01020020 CITY OF CUPERTINO
BUILDINo DIVISION PERMIT CONTRACTOR INFORMATION r
BUILDING Ao '21571 COLUMBUS AV RJ,-DOMINICK GEN C NST NO
. '01020020
OWNER'S NAME: '+ _ "t-.. APPLICATION SUB DATE
SHABDErSHEELA ,S AND .'SUi4IL N 1384 CORDILLERAS AVE. 02/06/2001
PHONE: - SANITARY NO. •-CONTROL NO.
4087208154 '
❑O O ARCHITECTiENGINF.ER: - _ BUILDING PERMIT INFO
qt LLD/ ELECT Ilbl ;MFCH
LICENSED CONTRAC FORS DECIARNI]ON '
zs �' In n Ir In 1 r a I n rcl-p, 9( s . .'- JobDescript n
OZ p wid5 f 7000) fD' i, 11,1 B dP f:: 'Cee,meny l' - _
m in Bre a nom, a 2 � TWO BATHROOM 'REMODEL
�$� ver
cu 6 Dm c I..... y .
ARCIII'I I;C N DI CL
if
1 anodesuand yplans hall he d as public records -
. �CO Licensed pf ': I ._ r ..
OWNER BUILDER DECLARATION
db Ih t, ff in,1 anti ,h Coal t sIn Law-frlhr ,
C. < +toll 6 (Section 7011.5,Business red Prof: 'Code Any oneor
County - -
�j
f ❑ wh h t' p u ptI pp p d LIp' nY.r crdm
_ -
Cie It
Cia L Pro , I I. requires theapplicant r f h p a Fitg d:,rmem
3— bid he licensed p I In the provisions of the Contractor's Licou,,L' (CI&plcr9S Ft. Floor AValuation - '
.(c. eng wish Section 700TorDivison3ef,he B,snu .v
,and Pn ft,'ona Code) q' rea
. A Or thinh is nxelnpr'mumnnno and the ba::r m Heged a p,; Any vialnl n. - ,` $1,8000
'orSection 7031.5 by my applicant for aP t' te ta,heappl' „ ledponally
n - -
..I of our, nlm
re,hanfivehnreadonor_"($500).' - L APNNumber, Occupancy Type'.
°'1.in on aer of the prolwny,«,ny em,Inyw with wages as Ihcir mde cou pensa,bp. 35E18027. 00
x'11 do the k d the n...nue is ad intended ,,Circled for safe(S c 7044 - - - r
Business and Proessious Coal The Contractor's I L does apply it) an Required Inspections
ox fp 1 ,y Wh buil - p 'll J h d such kh'msclf '-
r n a,h his own e ppl r e,nmvieed(bt ,hr i nyrove nem.are net intended o 101 — FOUNDATION.
offered for sale If,ho ,he building 'p ,=m is withinme year of -
nnplUnnmeownerhildrwnlhave,hna fpnvmgdust h 'adnmpudaor, - 102 PIERS _ • .
np t p p. ,1:a1 ) 103 UFER'- .. -
- Ella- the property, 1 ively countructinguillbt I couposevor,no, 104 REBRR. -
emutrum,he,area(See 7044.8,s',cs,and Profe a nun Code I the C,mmc,or f= ,. •. - -
Lite pseLaw rise,out apply,oaituwrierof properly whoaides orireproves'rhere°I'' 105 '—, ANCHOR,'BOLTS -' .
and who con,racln for such projects who a euarme,nrca)ranrea'parnnan,ro tiro • BOLTS. '
DI a'crnrsl.iuu under SIC.
106' - SEWER ' K WATER
°lamtor'sLicnaersec. - ,B&PCrnrthis re: '
0,, t, Dare' .202 — UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARATION 203 'UNDERFLOOR MECHANICAL.
I hereby affirm under penalty of actuary one of the following d,clauft rs: 204 — UNDERFLOOR
FRAME
El 1 have spa wiu n,amlunr a ceeifiame it Consent to aelr-iw,nre fir Works , 205 UNDERFLOOR INSULATION'
Courponso,wir as provided for by S,niou 1700 of the Labor Code, for are
unharinearce ofthewnrkfar wInch it,pe r shut. 301, —. ROUGHPLUMBING s ,
°Ihave 1 will a apain W�d'keis Cion,co,cane I p1 Ibys ui302 '— TUB,. R •QR. SHOWER .
57ID Labor the1 1 n for
ocobewnrk1' 11h'p ll n' is 303 _ ROUGH-MECHANICAL '
isxnCd.M My Weiser,Co ",- u n
Isncecnrr era,d policy
hrnx'
rnR r: Pnre,No. 304 - ROUGH .ELECTRICAL..' .
CERTIPICAPION OF EXEMPTION I RONI WORKERS'
COMPENSATION INSURANCE 305 — FRAMES �, )
(This c0rnnreednrnheeoraderedithepconitisporos,hundredanuars 306 'HOLDOWNS
rsiB las) `.3�0�f,7 -- ,INSULATION
-I Tfythe,intl pert m' rIcwar kfoIwhich(his period isi tied. - ,�08' SHEET.ROCN'
shall not� mil y any person y n as ne 1 I, Ih \Y kers' ..+ 5
Apyr :r' ,yi.>\.i ° Dm - ` . - _ 309 - "EXTERIOR LATH
Onctlt05�1 (NT H rn k' Lrn ,r re rF 310 — TNTERIOR LATH
z licca subject the W k 'C p ad ,howki ,fth Lab pCode yy hnundt _
0 .gym mentod,eyr,n ovs ,,a,l
hp' ni pr,;InhoBnclenmr...acd
1 . l -, . .311 SCRATCH COAT, -" -
CONSI'RUCTIONLENDINGAGHNCY '''.' _
F 3 Ihomny aH na d m lonelier
leading ng ager >barite,Ic;farmanec 313 ROOF NAIL'
w > ]a cukfor which m porous sued(s 3097,Cor C) 501 r FINAL ELECTRICAL ENERGY
a,'Q .I it,,',Name
U o Lendsea . 502 - FINAL PLUMBLNG 'ENERGY .
1 fee tocom 1d': gyred an,] late(bar d I f wl s 503 FINAL' MECHANICAL ENERGY
W Fy corm 1ngmamwnplY with dCHI..city andCranny nlaeand state laws monisadirg - ._
O V mbuilding nnstuatinn.and hereby numorirem,re,emmmesnlllisen,meare,""a 50 — FINAL; B ILDING ENERGY
>y r� the fib tin d p I+,y f inspection p p:c
habil aince lo save. and and k ,1 I,, he City ofcupennoag '„5 — 'F.INAL NG
f b e, peuo, h' h an,,to any y active against said - (.
V z shy I ee nal s r g,rd�i.p r.. _
r APPLICANT UN .RS ANDS AND WI COMPLY WITH ALL NONPOINT ” "* SCI GAS T ` ''
souecr s _ Issuedby: NGDate Z � '��
.ignamr of p1 'anlrcomraotor - _ Dale- - Re-roofs 5 8 - FINAL. MECHANICAL '
HAZARDOUS MATERIALS DISCLOSURE ,6 "
Will flee applicator or Whour h'Id6 Cocoonsron handle h' .rd retial Type•of Roof,.. 9 — FINAL GRADE
':def ,dly,l CI M 'ted Cd Chp, )12— dth fl IH ' dSley
' cdes , 25512f) - 10 FI-NAL PLANNING
°Yc ON. All roofs shall be p"cted pciTgs ApnyppdgLnat"6kll:Iegg Installed.
Will the,'y11 r Turn,buildoccupant p use equilunicat I 'xhcn If a roof is installed without first obtaining an inspection,I agree to remove
emah d .a eon„ xdermB eaArQ dlyMmagemem
Dultall all new materials for.inspection. Applicant understands and will comply with ,
°Ye °N" all'non-point.source regulations.
Ih ,ad the hezardl : nit `Ir reqummen,,,der Char h95 'fthe I
Califison.Health R Solely Cad Se n' :25505 25511 and 25594.1 inadera.und shat
f,hcauld'ngdues no,cloudy have aaenanr.'tiald nyoospon:hild,to notfy lie 's.
nu,unr r rcqul menta which ria."he ince prior to l"nenw fir n Cm,ificme of
cup c Signature of Applicant . Date '
All roof coverings to be Classl"B"or better
Dat i . ,
k,., OFFICE