00060096 (2) -'t• CITY OF CUPERTINO •• -
NUIMING DIVISION -PERMIT '° yr'' CONTRACTOR INFORMATION:
BUILDING A DURESS: _ PERMIT NO,' '
OWNER'S Ii pF -
,HONE:,DEE ! SANITAR .- .NO.
G m ARCHITF.C'rIF.NGINEFIi, - — - BUILDING_PERMIT INFO
KO�Z 'i. .} BLDG ELECT, PLUMB MECH
Z m 1hrrcb ,RICEN9EDCONTRACTORS DECLARATION lob Description,-
4 Cs
st
Y p ' of Chapter l mon ne e
O4 W wi,h5 1 ]1100) fWD�/,,n3of lheBu : ,dProf .tons Code myl r
U is fllCra
lnsxfirce� PVCs+. L N"/ '/� .. ,\':I t . '.• ,r
-,1 - treater ADD 3 TON •36000' BTU''AI R COND.-
on
OND
o BUT ITECT'S DLCLAR O
C♦y O I aderetand a,Pions xhall be used 1 bl hecto(, (
WY
n a OWNER BUILDER DECLARATION
I hereby orfiren that I pr f the Contractor's L Lawf the
toll g a. C t 7031,5,R a d P f 'C d ALL any y
E S❑ -whichq p t t 1.1.111L.43. II P J f a p y structure > „
aees
ae. _ Prot t. 1. q :th PPI' for h p t t I signed t 1 meat ` . - a �^ a
mat( I,f dnational t men- of the Contractor's E L (Chapter9 Sq. Ft:Floor Area ,'. "r• " Valuation
(ro nano ,g with Section 7000)of Dole' 3 flh &ed IPrecision,swIdian ,
or that he s exempt any
-f ,and me pe for heIc Regal c pr- Anyd porally - ..
of not maion Ilthn vanY'rd nm fisrap t subjects the apDl a vii paean
arum �oremanfkohundred dwlar.rssonj- y' � .. APN-Number � _ _Occupabc ype
❑I - ftt pap " y ,pl Y Ihwages'..,hiIp s I' ••
will t the k and thel t I J t fi d f .a I S c 9146
Basin.. cold Profs Code The Contractor s License La does (ppiy to an 359240??a 0pequired Inspections
r e 1 property Who I u'Id: prnvu Ihereo,,an 1 who 1 h work looser
- k
,,th gl h: coup,e p kdlthtrts 1 t tit dedor
offeredf 1 If, d buildingimprovement':: II within eycaror 204':— UNDERFLOOR ,FRAME'
, on me owner however,
the n.,vn d r dPr ting uld!ween ani )car or - ..
the r t To. f ) 1 301 — ROLIGH 'PLUMBING
l t'
711, ma pr lir t> t xel : ly I g with licensed contractorst 303 — ROUGH MECHANICAL
con t t m i j,l(S 90x4 H d P f Cd ) D C h u r. ' - - t
a.n Lawdna t pplrt fproperty wh builds pr 'mreon 304 — 'ROUGH ELECTRICAL -
and h contracts for such projects with a eonwaor(s)licensed pursuant to the -
.centraetorxueeaeLaw' .-505 —' FINAL ELECTRICAL
❑Ian,exempt ander Sea - ,B&P C for this reason 507- —"FINAL PLUMBING -"
'Ow D
LCIARATION ,508 — FINAL MECHANICAL -
In ,by,affrin e,pholy rfrep runeofinefou ' se_I ret. • : 514 "FINAL PUBLIC ,WORKS
WORKERTS COMPENSATION U
1 base and will ,u ldo a Certificate of Consent In It , In I woker'n
oI p' .31 . p 'd d f h, Scanlon 3700 of the'L h Godes for the , t
erformahce of the weak fwhich th is pr tissued.
. t"
❑I h' J will met Worker:,C np at I ' d by gel '
3700 f theLabor CCttoa fSSth pe fe ret f the- k rw'whichthis found n r
isauerh Ekinsurance carrier R1111CON OP EKEMPTI R and
Piducy number am e
Nh RKLRS /' r ,
a
COMPENSATION INSURANCE
(Th.we huh and me he completed f thePr mit is fit e hundred della,, 1 '
($100) .)
1 rrfsilent'I thep f flh kf 1"h J' profit s,aed,l "i'0. 0 \w 1
shall eat call at y P Y as m Miran,subject to the Wdrkcrs
Compensation Laws of Gd r rn a [)am -
Applicant
N<TnCETOAPPLICANI If Itmakingth,C ff fL pr y should- - -
z "become subject it)theta k Confirmation p fth'L b Code y..nu.t '
O O fonhw th ca.ply w'lli ch Por ion,ar thisp it shall bra the l nevekeds
FFF7F777 y CONSTRUCTION LENDING AGENCY 1 } : t " r 1 .
l nerea,affirm lh l them' t I' o radia,'agency for the Parti,na
of thworkrwhichln parent sissued(S c 3097Civ.C)
Lend .Name - • e i
Lend Aid : f y A
' V 0 Ireally(hat l h' mail his implicationods fe that b f 01 s " ♦ •h
'pr
correct.I t gree h co oply with all city and c ty'occurate,mW a hn law,rel t ng "
C.) mbulldirliemstruction,wed herehy uumo,ize mpresantatives of tnikeity wemc,,ma a,.` �.
W meth vem l IP D (yf inspection prp . s ) t
Fy G4 (W)agreet d fy leadk ph I ., theCity. fC per ag. sl - -
r, U) liahil Ig t t d I :: ry'n any Y u o against Laid (^l /lq.[�a
C.7 y City .Qgln¢e of th ,oras ng of O,sr IJ L/ �. .� .f 11 •::M
APPLICA NDERSTOMDS ILLCOMPLYWrlFIALLN N OIM ISSned VVV `.�/
ULATIONS V.
DatC .
sl n �r rDula Re-
torook
,HAZ MATERIALS 1 L RE •„ ^•
\ ILth PDI' t - Mid 6 P Lt t dl austerities n.3terial
as defend by m C p d M unc pal Cod Ch 1 ter 9.12,and theHalm' l Safety' Type Of
Cede Section 25532(a)? 5 ? ^r
❑r CIN All roofs shall be inspected prior to any to
material beingmtitalled.
wIltheappi ' future`n Ia' gner l ewnp t rJ ,who Ifo•roofisinstalled without firstobtainin -anins inspection, agree toremove
chat hasa%au, wn .n.as refund by the Bay Area Air Quality Management g. P
Dialaefr. _ •f - all hew materials•for inspection. Applicant understands and will comply with '
El yes Elseall non-point souree'regulations.•
/ 1 hate d, the d menu al q ams and Ch pt e e d the
California Heath ffi Salet}C e,Sector. lit1fli t itis oar 25534 I it d o d that
if t bt n Joen not Haim yhove le ttat'ti Iay,isups.of afiatCy the
' pa of tl e requ ianw tc vetch m b vl p or td'snuance of u n,core of
nay. -+ Signature of Applicant ,..Date ,
O r,nnendag Dae, All roof coverings,Ito bet Class"B" or better
OFFICE
' _ .. _ .. suss _ r.. - -' .... - . . � •