00070115 CITY OF CUPERTINO '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGA9.138s:FERNGROVE DR Pr.RMITNf00070115
OwNER`ARMSTRONG APPLICATIJB u,8 MY12000
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HONE: SANITARY NO. CONTROL NO.
O z z ARCHITECDHNCINEER:
u O O BUILDING PERMIT INFO
z u BLDG LECs LUMB MECII
oy Z LICENSED CONTRACTOR'S DECLARATION Job Description
an o y provucunma of Cn:mmr 9 a„marrowing '
z_ nereb Brom Into I run licensed under REMODEL
with Satinn](NNllnf Pismo.3ofine Nuws m
rinand Pressinrvs Cale,unJt li'
II li,rce un1 eta"at. 40
3 g ti -oe_I—CA—•GQ_ cmumaor _ .
Sdmy p-AItCHl1 Fthe use DECLARATION
I nnderslln, lena.hull the used E public rccnnls ^,
ce O LlcensN i'ndesamnW 2V^✓
o f OWNER tBUILDER m he Ctionowun
m=� TION
1 herchy Ulf nn Ih:n 1 am exempt farm the Cnmmev,r's License taw lice the
F li9lowing rerood(Section](131 5,Business and Profc'sa ms Goch Any city a,omay O
ISO which requires")coil to construct,alcor,improve,demolish,or repair any structure
C3a pribru)its issuance,also requires the applicant for sash perminn EkasigneJ smmmrm
that he I,licensed Pon,aatnm the polis,onr o'the Canu"emrs License Law(Charter 9 S FL Floor Area
(commencing With Section 900(1 or Division 3 of the Business and Pmfexsians Cole) q. i
or that he is exempt therefrom and the ends for me alleged exemption.Any violation
of Section 7031.5 by any upplicam for a permit subjects the applicant m a civil penalty
ofnot marc than foe hundred dollars(55(0). APL�I{lJpb('�6. Occupancy Type
❑I,as ow net of the p upcny,or my employees with wages as their sole mmpemation,
Will do the work,and the same ure is not intended or offered fur all(Sec.7014. �+[{{�y.f�,J�
Business and Professions Code:The Contmemr's License law does run apply to a" 101 — FOUNUH 1 til UNspee[ions
owner of prnprny Who builds at improves thereon,and who does such work himself
or through his own employees.prnAded Nat such improvements arc not intended or 102 — PIERS
offered for s:de.IL however,the huilding or improvement is eld within one year of
completion,the owner-builder will have the burden orproving thin he Jud out build or 103 — UFE R
it se far pbmnsc°r ade.t.
❑1.as owner of rhe pmpetty,nm exehuimly Contracting wan licensed cmhnacmn In 7.04 — REBAR
�,ntmrl tie pniierl(Se,.7()44.Bushlrss and Pmreumns Core:)'rhr Cat,me"'r'` 105 — ANCHOR BOLTS
icelhxe I.aw dura run apply Io amownrr or property who builds ,,imp.„vas Ihereol,,
and wlm cannel”'lin audh)micas an a amtmctor(sl ncenaed pnrs"a,tl 1n nc
C 106 — SEWER d• WATER
ommend I.Icmhse LIIw.
°l am exrmpl ander Sts. ,B&P C b,r mil re,00, 202 — UNDERFLOOR PLUMBING
Owner Dale - 203 — UNDERFLOOR MECHANICAL
WORKER'S COMPENSATION DECLARATION
I hereby affair ander pcnahy of perjury ane of the-poll—ing declararms: 204. — UNDERFLOOR FRAME
I have and Will m
maintain a eetConsent " 205 — UNDERFLOOR INSULATION
Cme nr corol
Cnpeosa
self-insure for Worker's ROUGH PLUMB I NG
mtuo, as Provided for by Section of ter Labor ewe. n,r ter 301 — .
perrtimnceBane Work far which thispem,hisissues. 302 TUB & OR SHOWER
have and will maintain Worker's Compensation Insurance,as required by Section K = ROUGH MECHANICAL
of the Labor Code,for the performance of the work for which this permit is v�0�v
issued.My WLo�rke�rs,.cnmpenratonInsurancecarrierandP°hcynumberam: 304 — ROUGH ELECTRICAL
Garrier:�,T a*trc�vNd_XCMpNn.: 305 — FRAME
C—F.k I IItCATION OF EXEMPTION FROh1 WORKERS' �+ '
COMPENSATION INSURANCE 306 — HOLDOWNS
(This section need not he completed iohe permit is for one hundred dulka, INSULATION
S100)orlrss,) 307 —
I certify nal in he pc,haaaoa ohne work for which dd.,Term'..is i',urd'1 308 — SHEET ROCK
shah m,l ellhpn,r try m sblh 1hI I,oy mnoner so ro m ne<nme ahmjerl Io na wh,rwr, 309 — EXTERIOR LATH
neon lahws m'captor„ice.Date
310 — INTERIOR LATH
TICI?TO AI'I'LICAN'Is.11,ulmr making lhls Cenilicme of Exrn,ptini,,You shnnld '
s,Inien nuns wnrkrrs canpep'mimm pmxisiona mane Lanor coda fart mutt
O O 311 — SCRATCH COAT
' fnnhwcih conhpiy wish such provision'or IM1ic permit shall be deemrA revoketl.
4 CONST RUCTION LENDING AGENCY 313 — ROOF NRIL
> Ihereby affirm that'be.isacompaction leading agc.c,far heperrurnamm 501 — FINAL ELECTRICAL ENERGY
°rthe Work for Which this pii'issued(See.3o9],ci.•.c.l 502 — FINAL PLUMBING ENERGY
L ❑ LenN
der's amc
= Z Leader',Address
U Itenlfythat Ihave tend this appbeationand state that the above Infom,mionia 503 — FINAL MECHANICAL ENERGY
Ow F roamer.L agree”)comply%ith all city and county ordinances and state laws re atmg 504 — FINAL BUILDING ENERGY
U tobuildingcnnamction,and hem hy authorize ' msenmtives of this city to enter upon
y m heawve.memoned nyf n up
ertmoaes. 505 — FINAL ELECT ICA
F. Q. (We)agrceb as in araleatneeityof CdpenmorrIniml ,
UZ liabilities.jadnr ct hi tmay'inany way accmeagainst said 506 — GAS TEST
Z City in cons Ira'.ft Ig. i it. m/yr
I, SPURICB .Ul LIE LY WITH ALL NON-POINT Issued by: 507 — FINAL P Date
igoantre nr ppnCiininiioous MATERIALS olscLosuke Date Re-roofs 509 — FINAL G OE
will me applicant or rmtue building occupant store'handle hazardous mtnedal 'Type of R ary — F I NRL P RNN I NG
as Jetincvl by the Cupenino MamrlP 1I Cock,Chapter 9,12 and the IIua11h and Safety
Code,Section 25532(:)7 - 55yy T Ap T7tt'^ rr��ppKKGR
°vcs C3 No All roofs shall'6e�inspe to ea pii�r( �IF623TinIRAI'(:rr81 being installed.
Will u,.11lrer cars a buildingoccupantuse equipment iirQul°t Micerwhich If a roof is installed without first obtaining an inspection, I agree to remove
art Imranl the ter enmm Orfutsnc Jennng bythe Bay Ar ea Air Qualityevices nam
nmwE all new materials for inspection. Applicant understands and will comply with
II"' °No all non-point source regulations.
I have read h hm erial' q remems under Chapter h95 0l the
C"liromia Ileahh Sa sty t° S c'nnc 2 5 25533 and 25534 1 understand that
if the buildnen'u to It a Lr cit is rots ondbility ,,unify the
occupant the I qui rust” n norm issuance of a Cenilicate or
ocwupa y. Signature of Applicant Date
w , am anted ngem Date All roof coverings to be Class "B"or better