00050003OFFICE
CITY OF CUPFN INO
CONTRACTOR INFORMATION:
BUILDtNa DIVISION PERMIT
BU LD] NG ADDRESS: -
PERMITNO0050003
18640 RUNO COURT
OWNER'S NAME:
APPLICAT05B )IU)JTig 2000
LU, ANGELINE
LONE:
SANITARY NO. CONTROL NO.
G C 2
ARCHITEC (ENGINEER:
B11ILDIND PIiRMI I' INFO
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LICENSED CONTRACTOR'S DECLARATION
Job DeSCTIpD(yll
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hereby rJRrnr that to licensed under pmvlsiun, of Chupn'r 9lcurnn¢ncing
wilitsemionnronlntolviaint,dmd,enaLmc,.aundrnJc..i,msCisco. nmin,rlleen.e
2100 LIVING SPACEi 424 SG. FT. GARAGE
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Littnsc Cla.vs Lic. N
Dam Contractor
ARCHIIECT'SDECLARAT]ON
I understand my plan, shall toed as ,.bit, rn,de
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hiccnncJ Royce opal
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OWNER-HUILIDER DECLARAI ION
aif mal 1 c,emre
1 hcrchy almton tonal the Cu director License Luw for ,he
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AN U 2 200
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following reason. (Section 7131.5. Basins% and ProfieWom Cade: Any cuyor county
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which rcl a peril m emi,m ct, alter, improve, denmli,h, .,.,air any .ammurc
3m
Prior to its issuance. also requires the applicant for such Peri, to file a signed amemean
Ft. Floor Area
q, �L1 QjI 0Ip
mat he is licensed pursuant to the provisions of the Contractor'., License Law(Chapter 9
ocneing with Seedon 7ugp of Didision d of thro
mmal e ntninesI and Pfessions Code]
no that he is siolpt ,hereVon,1 1 the Is.- Ga the allege) nacmptinn. Any violation
��ri nbb��
A375?�`031
Occupancy Type
of Section 711.11.5 by any applicant Gar a permit subtectw the applicant to a civil penalty
of not more than rive hmdrcd dollars ($500),
00
inapt0l, a, owner of the inapor my employees with wages as their sole aon,Pensation.
spections
will do the work. and the structure is not intended or offered for sale (See. 70,41.
Business unit Profosssion, Code: The Contractor's License Law does not apply m an
a f en' Who tai ld, or int thereon. tool who dues such work hilowit
101 .— Founl�a"fri$
oltahmrah his v employees. provided (hat wen iitq,n a ems a not Immrdid o
,rr
L he holding impoo,cmm,t Ia iri hin
]. 02 - PIERS
ffered Ro sule. however, ,, sold one year of
in pletion, the ax'ner-wilder will have the burden of proving that he did not (wild or
,
103 - UFER
mpalas pmliew.k.le.).
erof the pmiwrf.am exclusively contracting with licensed contractors to
104 — REBAR
L,ndrect he pmj,e, IS,,,, 7t94, Bistros, and Pmfmsh,n, Covey Thi: Connectors
1.05 — ANCHOR BOLTS
locre Law docs nm apply m i n owner of p,,,p,oy who huilth o, impmvice there,".
and who rrud I I r wch projects with a cm,lraclmtal licensed Pu„nam to tho
--
] 06 - SEWER & WATER
C%ne, reLaW.
01 am vsomp m ,Sec. H& P C for,his mason
7/�%�
n
202 - UNDERFLOOR PLUMBING
net -y' //7 L(
T
203 - UNDERFLOOR MECHANICAL
WO S C II'ISNSATII . [ I ARATION
204 — UNDERFLOOR FRAME
u,emny ani owk,c,RyofperJmy i euro ruo, ,,, decnmlia,r�,wr
205 - UNDERFLOOR INSULATION
rave and will maintain a cenircate of Consent in wdf-invurc for Worker's
ompensmion, an provided for by Section rrl of the Labor Cade. for the
301 - ROUGH PLUMBING
Performance nl the work for which thi.v peri, is issued.Cl
302 - TUB & OR SHOWER
Compensation have and will maintain Worker's Competion Insurance, as required by Section
"'g of the Lahor Code, for dw perrannaric, of the work for which his worth i,
- 303 - ROUGH MECHANICAL
issued. MyWmkeisCoi,criadonhourancecn,rooumlPadl,yntoa„Tore:
a 304 -, ROUGH ELECTRICAL
Curicc Policy No.:
CERT,ncA'DON OF E%CMPTION FROM WORKERS'
305 — FRAME
COMPENSATION INSURANCE
306 - HOLDOWNS
This sectio, need not be completed If the putmit Ir for one hundred dollars
rslanminw.)
307 - INSULATION ,
I eerily that in toe p,darnamo of ho walk lm which mi, perm, is iswed. l
308 — SHEET ROCK
shall not employ any peewn in any mann,, so en m become oll m the Workers
—
309 EXTERIOR LATH
Con,penwadonLax,ofCabooia.Date
Applicant
31.0 - INTERIOR LATH
NOTICETO APPLICANT If, anormaking this Cenificate of Ea,mptlon, you should
;f,
nr Cado, you nwt
, pnsmion provivorw dihe Lano
j,etme W..kcrGnn
became sunto
311 - SCRATCH COAT
p
lanhwimcomplywilhsuch pmvi,int„o,ndwpernotMnllhod„mndte-k,d,
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3]3 - ROOF NAIL
1
y>
CONSTRUCdONLENDINGAGENCY
Ihercbyaffinn„hmd,reisaeon,rctinnlending ag,ucyfnr]he pdomanee
501 - FINAL ELECTRICAL ENERGY
2.0 '
of,he work for x hich this permit is issued (Sec. AMA, Civ. C.1
Lender, Name
502 - FINAL PLUMBING ENERGY
Z) O
Isndcr's Addles,
503 - FINAL MECHANICAL ENERGY
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1e„ lit, dr:nlhovcromidsapplieatimnm,d.a:noho, ill chose ir,lr,orcolion.r
correct. 1 agree to comply with all city soil county mninanee,.and aline law, romeng
504 - F I- BUILD NG ENERGY
y
mbuildn,,un.amction.ind nercbyamhori+c nTr,onpaive, of till.,ci,y In enter upon
meahove.nwinumcdpmo<ny Iinspecrnnpmrs,o,.
505 INA ELEC ICAL
IWclagree tosir. indemnify and keep ham,les„he City of Cupertino against
liabilities judgments, costs and cepcnacz which may In any way ucome against said
506S TEST
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r
Un
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City in consgnene ,one gmntin • oflhiJ permit
APP ,ICANTU 1 its D. DW'NJ COMPLY [THA NON -POINT
$ RCE REG
n
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Issued b 507 _ INGDate
y'
_L Dm,
Sgaumrc of nppfi,rvc ractr
HA DousMnrERlnlsnlscLosuRE
Re -roofs
509T-I.,11INAL GRADE
Walid , appliant o Talon handing ac Pant wxe mhurdlehaeardousnuterial
defined ny the Cupaour. Municipal c -M torn. I2, and the Heulth and Safety
Type of Roofus
570AL PLANNINGCad,
SOc< ,n 25532(u)^ 0 ...
��1��114,00
� All roofs shall bE1'�rfSpf�0 R 1 j'�{f n �p T Ling installed.
i
Will the up,foom or fumrc nuilding as'cupan eyu"nue'd lir dcvi,„which
lfa roof is.insulfi@ witho1914TfYl otRJin k is�CCtltk l agree to remove
unit hae.,rdous air eomamin"ur, as nctued nn ynrea no trashy nunagernrt
• "p?
all new materiaGoRl incrpeRWFAAATaTiF-tRi$crstands and will comply with
i Dye, n
all non -point S06!0D4re9ulk0WF IN—PROGRESS
I hive rend the hazardous material, re luircmern, under Chapter 6,95 of the
-
Culifnrnia Herlth & surety Civic, So"noris 255115. 255J1 and 25514. I undersand that
a
if the huild'mgm„ ncurrntly hove a tram. that it is my respmrihilhy In notily the
aecupum nl me
no ionto)
e1, wl'cL nms�piuo m iwmance of a Cerificule of
r 7/7-- �
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Signature of Applicant Date
All roof coverings to be Class "B” or better -
owned or aathodzed ag Date
OFFICE