00090178 CITY OF.CUPERTINO " - - -
ButLDtNCDIVISIIN' , PERMIT CONTRACTORINFORMATION: •-
BUILDING ADDRESS: P12RMI'INO.
.��.r/I ' nPPUCATION SUR DkFE
OW,ER's NAM[: ., 1 v-M�-Y ,
' 4"i3i Air 'non-
1 v II Iii 'I_aNDscaraE 00090 78
'HON& _- - , r SANITARY NO. Co T, Rol.NO.
19977, BENEDICT LN' 09/28/2000.
'-O Z ARCHITECUIiNGINEER: ,
BUILDING PERMIT'INFO'
- , BLDG - ELECT PLUMB _ MECH
LICENSED CON TRACTOR'S DECLARATION
z mm'1a 1 an Iiron.e,t ammo Tcha t 9 rammene;I' Job Description
I hereby .
Z_Q Y n Pmvixinnx h p cr ..
F_F'a ..ams«dan nNgk,rniasien3anne Ba,ioessandpm&ssiens Cade.and lar Bancea .
,i f pf Ad cff[a � -
d z z a i,in
a Lie
se
3 a F Dm - • ca -
ARCIIII'N. r' ECLARAIION • t
t=°5 n:m ma. an UNDRGRND RECEPTACLE '
55w
caused Probes,
OW NF1 ILUFR DECLARATION
thereby
u7 1 thereby aro an that I e PI In th C i t 1 L t for me
t-z� foll y r (5 ).7158 ' JI f:. cd Any ry aunty
f r2 O h h q pe m u c .IN p pn J I'.I P y t Imre
i3pr, t t e d. re I. Ib role nr chpermu 1, y d.n mmemfail he tP II d p h C I Laov(Ch.plar S({. Ft. Floor Area - •' Valuation
tea nnearing inSection)Wld of Di,- J i Businessdl [ oda) -
e, mle .ux.„1uh I o db tribe alleged .
Ir Any udon
nun
ofW Sect nn)dl l s ny a y ol+Plican'f m a pit mniem.the uppl Coco n,,<i\il penalty
coon mare n'an can nmmrM dhnar.16500t, .APN Number � Occupancy Type
.
P Y YP
'M 1,as owner(if the r ern, eminees with woe,as their.sole corn .inion, -
7
pap y or n'Y P Y e pen
s ¢+ s will na Iha work,and In,ode: Du C ntr Contractor's
ul nr bl'ILwv I'm alfa(Seeappy 1.an ,.
Ba, IertyWhonncMn meconn n -1 - 'l.awdocsnetapply' n Requlred7nspechims ' •< _
' of property Who hl'Id,n- npmn. x,tu and hn thou a.h ti te h1a)WIF
or
l through his own em Ih '.fi Wid[d II,,inch,a maen'wi bre not intended year or --ss
B P L V p .'r�t4:]F1ft'I� 2. ���'
ofl'afnd Ian hale.,,..w de the l have
the
burden
env Ix sold within one geld of
om lotion the mvner huilder will hme the nurden of+rano•aha he did not build or
I 6
+ J
innnpne for pa'pose er xam.t • . - -
❑Lasowneronhe ru•rt,andexclaskel tunneactm with 304 - ROUGH, ELECTRICRL
property, y e ..
_
a., mu the prolal c. ,.)I 4.Bn,Imxx and I rmesx'hns,cedn.I Tea cammmnr•s 50 1, . F I MAI_ ELECTRICAL ENERGY
License Law Jocs nm apply m an owner of property who Wildfire inipnncs thereon. _ -
and tl'o a mraoti lot ,a pn Il a,emmetorcxl ensed'pr,,tu I fo R,e _ - 505 - FINAL IELECTRICAL .
Cnmmcior I.i ease Law +/JI -
❑lnme np Inder S . ! •tt YCti,r lhisreu -
Owne aI l`/
WORKER ATION
1 he. y aftuan under penally of perjury one of the Iullowiny d,elnur"Irs: ,
J I have net will maintain a Cmifcale A Conwat n,Shlf-insure for Wnrktu x - _ -
Compcosation, as provided fai by Section t)W of the Lahor CMC, for the -
performunaurlh—...k forwhich lhixpcnnh,,issnal. s :
•Olh nd i111uiminW All'In
by Set)Wto bCM k. tl p r 1 s �sa d � IrsC t ond of y mbcrore. �t ATI( O 'IiGM WORKCR4IRANCIi
' h' . n ncd tl anlplenJ'fd' P 'I Ix I'nn„c hundred Aollnc. _ u - . , �' ,
I c[n fy tt pe mance oft rk f 'h ch thispermit-.WI
hml 'nt enp 'vion if
y e s hl II vh ,
W,,,kk .
' Co R Sall I N C I'
Appl t n _
NOTICE IAP 1. 'A 1 a 11 mak' ''C Can, Pf > shield
� Oh aomesuh,M1mnd, sans of the Labor Code ynamuel
limhailh avnpl sm.orlh prmil nhal(Mdee Wed revhkeJ -
ti
E-• � CUNS'I ItUC'1'ION LENDING AGENCY 5 -
a I herchy winch Ink Where is n eon..i cern lending agemy for the performance
W of the wad for which Ihix permit h issu[d fScc.}IM1),Civ.C.I - a -
Q Lender's Nmne
Lender's AJArnn
V_0 I certify that 1 Leve read this applicatim'and state that the above infonnmioo is N y ••
come(.I agree to comply with di'cily and cmmty ordinances and slate laws relating -
O U -tib ld 6c t dh by authorizep m n Inh' cryo n pun
-Ihc libIwe-nuhnintedproperty I,,,in,lectrollpurp • . .
L., d
Ohe)agree to save,indeannify andkeep l '.deCny ofC peN banst
Lfn Imb t: W nxl yIn' Iny y,. i ny 1'n,aid -
U Z City di sn enceof' rani "pem �.+ �/ O�- �•t
APPLI 'NT DER. AND WILL 1 WITHAL -POINT Issued bOe, /"�' Date
SOU CI R 'L S. ' Y'
Si namreol Applien mto Jwe Re-roofs
HA7. ., SCLOSURE
Willi nlhrinwremlilln�rxrol4aat.mmerhandh,bma'doe.InalcnalType of Roof . .
a'-derma the Cupcnino Municipal CMe:Chapter 9,12,and the Health and Safety - - y
Code,Senien25532002 , i /' - g
�Yf4 41/1 - All roofs shall be inspected prior to any roofing material being installed.
Will aper[amh.'future naueiagapatd use egmpmaon or device,which ` If a roof is installed without first obtaining an inspection, I agree to remove•
'i,h,,odnuxnrconuuninantsasdetl M hy,the Bay Area Air Qunlit Mnnagemem
'h,riett - all w ction. Applicant understands and will comply with .
°Yc" al Aiv ti S. ,
I h' 1 th d d' . nom al. req nt v under Chapter fi 95 of the s
C'ah it hh dos IyC 1 5 t s 25505.25533 d2551d d .tanII
if theholdingd inch mlyh m thou . yrcgn.bltyt notify the
sup, t of the cyuire env.wh I net pr'or , 111race of a Ccniftaac of
occu icy. Sig ature of - `- D aile
' AI root'coverin s to be Class "B" or better
rl�i neo r mnnd.e asem — Data g .
t