Safety Codc. Sections 25505.25533 and 25534. 1 understand What
if'hebuilding([Lie." not currently have a tenant, that it is myresponxilclityto notify the
mcu,,,I Lir nbe rtyuiretnents whim nuol be met prior m i..uame el a Certificate Ir
� �
—
(/J'�604 —
,p-�'
ROOF IN—PROGRES@4
ROOF IN—PROGRESS aZ O V
Occup.
Signature of Applicant Date
All roof coverings to be Class "B's or better
owner„raannuiodagen, ane
OFFICE