00020194 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: '
RUILDINGIgPB48 BRET PERMITNIZ100201.94
10 /l/eh<A%7C4- I'�VNOD�
owNrR'SI3UNES /033 % APPUCA110a)IIE1yy2000
.ONE: SANITARY NO. CONTROL NO,
0-7. ARCIII DICLIENGINEER: ItI,DG ELECTING PLUMHIRMI r INFO h1I!CU
°c ' as7- 7753 - -
�Z LICENSED made, okio,of Chard Job Description
oz 0 11 g nrnrhe,l .[them u p :sun: vla,Ccer9tS�,mneeing ADDITION/REMODEL
Fw 'ith5 I ]land ,fU cotton- 3 Rhe Ru JP r.'ms Gxlc and myl cense
zY :'mfall r defR ,
C z 6 lit Cla:. L tr
x t'F [)are Contractorr
G 'ARCfrITECTse DECLARATION
� 1 understand my plant.hall he used a,Public mttnds
read
5 x 0 0 Liccascd professional OWNER- O
ad o�y
OWNER-BUILDER DECLARATION
I hereby liffinn that 1 an,e,empt from the Contmaor'z Limns,Low for the ,
l.'= .allowing meow.(Section 7031.5.Businessland Prou,,k)s Chile:Any city car coonly
I t� which requires a permit In conswel,altar.improve.demolish.Lir repair any.arvelure
a 3
poi it - L q :tM1 ppli t
l fm C r I 'lCh ler9 S F[. Floor Area
aro ,n e u w d,See, 70an of D'n.....a 1, the luo ,e aid pmrc„oar code! q'
or that he is exempt morefon,and the hurt,Ra lM1c tJlegcJ s......lion.Any violation
olSection 7031.5 by tiny al,ficanl for a..hoop wbN,l,the tmpiicmn to a civil penalty -
orpt,tmorethan live bandreddollars(s500) APNNumber Occupancy Type .
°1,a owner ot'the pru,drt,we aty employee,wan wages,as dicirxole ton,ptnmunn.
will Ao the work,and the swaurc Is not intended or uttered for silt,(Sec.9(141,
Business and 1'mfcsiore Code:The Contractor's License Law does not apply low - Required Inspections
ow of prnpcny Who builds or improves thercen,and who does such work hin elf _ a
or through his own employee,.provided mm such improvements are not intended or 3751 @035. 00
offered for sale.If.however,the building or improvement is sold within one year of r^ ,
completion.the owner-builder will have the burden of proving that he did not build or
impro,e for pl oo,of-10. fffJ''
01.as owner ohne protery,am exclusively contracting with licensed conalwatr,to . 101 - FOUNDATION
Li,n,wc,the..mite,(see 7014.Bosom,,and Pmre..ion,Coale)The contmemr, _ - 102 — PIERS
cense Law does not appyto an owner or property who build.,or impmoes thereon.
n1.03 — LIFER
ad who comms for such projects with a contmmons)Ecen,ed pursuant to the
1at,,exemn,;uan,elaw.
C104 — REBAR
l anlpt,mdm Set. .RxPcfnr this reason
owne, Date ' 105 ANCHOR BOLTS
WoBKBR'SCOMPENSRru>Nu[CLARATQ)N 10E — SEWER 8• WATER
lncrcny mrn,„under penaly of penitny one acme Bdmwmg declarations: r. 202 — UNDERFLOORS F'1_I_IMBING
J I have and will maintain a Cenilicate of Cunxcnt to self-insure for Worker's
Compensation, as provided for by Section 1700 or the LaM,r Code. for me 203 — UNDERFLOOR MECHANICAL
penormwa of,he work for which thk p.to is i...ed,
204 — UNDERFLOOR FRAME
°I have and will maintain for
�om ance,of teworInsurance.as required by Section
17w of me laM,r code,r°r me performance,nr the work sur umth this permit i, 205 — UNDERFLOOR INSULATION
i'lond.m Woam
rker',Compemaon ,win.emorr randPolicynumberme: - 301 — ROUGH PLUMBING
Commit, JZ.TL C Mainly No, /SG� =Q� 302 TUB R OR SHOWER
C17RTIFICATIO OF EXEMPTION FROM WO K v S'
COMPENSATIONINSURANCE - 303' — ROUGH MECHANICAL
(Thi,,ectionnemnotbeemoniillnepermitisforon,hundredaonar” 304 — ROUGH ELECTRICAL
($10porlts.) - _
I really that is the saf.r mwve ol'the w°,k fit,wH0,this permit',i,c,..tE.1 305 — FRAME
span nAl not„toy y..than int any mann. ,,,a,m htaAt„a,onieet m me worked 306 — HOLDOWNS
cottgwo,atiw 1.a ca.ro�� to _ _
, TO .I.A ng this cntficom nl'2xcmptinn.you should
307 — INSULATION
N(to'
beeumt,obi«tmmewAnker:co pt ,mn,npm,nmm,onntl.a orG e.yoam", 30B — SHEETROCK
O li,rthwim mtnply with such pmvizions°.,his permit,M1all be Jenned revukeJ.
CONSTRUCTION LENDING AGENCY
309 — EXTERIOR LATH
I hereby minden there is a[omuurim lending agency for the pedurmence 310 — INTERIOR LATH _
iafire work for which Ni,permit is issued(See,3097.Civ.C.)o Lender,Name 31 ] — SCRATCH COAT
Lent Address
C.7 0 1 cenify that 1 have read(his application and stomach.,the omove inform"tion is 313 — ROOF NAIL .. _
F•t sono.I agree n,olimply with all city and county ordinances and hat,law,relwng 501 FINAL ELECTRICAL ENERGY
(,
to building con,loaclion.and hereby authorize represn,mtivex if(his city to enter upon
y w areabuoc.,mcutionedpmpanrrmin,p«dm,purnow'. @2 — FINAL PLUMBING ENERGY.
j.. Pr (Wt)ngrec to,eve, ndnnnify and keep hannlcx,the Chynf pe
Caninn against
a .ahTdn,i..Jgnornt',<"'N amt expen—which"In,in tiny way acerae again,,aid 03 — FINAL MECHANICAL ENERGY
U .Z+ City in aro 't,m ncu 0 the granting or this..choir. a
APpl,,r N'1'UNDERST DS .LCOMy1 YWrnl ALLNON-PowT 04 — FINAL BUILDING ENgnPY(P'VI 0 AL -t
OUI ULATI / —� (SSU
Simadium, ntAppl¢aHAZARDOUS MATERIALS DISCLOSURE R -rOOts 5@�� — GAS TEST
Will the applicant or furore building occupant sore or handle h"eardos.memdal ype of Root07 — FINAL PLUMBING
a.,defined by the Cupvnino Municipal Code.Chapter 9.12.and the Health and Safety
Coot Section 25512(x)? � -
0Ye, ON. ' „� 8. _P F�If},�IAyL MECHA r �1 € '
\ All roofs sh ms a otrt't Yoo[r[R�f}avl{ o tit a1-terial bei.. installed.
Will the applicant or future building Acceptant use equipment m decide,which If a roof is in.t. d wit I o'TH1((iiG�ilhhii an inspection, I agree to remove
nit harmonious air conwmioams as define by the Bay Arca Air Quality Management �t 17L. r—T hlDl =101
jl p
i,ri[t? all new metes 0i In. 292. AYrt7•p t�,� �I� .stands and will comply with
❑Yt, °"° all non-point5di4ce-TI, UBLIC WORKS p y
I have read the mentsmue notarial,requirements under Chapter 695 of the
California lleullh k Safety Gale.Seclions 25505,25531 and 2551ar.1 underhand lh.,
ife bullolnydocshitcuncmly havo o"benthe itis my nancei of
enoefy the
ice tpunt nl the rmluircmenu, h hitt,be amt pan w isxuunec of a ten Bieatc to - - v
d2,9
Signature of Applicant 'Date
n ,e ast,tembod (L Data All roof coverings to be Class "B" or better
OFFICE
i
CITY
BUILDING
G DPERTON' PERMIT CONTRACTOR INFORMATION:
13UILfb(53s UINtESHRET PERMMIITT NO. 00020194
D'NaPF 00020194
OWNJONB S- APPY LTj 2 Y/ L U O Q
HE SANITARY N0. CONTROL NO,
P»C O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m_ BLDG ELECT PLUMB NECH
z
LICENSED CONTRACT'OR'S DECLARATION m z I hereh firm that I am licensed under f Chu 9(commencin Description
;z"a rat vmuPromo per s ADDITION�REMOII
sc with Section of Division Sof the Business and Profusions Code.and my license
[m f=