00100073CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BIT LDING ADDRESS:
PERh11'F NO,
1 1 1 G0 SANTA TERESA DR
POON
001 O L7107
OWNER'S NAME:
APPLICATION SUN DATE
PnON
10/09/2000'
PHONE
SANITARY NO, CONTROL NO.
ARCHn'ECUENGINEER:
BUILDING PERMIT' INFO
BLDG ELECT' PLUMB MECH
CI 1=1 CI I—I
LICENSED CONTRACTOR'S DECLARAf10N
70b Description
herchy thrum that I a,,, licensed under pro, moms of Chapter 9 feommencing
with Seelion 7q W) of [)I, kum 3o! the Hu,iness anti 1'm@sxior, Cada and my licence
'l for hoccanaelteo.nse
IJ
.REMODEL:-
.
ecin
CWss I.ic.k
Dale Contractor
ARCfIlIECI'S UIiC1.AkKl'ION
I I le,bind nay Plan, shall be uvcd a, pnhllc record,
,
LianscJ Profes>innal
tUILDEk DECLARATION
Oita
I con License Law for the
Immo Ihm 1 ran exempt h'nln ❑
r f—ions Co
(Section 710 L5, Hminesx and Prof—ions de
, (Seel Cede: Any city OrrcountyLure
1
nous
w hiching mms a or repair structure
which ¢,aims o µmot ac cvnewor, altar, i
V
t for h p,mnish,
prod 1 y the v,pTatf hpe Oh flsignaltr em
Sq• pt. islOOr Area
IatlOn
, d
Il ala II a IIII, flue piniviauun,olII CII a Law (Chapterode)
(enol 8 ' I pt til 7rn an f D ' , i III N : J i 1' : ` : (dc)
or That he is Iheofmm end the aver% for the exemption. Any violation
2
,tis the
of Section 31.5 b for a permit euhjatx the applicant m u civil penalty
5 by any applicant
APN Number
ll
.,rI,nllmrem�l,Iivebhnhdreddnllarls5ao.
a Into
.
copcyType
❑I.asownet ofthe property. maty empinyws with wage% as their sole compensation.
•tu
-
Required Inspections
will Jo the work, and the struclme i, not intended or altered for sole (Sec. 7W4,
Ber,ince, I Prnl'e,,imn, Ca Is I he Cantmelara Liva h,e Law dose., not apply to Iia
owner of property Who humWx ur ialfr nve, thereon, and woo dues well work hiln,dl
or through his own employee,. powded that such impmvememx am not intended or
- ...101 .
'
—_ FOUNDATION
onerN for sale. If, however, the budding or improvement is .old w'imin one year of
}
1.02
PIER-
•Implelion, the ownmr 1Nr1der will have the under of proving (Willa dad not build or
ltPo''cmrpnpn.enf.me.t.
103
—_ LIFER,
ssar of the proµny, ran exclusively contracting with licensed contractors In
1 MA
— REGA R
he Commeo s
ith he pro,, (See 7044, Ensues, :rad Pn,fc„inns Cn If ) Ti
_
i.«rseLtovdoesnuoapply tnorwnetafpmped,who bdrd,mrimprnne.merenn.
105
— ANCHOR R01_TS
and alto contracts for such projec¢ with a contmctortd licensed pursuant to the
License Lav
11�r
.— G[I If ? P.. LIGTrp
cr. 'e.B A, P C tonhis reason
nate ���Jr�ia'�
)NA”
±''m'''
- UNDERFLOOR' PLUMPING
ORKER' S COMPENSATION DT:CLARAI'ION
_
203
— I.INDERFLnOR MECHANICAL
IJmren, all.... ande, Imall, of arjmr"rte of the fallowing dedamflma,:
204
— UNDERFLOOR FRAME
❑ 1 have and will maintain a CUrtfecatc of Consent u, self -insure for Worker,
''l5
— Ul`IDFRFI f)OP TNSUI..ATTON
Cnmpcu,afon, a, oa,iJN for by Section 371p of the LuM1ar Code. for the
performance uI the work sen:' which Ili, permit lc.swat.
!T
3011.
— ROUGH ROUGH_PLUMP I NG
O l have and will maintain Workers Compensation Insurance, as required by Section
362
— TUD & OP. SH0I1F R
371h1 of the labor Code, Iia the pe,tormancn of IIm work Iia which this µ,,air is
iswod My W.akeev Cmn,n,adu; lmurance carrier and Policy nunhber are:
:303
—' ROUGH MECHANICAL
Ckmicr: police No,:
7014
— ROI IGH ELECTRICAL
- CER'I'IFICAfION OF EKIiMPT10N FROM WORKERS'
— '
COMVENSAI ION INSURANCE
305
FRAME
I This section need not he completed if the sernot is for one hunJmd dollars
30F•
— H01 DOWNS '
DIIXror1e,e.)
7m7
--TmRUL•ATJON.
I acnify that in rhe performance of the work for which this periiiit is issued, I
fl
— 7
shall a,), employ any person in any manna w as ,I bao.re wbjW In the W who
•.
c:HEF.TI,1.ICf:
Com .Malian Law,, of Califon is Date
Con,
3�)9
— EXTERIOR LATH,
NOVC1nl
N(1TICETjvv,,, Ie thisnvi,iocam
W. aftermaCompensation chat should
3tO
- InI EPIO LW.H
W the must
Imrome,ubjecnn the N'mrAcrs Cnmpenvlian prvs'inions of the WMa Code. you our
�. .
forthwith comply w ih such prov hhn,.s lit this perink xhad be deemed ra4okeJ'
311
—_ 9CRATCH COAT
CONS "I RUCTION LENDING AGENCY
31
'
— PnOF NATL
1 hereby alGnn that them is a con%mo tion Inuring agency for the performance
In, oed(Sse3rn7.Cie.C.)
one
5507
—FINAL ELECTRICAL ENERGY
—
1 -cock, , Nice
TendersAddre„
5002
— FINAL PLUMBING ENERGY
I candy that l have mad this application and share that the above information i,
503
— FINAL MECHANICAL ENERGY
core". 1 agree m comply with all ally Ioit only ordinances i I aam taws teaming
nutheng cl orametnn. sad och,aun,ori,clicpocatedv'e,d1 this cry to enter a tom
9_IZ)4
—. FINAL BUILDING ENERGY
.a
rte ant dpnprnde ".lane° pmt
the City fCupertino agamst
(w) g t indemnify ilk Each
IIvdI I I ly r cL t. I U soh y . ;my way geinsl s: iJ
_
505
— FINAL ELECTRICAL
ity ,:eq e fth b I g Idris,
st71r-.
— eA TE T
I )ERSTAN)SA )WILL COMPLY W�TIf ALL NONPOINT
ISSUe
Date
[�APPLICANET
OURCE RE( TIONS I��) •�'�,�
y'�
! V
e_ 50,9
— FINAL MECHAN.T.CAI. '
Signer •at A, eaalf raborern Date
UALARDOUS MAE FRIALS DISCLOSURE
Will the vpplicam or future lmilthngnccuphnt sort or handle Emanation, neitmihl
Type of Roof 509
— FINAL GRADE -
cmeter ued by the Cuµn'mo Municipal C:sle. Chapter 9.12, olid the 11.11 and Saloy
51.0
—' FINAL PLANN I NG
ode. section 25532fa7
El ye, ❑No
All roofs shall-be.ins
ecled ,r�IoAr t n o m rt\ .ill being installed.
P y*lis• �v�r+C 4a. 6
Will me n,licamor ItIone haildihl, nnnmol me crai ton device, wilco
'I n g I mien
If a roof is installed without first obtmmng an inspection, I agree to remove
emir nararJuus air contaminant, a, Jef incl by Tae Nay Aron Air Guulily hlanagcmmal
Diadn�Ye
all new materials for
inspection. Applicant understands and will comply with
CI No
all non -point source
regulations.
I have read the hwaohms materials n niremenb under Ca:ymt 6.95 of the
California Health h Safer, Cale. Seen 1,25505.'_5533 and 25534. 1 understand Thal
if the N II Ahm. nal currently have a neither, that h is my responsibility o notify the
no
rcyni2mem, w h mtol he met pdm m r,pmnce,ar 11 Certificate of
oenmml
ecarmmy.
(�Signature
of Applicant
Dale
1
All roof coverings to be Class •'B" or better
ownerm marl agent Date
OFFICE