01030011 1 CITY OF CUPERTINO
- BUILDING DIVISION. PERMITGONTR9CTOR IN ORMATIOO N .
r BUILIIING ADDRESS: a • ' PERMIT NO. �r
ALVES DR . BCRCH CONSTRUCTION COMPANY01.030011.
-
APPLICATION SUB DATE
OWNER'S NAME
A SOC OF -'1650LAFAYETTE ST 110
a3/a�l�aa7'
PHONE.. . f' ;, SANITARY NO. CONIROLNO.
BUILDING INFO '
�0 0 ARCHITECT/CNCINI BR - -� - , BLDG El ECT PLUMB MECIi '
dP on rile �[ iec+s .r
Z S?3 LICENSED CONTRACTOI S DI CLARAd ION - a 'd'- - lob Description- -
11 by d m Guy I licensed d p f Chapter 9(c n,ma a ng
OZ ad
ads f 9111118�,fr�Ilu� 3 rWeBu dP f,.,ta,Cd dau'licen,
�za Isii ,b„url. enndprj_a .'.'GAS LINE •.
o n u Dale —s•F4�-' f•j— C,nrad
X-.-3u,F„ ARCIII'I'EC'I"S UECLARA
or�' I amluuand my plan,shall be fixed a,public.record, r
t
" p0
Liferowd.P f. blit • RAI ,"
OWNER BUILDER DECI.AION
�i 2 of of 1 Thrifty ,Olin,m n I am exempt Irom he Contractor's License Law far Ne
' 7,Q following (Sect Sous B d Profession,Cwt A r tY many -
F G uh h'e'l apemandt 'I t n rant,mord,de dish, p any structure -
3 p( tt)its issuance,alsoI s the applicant lot such Perini[tfile a signeiri.mlemcm .
lot,be II .ran,t m p 10 c l- l L 1 (Chapter _ Sq. Ft. Floor Area +' Valgation
(co memg th Sehon 9(1001 cf Divi m 3 ofdm B anne,tind Par l e, n,lCode) -
or mit he is exempt Ihershom mid We Is....for the alleged eacandinn:Any violation t
ofSemion 9031.5 by any eppl,rdl for if pem,il subjects the npplienn to n civil penally -
of not mora man Eve hanared dollars($500). APN Number - ' Occupancy,Type
'D1.o,owner'oro
fthe pptnay,orny ampinyees wild wage,as their coleealnpemt:tfn,
will do the work,and lire.truaute is am Minded or offered for sale(Sec.91144,
➢mins,alae Prnredoux Gum:The Cinamedn'e Tro
License.Law does t apply to i n _ Required Inspections'• ,
;w f, , ny Wh bodies v;lir d 1 does scM1 kti If -
r through i' ply p poniard that such p heal intended Ii 10E — SEWER K WATER
offered for If however,the building nnroveneal It within one year of
plerammrawnerbmlderwubase the barde,ofprovingthathedid dru Ido, 2a� - UNDERFLOOR..PLUMBING
-
ilnp fpm f: I.). _ ' _ „?a1 - ROUGH PLUMBING '
❑l a. nr fd, p P lya exclusivelyruminant,g withlicensed t a oto'
onsi an the pn;ect(See 9144.Business and Prod e...tons Ceule.)The Cotlm tors 302. . TUB & OR SHOWER -
License Law does not,apply to no owner or property whn bunds or improve,marelm. ..and who contract for such projects with ICconlraton,) licensed pyr.uant to the 5a2 - F I NAL. PLUMB I NG- ENERGY
-Combac or',Li,faise l-no -
OlanexemptunderS •. B&ICfor hisrea,.n 5a6' -- GAS 'rES•F
On;ner hand 507, - FINAL, PLUMBING
WORKERS COMPENSATION DECLARATION
a'•� pIh ny fE Trp illy Epp 111 f1I i i f
El u J will mdml .0 fl l t 3 I t . It' f Worker's
' lothe •' ,
Co :1 p J ed 1 f r M1y S u 1)00 1 tiro Lubar Code f the , >` ,.
,erforboxcul Dust,
A f inchCn or l J. ,
h J dl ', t W k .0 p l 1 . I dbySection
• .
r.71 fah L! C,J t In p 1 fah k f h' h.m. p mol d.�My�Woorrkerrs C/�pe t Inai r'rund Dfe�y mmheryVkllll\l L I)''Ql)�L Policy hum, r
C[A., �A110N OP EXE NT'IONFROM WDNKC•RS
COMPENSATION INSURANCE
(Thia,eclidn need not h.complemd if it'.mrmil i,far one hundreddollars -
($100)orleseJ ' -
I ce employ
than mine n innrmancc nr the work for which lhj path a issued,1 - - • '
snail nal employ any person in any roll m m become cunjam to the Warkerv.' - h
Campcnsutinn haws oI California.Dmo'mc
Applicant
NOTICE Thin to AN'f:lr.Campo enum ficutly Exempliode, ,ahould
a,( -
t bermobject d W Bl'C p f p -' flh cordo do you muss,
z� Q
forthwith unnply with I p'aviapso tlisperntshall hcd d okcd.
^ V1 CONSTRUCTION LENDING AGENCY„ s' , ` ' • •" _
a ? I It affi-in that 1h di
construction lenng agency for the,performance _ -x•'
W nfth kf wh end pmui, Swed(See 3119"! Cv C) . - ..
Led .Name
� z" .Led .Aids _-
V 0 1 certifylktlbase allh':fl,li nnand-m, that the h...c raffinumbars' - f
W �y
founded.I agree to courtly with all city and county ordinances and slate law s mining / '• •.
-_QO Ian building .t ( and thereby authorizep n'I fah "lyl I upon
me(11 r a&1P' l pn " >
fiC
cGy [6rJj 'gcl dAe Pla ml :IM1 Cny rC pep 'g elJb colase h 1 wy in a y y a e egj,m sTJ
encet1h'p 'l.' "" . . /M _OI DTWILL COMPLY WITH ALL NON POINT Issued by: /Q� /'�"'v���i( G��,.1'' Date. J /
Signs P :in Tintrecmr Date Re-roofs , ..
"
HAZARDOUS MAI(RIALS DISCLOSURE
• ,t `
'll lir 'ppllc t r l nnld'ns ..p' t 1 ,rM1 a1 na�rd sl„atnnal Type'of Roof, `
an
de tied by the Cure u nn Municipal Cn a, Chapter 9.12,and d,Hodlit and Safety
Code Section 55M1 mf - r ; , �. • ',
°Y < All roofs shall be'inspected prior to any roofing material being installed` _
Will the almloind or future hada ng oceupvm use equipment or devices which ['a root is installed without first obtaining an inspection,-I agree to�remove y(
emlth/aN ail,coug rallyn d ed by the Bey A,00 A' Quality M,,ug em
D"hilt?t �� all new'materia or inspection."Applicant'understands'and will comply with
�t ❑Y ❑N' " ullnon-points ur'e'regulations. l
I base read the un7jadourfrmilerfus ruidirearrentsd Chapter 6,95 of the
CalivMiliffiltutfib& etS Code S h 255115 25533'nd 25594 I made i nd that
if hI
'does c11Ym t nlhn t: y Ito 'h ltyto notifythe
c pn the re I ment, hich mist be met prior to ismanne,of',Con t emo fiton -
T SI a re of pphcant Date
oe Demi d ge,l Ram '- All;roof coverings to 6e Class`B" or better-'
OFFICE.,,, —