00110125 CITY OF CUPERTINO
BUILDING mVISION PERMIT CONTRACTOR INFORMATION:
HUILDINGAp)JY 9 PERId ITNO
c�`�47 RAINBOW DR BENNINGTON 001. 1.0125
OWNER'S NAME: APPLICATIo.T SUI c�'/2000
BENNINGTON
PHONE - SANITARY NO. CONTROL NO.
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BUILDING PERAn r INFO
7 AlCl{ITf,CPIIiNGINIiIiR PLUG ?l ECT I'L(1MR MEC CC
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LICENSED COMPACTOR'SDECLARATION Job Description
oz V. I herby arfin„mm I ant licensed under p,,wi ah,or emmm,t maalmratio,
!n1-J w �secdsrn�ululnruicisinndnnneHu.ine..ar,drn,resqlnn.```/rJ andmyreen,. BATHROOM REMODEL
K- in full have and efrecl.g r •� L/�_
eI LI'vev Clain—, — Lic.M LG
O a U U e Cnnlninur
3 e.
ARCIII'f P.C'I'S DECLARXI ION
5 g O 1 unJcomnr my plans shall he ua,J a,PuM1li,muM,
a.a O O hiccn.ul I'nd,e.umnl
a. o Fe OWNER-vmnnUlik m flit RAfIUN
_ IFeel
naso alien that I an,e.aunpl form the Cnanrncmr's License Law fn,the /
tzy fallowing reason.(Section 7H5L0.Ho,inas and Pmfcssreli Cale:Mycity or rouure
O wti ch P nIn I alter. 0 I lush p: Y.,structure .
ca that he
I Lx ry a HIIic' I I na-Dill 6 dCh men
L romalicensedInformal I m p si nn t I Business
an Pm (Chapter Sy. FL Floor Area V Il tl%5 0
(commencing is ewes Scuhefrom 7")of,basis Jot Inc Hgedex andion.Ana n,cote)
of Inas n i,31.5 b therefrom and IM1e basis for the alleged exemption.Any violation
of Sa:eon911115 by anY,eddallfurap,mnit eubkesn the uPPlicnnl lu.civil punul,y
or Dol tmrrc luta„fist ntl,droa annals($SHH) A PN Number Occupancy Type
35623027. 00
01,d ownerofthe nd'11hesenfuresno,nwile wages lerheicantele(S n7044.
will do lite work,and the xmuclun is no,immnucl or uIf J fur Dale(Secs]M4' R
Husns and Prcrenau Code ode:'I eCmh,aI ',Liccn,e Law does mo apply to to 101 — F0UNbHIfjc�Wpeelions
r of pfopcnY Who mild,in improves themor.and who docs such wed himself
or through his own employees.provided that such impmv,menu am not intended or
offered For sale.If,Resescr, he building ,,impravemc ll i,sold w'uhi.one Year of 102 — PIERS
.. pm, Ii,own”Ibuillerwillhavelhenmdenofprovi.,mmheaidaalbuilanr 103 — UFER
m pro Purpose n
ownerorthe pm,eey.nal exclusively contracrng with licensed contractor,to 1 —
.04 REBAR
ml...I he Fertile,,(See. 04
74, a I pro,..s a,.nags The contractor., 105 - ANCHOR BOLTS
i;ecu e law doe ,m apply loan owter of h
property whoarlds or in,prr n mcosm.
and who common,for such prop,,„wish a conte sant(,)licensed Irmouam m the 1.0E_ — SEWER & WATER
commuorn Liceme law.
Ol amexcmpt anit,sec. .H.0 PC roma,churn 202 — UNDERFLOOR PLUMBING
tins Dula 203 — UNDERFLOOR MECHANICAL
WORKER'S CUMPENSA'1'ION DECLARATION
Ihcrchyamnntinder penaltyorpe,inryone othe fodowit(;declaration.: 204 — UNDERFLOOR FRAME
0 I have and will maintain a Certificate of Consent to scu.ia,me for Workers 205 _ UNDERFLOOR INSULATION
Compervfian, a, provided fm by Section 5700 of the WMrr Care. hex the 301 ROUGH PLUMBING
,verve...an,cof,he work fur which dik,snout i,i,wed.
❑1 have ami xtdl,n odeM waders Comp,nsanon ham;n,cfi as n ch tai by --il 1'
30c: — TUB R OR SHOWER
tT(p of the LaMrr Chdc,for the perfum,antt of We xork ror which Isis permit is 303 — ROUGH MECHANICAL
i,wed.My Warke,'e Cnn,penwlion In...amecmcr u, t'o'y n�r :� r]
S�� �� � � 'Y 304 — ROUGH ELECTRICAL
calTi,,:_ Pafie'rN 305 — FRAME
CERT I'ICA'r10N(lP EXL'e11'1'1(lN I�HUM WORKIiRS'
COMPENSATION INSURANCE 306 — HOLDOWNS
(Ihis sudorstwat ora Va.,o...'Itedilthe mmmdt is,orotic htalrod dolma 307' - INSULATION
($100)or icod
1 certify that in the momlance tf the outs to,xa ich this pe,mit i,issued.I 3V.18 — SHEETROCK
shall nor,mplor my penal,in any than" o,,to hive re subject in he Worsen' 309 — EXTERIOR LATH
Compcnxalioa Loss of Calderon.Dice -
NOTt
ICE'fOAPPIJCANT:IL attar making this CeniHemeofEmanglion.y11ushould 310 — INTERIOR LATH
.z h„omesuh,el to he workers roat,ax.ntion pro .....,„afore Lunar arae.you oro., 31.1 - SCRATCH COAT
O C rmhwilir.....py will.w,hprovd.{ol,n of Jilt,„ t vull he acu�mdlevakcd.
Z
313 — ROOF NRII_
VI
CONSTRUCTION LENDING e,ager'
. � ; Ihcmeyah,,I,thaflhcrci,acons,malnn lcndingas,ncy fur the lrvrlbmunc, 501 — FINRL ELECTRICRL ENERGY
soli me wofk ror wni,h des InIla
" l ix ixnned(See.JH9T,civ.c.)
a,rs
y p IxmName 502 — FINAL PLUMBING ENERGY
= 7 Least Address
U 0 1rlifythatIfall11add,isapplieatiahand s,are mmlheabove imm,ati
!.lot all 503 — FINAL MECHANICAL ENERGY
a F re”.I`,grogmal"rlrwahaHcaYamlr„uaymamnalsaml.slAew-11hating 504 — FINAL. BUILDING ENEP.GY
0 V to
buildins caramnion had hereby amhmimmIummnmtirc-ami,city to caner upon
the abuse.mentioned property for ln.peetion purposes. SIDS — FINAL ELECTRICRL
E},,, y (We)agree testi.adennnifYand keep harmless the city ofCuperthm again,
Z) Imnihhn,loagm„rax.arae anln espee.n wm,lr Il,uy it:fur way scam,ae;ans,suis GAS FEST p
U Z Ch nmmuluence tl'Ihc smming of this permit. z
APPLICANTl//UNI iRSfANUSANDWILI.fU,NPLY WIT ;L nONp(l�� Issued by: e FINAL PLUMBING Date C/
SOURCERYC '
S Forriae nYYYI App natmcommemf Uah' Re-roofs
IIAI future
reALS Dweri handle — FINAL GRADE
W511 be vpplicam o,fmumtvilbng tacapam anre or haallc MvaNwx material Type of Roof
asdelincabythe cnpcnmoMautipdCody,Chapters.12,andtheHealthandSafety 51.0 — FINAL PLANIJING
Code.Se, 2s512(a)'l
OYes 0 N All roofs shall WAspUctcFtllpMTLto Pl�h*cfli l MKIRaPbeing installed.
Will he apphcana,human,naddiagaceupm„use mlater,or de'sicc,which If a roof is installed without first obtaining an inspection. I agree to remove
cn,it Ira,... Ali.a„mmaintal,as d,Enm lb,the Hay Ada Aa Ua:da,nwm.,gemem
Ili„fie,? all new materials for inspection. Applicant understands and will comply with
Oyes • ON. all non-point source regulations.
I have'call the hnaxnam,m:neriul.,e,aire,lan.under Chapter 6,95 of the
cahkanne Ileahh.ft Safel,Conn.Seen... 25505.25599 and undm
255)4.I o. ail bar
illhe (ding does not currently have a tenant.Nati,is[try ox,thribilay it)notify the
occ pa I of na,iremeno which must be met prior In issuance of a Cenifi,um of
�Y Signature of Applicant Date
Owneraurnoriardagcn, Dale All roof coverings to be Class "B” or better
OFFICE