00120073 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS' PERMIT NO.
10240 BUBB- RD •00120177~
OWNER'S NAME: ' ' APPLICATION SU&DATE
DE ANZA ENTERPRISES � '��� 1.2/12:/'?_000,
HONE: • NITARY NO. CON]SOL NO.
Sia
D K Z ARCHITECT/ENGINEER: " - - - - BUILDING PERMIT INTO `
- - ELECT„ - PLUMB,y MECH
Z 1 nearby E.ICFNSED CONTRACTOR'S DECLARATat I am licensed under provisions of ION
pl 9(commencing
lob�escrl ion
,z�Er wms r 9a1n1 ririnot sanneea sawlmles.rrICod,rural,
license REPLACE BEAMS -',.�- . .or
.
sG Ill[ and•lea ('y
gg,4 sc is nscChss_ Ieq /
u7 3 a o me�p Contuu or -
" Pelf TF:Cf'S DFCI ARA] I
I 1 n 1 ypl : h llheatel a,mbliereculd, + .
'z of
aCp�O
Licensed Pf.. al
F.= OWNER BUILDER DECLARATION
u�lto I hereby affirm that I n asempt from the C I I 1 far the
3< ,f.h g (S i 901150 JP f.� Cw:An, ty numy P
�O -wac
l l :ap rinit loorratio,alle, P ed Ish r Pa y:l.slam
n3� prion t issuance.al 1 :theapplicant f h p 'tt fl s d.t lament
matolicensedp : II the prov,ions alln Conrmct Licalise Law(Chapter9 Sq.�F[. Floor Area - Va tiign
rca t s ll Section 9wm rD' 3 fin R 1P r Cartel _ '.G,wi'w700 -
or e I ha n,slump,Ih mt n J m h [ (he e ..........Anyviolation
of Section 70315 by city'ppl' l for a Istrimit. bd t. the applicantcivil actually -
arnelmorem n ilia hundredn u ($la) `APN Number, - (&upancy,Type "
111,atmencruffireirrohnery,r my employees with wages as the ,bwmpemoti n,' `.:+5720022. 00 J • -
w e e e k a me tantrums s o I pleadedor ollarini for a (Sce,911x L. - Required Inspections
Bu. d Professions code The Cont t . LiI does t apply t n - -
rp wiry Wmbnmsarmprosam d 1 dc :rm a flauself t
— FOUNDATIOhI '
orthrougl his own employees,prodded m,t such mpmve owns nee nm(mended or 1sD1 - n -
arfered lar sale.If,however.the molding arhainwa ncm is sold within one year of 1 0 F'I ERS -
oomlplinion, c„woes-naedarwel nave thebarecnofprovm,elm braid notbaodor '1-
ram,eforparfuseaream.). -• :1,2T1s, _..•UFpER '
°1 f[he P pets- I .i ly n ry In licensed 104' _. RE,FSAR
,. construct the project sea,9044.Basis I Pmfe....ns C>ved The Commwnr x -
l Law does not applrlo an owncrofproperty who bunds or improves thereon: - - 1,05 — ANCHOR BOLTS - r
and ncontracts r n projects with a co ermtorbsl r :d p tm I the: - . -
ola.twn",gLicense
erls� H�Pcrm lois rc„o, 1.06 SEWER N._ WATER " ^
Owmar - Dam ' - 202 -•UNDFRFL�OOR, PLUMB 1146 "
WORKER'S COMPF.NSAI'ION DECLARATION 20? - UNDERFLOOR MECFIAIsIICAI_
ii;romy alrt,n coder really of perjury one of following demarminm.: •204• UNDERFLOOR FRAME
_73700
1 nave and will maintain n Cembeme at Call Ila,cls-ins mfor Wm ea;s' x265 UNDERFLOOR IhISULATI ON
mp t pr isd lar by sat 3700 "1 me Labor,C«m,-for lar 01 —' ROUGH PLUMBING'
,�. Rftle wok l' Much this it is'issued. .w
n e '11 m.; I-Iw k c'-iinr I . q ' cess ran 302 — TUB 8; OR, SI-'IOWF_R
My L l rad il l p r, a e nn k i n 1 n . �, n is 30� ROUGH MECHANICALas
ca.Mywrrkmse nlpen t i,n b,:arwee rr cr dna Prrny fon roar are _ u .� -lee� Polmy No.: T' a'�1_L �s04 ,- ROU(31-1 ELECTRICAI- .
C RTIFICA'r10N OF 19XBMPHON >ROMWORKERS' • n _
COMPENSATION INSURANCE •x'305 — FRAME.
3OEs — 'HOLDOWNS
ernes section need not be comploaIr nIc panne i,future nandrwl do Be'
islra9 ail less.) 34J7 INSULATION'
I reall'yalarm the perfomnane.:of the work for which this permit lsm,mai - .~308 — SHEETROC:1<
saill not employ any person in any manner so as m beconla.subject to the Workers' ,
Cvmpcnsaenn laws,)]Canrnrnin Doe _ + 309. ' EXTERIOR LATH
Applicant
NOTICETOAPPLICANI If R k. 6th Certificate fP npr y should - 31. e0. — INTF_RIOR LATH -'
bac to'abject the Worker,C pe I p offs,Labor Cor y wet
`C C mellow all comply with suchprovisions trthperantshwlbe deemedravokee 31 1• — ,SCRATCH COAT
V7 CONSTRUCT10NLENDINGAGENCY" ?13 '— ROOF NAII'
' r F' I hereny an r n e t d mraafan tering+genes forme perrrrma�cc , .• •' �. • t
ofthe work for wbebms pemi�is issued(Sec309yC'ee) 501. — FINAL ELECTRICAL ENERGY
(� Leaders Name
Z Leaic,'sAddre.ss 50th' FINAI.. -PLUMBING, ENERGY '
v 4 nlyunit hn m ed this application estatethan b m r is 503 — FINAL'• MECHANICAL; 'ENERGY,
correct.I pow to comply wilt Bty'nl totally e m,I l Pr , -
" O p loh-la gaonstmeranaadhe�,yunit., p .vnmt9esnlmsctytoemeture. - -504- — FINAL_ BI I_.DIN,G ENERGY '.
r� the obova....railroad property for.inspection po,swes.
a,- rw> gm ,a keepAdtaintless the City rCupertino against 505INAL'E _CTP,ICAL
m Bah Ipull�a I d p uses w n any Ia any y recruit ago nst said - �:
Q Ciry n rnmgl once of he gr tI ` fth.s porn t. u - 6 "f l - - '
it .CANT INDER TA )5 ND WILL COMPLY WITH ALL NON-POINT l
RCER7 n INS, Issued by: t Date.
�a� }2—,19_— oa
~Codon of Amit... oma. Re-roofs ' t is' � '-URI—
Wilt -
HAZARDOUS MATERIALS DISCLOSURE _ -'
me.Ipp1 m r future milmorg . t, mor handle armadmo namoni - .Ty'pe of Roof• ' 9 -. FINAL -GRADE
its definedby me Cape t M "pm CmJ CI apt -a 12,a td me Beahh a,d Snmty - - _ -
Code Station 25532(')? L 10 FII\IAI, PI ANNING.
°Yes.- 11 No
All roofs shall] ectd"d Belifts Pt6dto
p f FNylhMoliftg dnf2Ebeing'installed.
Will theirplic, I or future l 'wog lent v n t or-dr,wa,wn cli If a'roof is installed without first obtainingan inspection, I a gree to remove
emit hazardous s v r contaminants as call by the Bay Arca A.,Quality Management P g ,District all new materials for,inspection. Applicant understands.and will coniply with
°Yes 1:1 No all non-point source regulations.
I L d'hattenuation,minerals y 'rem I. n I CI pt .f 15 f the - ..
Calif Recall h S f ty C d S cti no 5505 25593 a d 25514 1 d t d that
flh hu ldinydots to nayhavealannm that. slay responsibility lonmifythe - - y + -
pvm of the byui emem. which mm1 be mm prior m Issuance of it Conocmr of
r _ Signature of Applicant • , Date
(2-12 00 All'roof covenb s to be Class B•' or better'
Own or anhodzea ag Data g
i
OFFICE