00080104 CITY OF CUPERTINOI
BUILDING DIVISION :pERMITCONTRACTOR INFORMATION: "
BUILDING ADDRESS: t PERMIT N(1.
a 41 . .
:110 I.A BRITTANY CT
OWNER'S NAME: - - > APPLICATION SUB DATE
5
_ r -
7A:R: SANI'I'AkY NO, CONTROL NO.
[CT/ENGINEER'. - - r' BUILDING PERMIT INFO '
. , BLDG ELECT" PLUMB MECH
LICENSED CONTRACTORS DECLARATION
oIn hr n d rl :d d p fen P, 9(cnnearna Job Descriptionor or
ibS , 7000) fD Iof,heBr dP fa :Ede anlny lcexe
rl �rc
!1 force d9i s n„ c R , BATH' REMODEL
RCHITECTS DFCI ARI d d d ny pia -,h ll be used :vt....too ds' ..
so
au q Coen Iv r.'
OWNER BUILDER DECLARATION
I h by ff II 1 1 p,l ,h Contractor's l I 1 f II a
Q
following
. (S 7031,5,H :' I P .Coal A 5 not,
❑ wn h p,tr.ap rptl c 1 ', h p d Lh P r an,Ft 'I
da purl a 'su r I q dapplicant1 hp tin fl g Lt, ,
mato I tip tt thep Id c t t r 1 I (Chapter 9 - Sq. Ft Floor Area(con - 'f. Valua n�
or ngw,b Section 9000)land tetue,siou 4nflna Busin1,,td por.Air,
d Pact fm"C de) ..
or that he is excm,,bit,u,n m.nd the nods snob"nue ed oxum ,Ion.Nr vii rena6n - .,
P s
ter
of Section 7031.5 licam fore icon Crls leen lip nrtnn ervil
nota,team d�anR�n�are°a dauam(ssan.� ' Pr -� pwiahy APN•Number Occupancy `
P Y pe
O L."owner of the prope„y,or my employees with wase.as inei''sole co 4ene'atlon. . .
will do the work,and,he structure is not intended or EHeced,fopsale(Sec.7814, _r -
Business and Pmfcxnions Coca c .The Ca6lracmr x,License
and w Law assn not apply to an equired Inspections
owner of property Who builds or improves Inereo hand who does are
work himself '
or th fh sa days,the
pr anal I,, such r ted I, ,: ,I be year ar
On"Ishar sale.If, w naldngermnrav .... "sola w'in'd be year or 101` FQUNDATIQN-
omplu,ifar thaowo.174tlirwHl nave lnennMun of proving dml heard not nnHd of ,102 PIERS . • , '
crrp Put I c
❑I of,ho prolx lY nor"cla,istly coubbific'eilth lmamw contractors to 103 — UFER'' x .
Lons,n et,he pN cs((See 9044,Husi,to,and Prof...ors Coda)The Cnnrwors
icense Law doe notapply lo an owner of property was builds or innoves thereon, "r 1.04 —' REBAR. _. . l-
and whit ranlorla fn,stah prpi s withg currents(s) heensed pnrsand are' 1.05. — ANCHOR BOLTS
Ca faconf,Liberia,Law, -
❑1at.exemjntrader.Se.' B&PCbethis reason 10F, — :SEWER-'&� WATER. .
Owner I Dam` 202 '— UNDERFLOOR PLUMBING. -
' WORKER'S COMPENSATION DECLARATION
I hereby arHrtd trnderpdanityafperjar arta anon rauawmg dealaratims' 203 — UNDERFLOOR MECHANICAL,
1 naw fr will Innlnlain a eaten o,a or Consent ,n neer-insure for Worker'. 204 — UNDERFLOOR FRAHE '`
anrpansadan. ax Pr.,Led faF.hy Section 370" or the Labor Cann, for the ; ' 205..- .I_IND'ERFL_OOR 'INSULATION'
pail n c f Ih wo'k f h 1 thio pe t ul. _ -
❑Itr and nrnamt H k scoop f I :ananr gtmnysa6nn 30.1 — ROUGH ' PLUMBING •` -
3nu)- ar Labor Code,r m.pert rte wrtHr 1 this pe„ 'lL , 302' — TUB 9-r,OR SHOWER
i"wed.Mr Worker' eampenxadan ln,xnraone barrier and Pouey number aro. 30.7.r — ROUGH MECHANICAL _
co,aier� RTIFICATIIN OF EXEMPIONFRO WwRkek�� 304 — RODUH ELECTRICAL_
COMPENSATION INSURANCE ''
- r 305- FRAME
(Thissecllon need not b cumplelw if the penult ii for and hundred dollars-
. (sI )arlexx.r 30F '— 'HOLDQWNS .
1 certify that un'he pedonnance of the wore for whirr this pe„nit is�ixsned.I '. 307 — INSULATION
shall not employ any wr,un id any Inanne,r.a”lo become subject,b,hoWarkard "` — '
Conipeasaden La"of Carmmin,Date - -"I ,'08 SHEET RACK
Applicanr
NOTICE TO APPLICAN 1.It.after facking this Ctudificed,of Execiption,you should 309 '= EXTERIOR LATH
m
becane bjecl to theWorks,',C .,p ran,woronifth Ln rCode you aril D ' x a
O C ht„nwthsturdywnn. I p,t,ckorth-",mtshelfbese nw.reyaked: 31.0 — INTERIOR LATH - .
H 4 CONSTRUCTION LENDING AGENCY - 31.1 — SCRATCH COAT a - ••
a In nyammthat th sltuctorleading agio yrrame�off rnmrd — ROOF NAIL
w of the k f hich tl p boart ped(Sec.7097,Cor C.) 31."' b' -
.4 `p Leader'sNatuawI 501 — FINAL- ELECTRICAL ENERGY' ', .
� z Lenl Add
0 nvthnn din ppr , nand:mlethtthb 502 — FINAL PLI_IMBING ENERGY
'w E a,rr dl steel Ply toll ,,ado ty d d ,at lawsrelic g .503 — FINAL' MECHANICAL'.ENERGY•-•
C V
SS,orOgbUmR'tISCbanE g Rr E,GfUt , NSdl l i rby /,I
he 46 ,r tiTracer,f J p p l i a'f,,rhj./crymcnmrupon
504.
`F'IhA_ BUILDING 'E�
NER
GYy (w)ag t1 pe edue, ctof g a"t
liabilities, d!, n t d expenses which uyJatanle>'notice
City ...... 505 — RINAL ELECTRICAL
APPLICANT UNDER DS DWIL LY WITH ALL yyON [[INT -506 — GAS TESfSSUedbr Date ..
!IA <�
I
+
_.
FINAL
Dam, Re rOOfS- a PE
:
HAZARDOUS MAI LRIAL DISCI OSURF - 508 — 'FINAL MECF-IANICAI .
WIB the applicant future building' ' µpant stare a handle n�a d -nincr'al Type of Roof '
deeded by the Cnperma Mt cO,r l C..de Chapter 9.12.and he Health add Safety 509 — FINAL -GRADE
Code,Section 25532(N ( ) • _
oY °N - .All roofs shall ;613{ pecteHARtU P%ff8 Pat'erial being Installed. '
Will ppbit r m' s p l xe ept 1 nl as me wman Ila roof is ins[a�1l�dtwithoit 66t�t l -ani nsKW� I agree
` to remove
n mI ,
emit hi, dousar contain heads asder ted by the Bay Area Air Quality Meragenen,
trirlr all new materials,fo¢inspection. Applicant understands and will comply with
'Oyes El No °
�,� � � all non-point source regulations:
I have mad the be;udous mnieri.ls abirimnranis'under Chuprer 6,95 i f Ine
California Heal n&&for,Cade,Senions255O5,'25533 and 25534.I undferment!Wm
ftire h 'II ,due,a , accallyl eacan ultnl , yresp bltYl entry the
ea
, f 4yJy , I- 1 P 1.issuance f Indicate I ,
been �///}" Signature of Applicant ” -Date
t ( Mr s 9
aathar,..w ag - - ata a - All roof,coverings to be Class B"or better
', ' OFFICE" ..