99080074F
III
CITY OF CUPERTINOWUKKb
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CONTRACTO ECJ 6J
OD NAIL "
BUILDING DIVISION -PERMIT
BUILDING ADDRESS: e
604 —
ROOF IN—P
R IT NO - -
OGRESS
OWNER'S NAME
10547•MANZANITA CT'LT37
U3' C
APPLICATION S"�3M0074 ,
J'IVO -
PHONE:SANITARY
O'BRIEN GROUP
NO. m@/iCp�Typl, An..
1 1777
THE
z❑ ARCHITECT/ENGINECR: -
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BUILDING PERMIT INFO'
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BLDG ELECT PLUMB MICCII
- - LICENSED NSI D CONTRACTOR S DCCLARA'I ION
of9 one g
I norch, tiffina"ilh I am licensed under pZi�n
_ Job Description
hhS I 71MNp fl n of the B yl'
I f rc Well
ae
cHITE( SaCc1,A
3787.CONDITIONEDLi
SF RCE, 5�4: GARAGE1
oo t y l l h II I m m Pub
Licensed Pmeo,namil
OWN(R BUILDFR DECLARATION
,
1 hereby alhnn the, I a erupt fmm.the Contract rs Lanese Lau for the
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followingreason.(Section 7031.5. Bulini and Professions Code: Any city or county
❑ which requires it permit to construct, alter, mipmve, demolish, or repair any structure
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prior to its issuance, also requires the applicant for such Permit to file a signed statement
- -Sq. Ft. Floor Area
Valuation ,
— [hit In, is licensed pursuant to the pal isimo; of the Conawbours Licedual- Law (Chapter 9
(commencing with lection 70W) of Division 3 of the Business and Professions Cruel
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or that he is exempt henchman and the basis for the alleged exemption. Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant m it civil lxrally
nfnmmore than five hundreddogars(SSW),
APN Number
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Occuga3nc�y�Ty�e1
01, es owner of the prnpcny, or my employees witb w.,, as their sole compensation,
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Requirefj Inspections . -
will do the work, and the structure is not intended or offered for sale (Sea IIH4,
Business and promotions code: The Contractors Liccme Law dsws not apple to an
owner of pn,fany Who hitilds or impmves thereon, and who does such wok himself
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or though his own employees, provided that such impro.ements are not intended nt
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offered lar sale. IL however, the building or improvement is sold within one year of
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emnpleshm, me owner -bander will have the hnrdan of panting that nc aid net builder
101' —
FOUNDATION, -
imprne for purpose of lade.).
a
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102
PIERS
contracting with licensed cnnttmq.m.
❑Lax owner ol'the property, an esdao naly ru
t
consumer hp ject (St,v. 7044 B `n d P f .: . Lane ) The C h i
1'' -1.03: —'
UFER-- F
License Lmvd,w,aal al,pl, t - I P open, who hadd. p s there
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and whootnmets f, eh.p sects won n a contmc�oaa f .ed paaiim to rte
104
'REBAR
Cofactor, Litman [.a,r
❑Itnnexemptorder Set. iB&dchnthiamaxoa
1.05 —
ANCHOR BOLTS •.
Owner Data .' .
- - .1.06 —
SEWER 8 WATER
WORKHR'S COMPENSATION DECLARATION'
202 —
UNDERFLOOR PLUMBING
I hereby uflirm under Penalty of perjury one of the following declarations:
203 —
UNDERFLOOR MECHANICAL_
0 1 have and will maintain a Certificate of Consent to sel4msm, for Worker's
Compensation, as provided for by Section 37W of the Labor Core, for ere
204- —'
UNDERFLOOR_ FRAME '
perrmman,,aofthe work (or wAichthis permit isisum.
2Q15 —
UNDERFLOOR INSULATION
01",a a ad will maintain Worker a Compensation insurance. as requited by Section
37W of the Labor Cole, for th galfinarmane of the work for which this permit is
- 301, -
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ROUGH PLUMBING
isFard.n ersCompcns.Jo w etarrierand Policy n erarc
302 —
-TIJB & OR SHOWER
`' 'I
'rIFICA ONO E IO 1 FR ORKERS'
303 —
ROUGH MECHANICAL -
F5 01
304. -:ROUGH
EI_ECTRICRL
ma.. xtc iaa nem not be completed if the permit to for one hundred dollar.
'. 305 —
FRAME -
tsiapenm.x.)
'snumhl
306 —
HOLDOWNS
lunrly thin i rl p soh slot whi lith p t':
,hill not enplryan, person 'ranybann mheren ahlaetmtheWorkem
3Q7 --.INSULATION.,.
.Corp f :rt(II Date^
Applicant
308 —
SHEETROm a'
NOfICETO APP ICANI it aftenntk gth Cart E.,andien youshotld
krome,albeett the w d r: Coloparsibi .Pr of the Labor Coda yet must
309 —
EXTERIOR''LATH
forthwith comply wase such provisions or the permit shall he deemed revoked.—
3141
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INTERIOR LATH
0 CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance
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311 —
SCRATCH COAT -
if the work fur which this permit is issued (Sec.3W7, Civ. C.)
Z Lender, Name
313 —
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ROOF NAIL
Leader
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501 —
FINAL ELECTRICAL ENERGY
I vinify that l have rad this application and sumadd the abovx information is
rtes. I agree to comply with all city and county ordinances and state laws rearing
502 —
FINAL_ PLUMBING ENERGY
to building comuuction,and hen.bymalamiza represcrouroee of this city to cma apt'n
the am'a •mioneJ property for inspection puryoses.
Indemnity keep harmless the CirynfCupcninoagainst
_ 403 •—
FINAL''MECHRNICRL.•ENERGY
L lN)t6mcrosave, and
O Imhili s 'r'mans, ours annex uses which may in any way ace .9. it said
City t o tl ryace, - tF Innis pem d •.
AP ;to
.RS > DWILLCOMPLYWITiq�L gSN,rly'1-1
S 1RCE
,504. —
Is, Lied by:' -
FIRIRI_ BUILDING ENERGY
Date
Re -roofs
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Sig o APPlicunV ontmctia T Dare
HAZARDOUS MATERIALS DISCLOSURE
Will her,duandian nu'm'b«t p t.t 1 a1 n d 1 ,1
Type of Roof 505` —
r
ELECTRICAL_
as defined by the ftp art d MtnnlCChtt 9.12 bit the Hall IS,rty
Code, h 25532(e
El s
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506 —
All b'
,FINAL
•f'
GAS TEST
' r being installed.
Will ff pp1 t f t b 'l l g P nt umeq 1 r J 'us h eh
roofs shall s ected I L f nal
If i roof IB ID§tai (�[t/L'1 ithou Till Ion, I agree to remove
f plipp
tut rh¢ contaminant9" .defbed by the Bay AraArQsm ly M. nope nem
D.rdm
fn Jj P
� all new, materials ns ec
lyt, Py
I I f and will comply with �
0Yes V
all non-poinhsouW%gulatF61NAL GRADE ' —
�
1 have read the hau,Mous materials requirements under Chapter fi 95 of the
.510 —
F I NAI_ PLANK I NG
California Heal Stiroy Cme.Seomr,25505,25533 and 25534. 1 understand that
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ifrhebuildin notcurrcn0amna that it is my response lityt city the
the mi
r 1
o n ryircn¢nts .51m�g(c(r/,��'J�tf t�p��or w tate of
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Occupant . G s�
Signature of Applicant:
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Date
/rsrvspymns
::XII roof coverings to be Class "B" or better -
o ie
owmer er n dagat Date
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