00060095CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS..
PERM] INO.
OWNER'$ ..
r
APP..... ,l95
,
LUMIJU
PHONE: LK
nit unisioN
STREET
SANITARY �, ,NO.
Z ARCI I ITECI/CNG IN HER;
319-0400
BUILDING PERMIT' INTO
❑O
RLDG ELECT PLUMB MECII
W
LJ I—I ' I—_I 1=
i LICENSED CONTRACOR'sDECLARNHON
Job Description
I hereby of ...i thin I am beamed under provisions of Chapter 9lc nnerma ing
x'i,h Sen ion 7000) of Do"'n 3 cf,he Foomea and Pmfia'andin tic e
is in full force and effec 'jZ (V//!r
6 L' ` hlc.a_(/
neC7a.
/ c"anon„r ��f—
P�/5
TEMPORARY PERMIT/EXPIRES 7/15/00
ARC H ITECf'S UEC I,A RA'I'IDN
] enders,: l nay plot., r:hu]I he used as public record,
J Licensed Professional
y OWNER-RUILDER DECLARATION
I hereby action that I am exempt from the Contractor's License Law for the
< hilloong mason (Section 7031,5. Business and Professions Code: Any city or county
-
O which requle, a crout m construct, alcor, improve, demnhsh, or repair any suunum
v, "lion",. los.. mel, ad-nequim, ffica Ah,undl"rmeh permit to lilt ao,red,,tatemnu
Sq. Fl. Floor Area
Valuation
- fled Il licensed parannmtnthe gown,In,I. sit the Contractor sLia�n,eLnw(cl,aptn
(s.,nmeneing with Secular 7mNR "f Division I of the Bus;ne„ and Pndcssinns Cole)
or that he is cxauum thcrclkem and the Nasi, for the alleged exemption. Any violation
of Section 7031,5 by any applicant for a permit subjects the applicant to a civil Noun
Number
OCCUP4291ke
of nthan five hundred dollars Piflkp, ot union,
01, as owner of the Im ity, or my employeeswith sage, as Ih<irhole compcn,mion.
36902030. ��rs�s
will do he work, and the shall is ren intended or nutted lie Sam (sec. 711Y6
Bmn esss and Pm4v,;ons Cilie: The Cmninnnr's License Low duos not apply u, nn
i,elf
'Mquired Inspections .
r "I yr,p,ny Whn build' of hnprnwx thereon. amt who dues sell, work I
,o through his own iau loycn. provided Ban such impmvuomms are no, intended of
offered for sale. IL hnwner, the budding or ho,rovemen, is sold within one year "f
101
- FOUNDATION
completion, the owner -builder will have the burden of pmving that he did not Mild or
impost, far
1.02.
- PIERS
01. as owner of the progeny, am exclusively connecting w ith licensed contractors in
103
— UFER
mown be projan (Sec. ]IW. Business and Profession, Codl The contractor',
w.,
pian„ Law that, re.t apply m in t , "fpm er,y who nand,,, improve, thereon.
1.04
- REBA R
:red wl,o comrtn, ',r, , p"ct,i, 'm , nuramorc,) fic,..,cd ry.rwam m me
105
'
- ANCHOR BOLTS
(1/
106
- SEWER & WATER
°
N'URRER .'C .NSA'I'IUN UECLARATI
202
- UNDERFLOOR PLUMBING
I hereby anirn under Penalty of perjury one of he following declaration,:
?_03
- UNDERFLOOR MECHANICAL
0 I have and will mahnain a Certificate of Con:cm to,en.immc for Worke„
204
- UNDERFLOOR FRAME
C"m,n„ednn .,, mnklor Ill ell
Con..
sunhni too "f he Lanor code. for, d'cperfor
205
- UNDERFLOOR
ich11 .in is issued.
nonce nl',he work for which this
.INSULATION
o l have and will maintain Worker's coallmatlon m,mance. as reunited by section
301
- ROUGH PLUMB'.ING
37M of he Labor Cotte, for he performance of do, work for which this man is
302
- TUB & OR SHOWER
sued. Aly Worker', Compensation Insurance comer and Policy run,her are
•
303
- ROUGH MECHANICAL
Carrier: Policy No:
aKIIFTCAnoN01:EXiMPnONFROM WORKERS
304
- ROUGH ELECTRICAL
COMPENSAIION INSURANCE
305
- FRAME -
(This station reed not be cull The permit is liar one hundred dollars
fM(n)one,,.)
306
- HOLDOWNS ,
roaraure of roe work for whim this pain,, i, issued. )
I unify that in die p m
307
- INSULATION
shelf net employ any person in any manner so as m helium, subject to he Workers'
Cornet on Laws of California. Dm,
m
ApplicnTo
308
309
- SHEETROCK
-' EXTERIOR LATH
NOl ICEnppLlcnNlnL ant na,uog d.i, aniEnocona,ntiyio.,. winan"add
C
7 become subject lu the worker'r Con,p,maaion pmvi,iom or the i,m(r Coca, you must
lonbwith comply with such provision, "r his permit shall he deemed evoked.
310
- INTERIOR LATH
O CONSTRUCTION LENDING AGENCY
311
- SCRATCH COAT
1 hereby uffrm that hem is a comwclum lending agency for the Performance
,if he work far which this pe.,it is issued (Sec. 3097, civ. C.) -
313
—
ROOF NAIL
:ta.r dams,
501
- FINAL ELECTRICAL ENERGY
1<,,lily lanlhavore,dill, arrucai.nand ,are lie, Ill ahl,atraormaoo,Iis
502
- FINAL PLUMBING ENERGY
tect.Ial,v,it, lour,lywimaua;ayand c"nmyommame,and .,am la ... claim,
o building construction, and hereby outhodm representatives o, this city to enter up
503
- FINRL MECHANICRL ENERGYentatives
z thealme.mcofonedproperty for inspection purpmcs.
y (N'e) ogee m save. i miItin kcephmmle,s,he Caynfcupeninaagainst
504
- FINAL'BUILDING ENERGY
l;JymeI�.t n, in anyxvyaccmcagain,sail
'i,x
C*rfll
505
—FINAL ELECTRICAL
grJ^� oil
R lYdf 1PLY WITHALLNO -� AT
Issued by:, SIAFa
- f qR TFRT Dale
Re -roofs 7
- FINAL PLUMBING
7Cmran r Da,
A7AKDOUS>1A1IiRIALSDINCLOSUREant or future buildi„g oecupam see or hirnrdoa, mmedal
Type of Roof
as defined by the Cupertino Municipal Gale. Chapter 9.12. and the Health and Safety
Code. SectiGn 25532(x)7 0 No
All roofs shall be inspected
prior to any roofing material being installed.
Will ha,pli-mmfa,ar,hoodiogo„opamuse nlniPmnno,dc,icc,whim
If a roof is irilwitjrOPNVgLtoHEjG19ANjieMjLction,
I agree to remove
nJt harmiI ni. conunninares as defined] by ,be bray Are, air Quinsy Managemmat
Titaricfr
all new mateer ounjpTNpjL AtVRMp! understands and will comply with
- 0Yes 0 N
all non -point Le ret CI) S,
9. �� OL
1 have read the himen mase' mean a unJ Chapter 6.95 of the
m
- PLANNING
Colifom;a Health HI S , code Se nn 5505 and 534. l understand that
•m
514
- FINAL PUBLIC WORKS
if the huildingd > n randy h' nom, nsibilm oradfy the
cupnm "I't ant, vd uanw at a Car fcae
t r n
`” y
Signature of Applicant Date
,
All roof coverings to be Class `•B" or better
Dat
wrier .1and ,tied again
OFFICE