06030132CITY OF CUPERTINO
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BUILDING DIVISION Pyry�dy'iyT
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BUILDING ADDRESS:
SBI
'M"06030132
10982 ACACIA
NAME:
PERMIT L%VE DATE
:HERS
HOMESTEAD RD LP
395 DEL MONIE CT- 4153
QS/19/2006
PHONE
SANITARY N0. CONTROL N0.
(831)274 -2518
ARCHITECffFNGINEEA:
BUIING PERMIT INFO
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BLDG El3LT PLUMB HECK
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LICENSED CONTRACTORS DECLARATION
Job Description
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1 hereby dfmn Nu I ern liam� u.dcr Prnviv«u a Clupec 9 (commcmmg
NN Section 10011) of Dinurm 3 a to Busi.md Prof si,.. Cade. W my Ikcnse4
In full rme dc7c %
REVISION- STRUCTURAL THROUGHOUT
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ORIG PERMIT #05090178-NO NEW PERMIT
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ARCHITECTS DECLARA 0
fwd wl my iWu"I ho umdupobdc rtmvd,
Lkcmcd Pruir.o,l
OWNER - BUILDER DECLARATION
1 bcrcby, ullrn Nu 1 w ucmpl 1. the Conu,cld, Lirrnrc In f« tho
rolbwing wan. (Sc eu. 1031.5, Bu,lrlas ,m Pl ureW. Code: Any cky or colmty
which ro n= a Permit to cmlmttcl ,Itcr. imPrO.e, dcmofuh, ar telmlr ,ivy m,vum
Prior to its i4v ,ahu raIuuc, tbcapplkW for aeh permit m fika mpnii ,uomcm
Sq. Ft. Floor Area
Valuation $0
N,tml,li"mdP m,mmNcPmw,mn,ofleaCn utr`,LcacL,w(ChW.9
(c«am nci, with Section 7000) d tMUion 3 alhc Buuncu,rd Rafuuaru Codc) «
Jut u, Is .....p thme(mo tmd the bask, for Ur almgod .,Pdm. My vmmdan a
NNumber
Occupancy Type
Scrotum 7031.5 bym y wpllam far. prooft mbJea, NC appllmnl to A ciB Pm,ltya
oatn�thm ew mmatm mu,n (s5at
- 32602070.00
❑ Lmowta athe prvperq,ormy erapmyem wlN w,p uNCtr mle compeoutlo.,
Required Inspections
q P
xmmthex«k.aM tie mumwe hlbtlav�tled «arum mr,am (Sea.7o,4,BmLem
,not PmI.L.I., Cade The Co.vaeror, L' law does mt ,wh m u owme( a
pralwry wlm Wid,orlmlaow,Ilemnl. utd vbOdlYasla:h work blmsdfm Nmaib bu
�D
^rx «Weir,
wa vopbym,ptwlor
Lz sold one yteom Plcuo.f
kcpr mwVWdwithinareywacomPkdon.theow«r-
boilod,,
W ibo x00 haw Abe burden a pmvmi th.t he did not ddW or knpmw for pupox of
LI urd thiar c,,a
0¢.aed rauu b
a ISc popery. .B —hod" COntrltli.
Cl L u,,
A
.
Code:) The Coovacmr, L4
ft (ice. ]014. Busi.a am C
Ile
�Jv\
\F
rt, hot bu
Vr doeroat,j,M man owner a I.openy hot
. La es out
dp,Ofdnprowa Cmmowc,m.
who mltncu far,ueh project, with a cmoanor(,) Bcemed Par*•a•l m the COnu.emll
who
k ae aw.
❑I,m eaunp tmdm gee ,BkPCf«Wsreuau
Due
WORKERS COMPENSATION DECLARATION
1 berch5' aBhm oral Irodry a Po*1 arc of de folbwmi ,s..t...x.....
❑ 1 mR and wN mimaln • CodGOU aComml m,eB.buurt r «w«�r, Campco-
.
s,rim. u provihd Tor by Section 3-100 a ok Lab« Code f« the Wlfontunm a the
wale for which LL permitu Lvncd
❑ 1 baw and vW Inumsin WOrkcr, Compc.tuWoo Itumrmscu, u IcPtirm by i ;n
.
3700 a the ubdr Code. for W perfotmmee of the wmk r« wbkh lhu pcmk is
Competuulm lmtaa cm,or nxi Policy m m/bo� a
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CMayvW vro ��Z, J
Ertf.�RA:✓,S
CFl EXEMPTION FROM WORX
COMPENSATION INSURANCE
01tht selm Rem tbt be compked If the mmort Is f«anc bomrm doom (SIM
1 certify then in the Prrf«m„Q a We .ark f« which this Perndc U Imrd I ,ball .m
emPby aoY persen in svy m,mermubbecorx mbjmblho Wmters'Cum1-1thuu
.
Car, of C,Ilfamlm Dme
"L,hm
NOTICE TO APPLICANT: IL ,fmr making Ws Cmfctic of Eam,Pdan, you shouA
became ,ubjoct to Nc W«j Compem,lbn proWim, a the Lab« Code you mom
forthwith comply with such pr . or NU P.4 thtill be demlm mokttL
LENDING AGENCY
CONSrc
t..ONoodon alPmcY f «Ibc perfarnurt¢a
4.car(v
1huwhich th tN.mut
i 309cttding
de wale for which thl, persat 6 Lvucd (Sra. 309'!, CW. CI
Lodcr,Namc
'
� nM•r, AAAT^
1 cni fy at 1 hive rvd NIs appBUdm and mere Ow tic above mf«mado Is
^ cmrt I agrcc 10 Ply with .11 city and colmlr mother m(i sue laws rtHdng b
jWilding coumetion, and hcmby autborin rtprcrotAdw of NU city to color ulnn lM
amw- Pmperty for Puryax,
(W.) agrtc m ut . iMcmmfy am b<ep hutmleu the City of Cupertino ,g.im1
ci.jdScd
Weper,
ni.,-n O.JvdgncoLLCO,m aM eapwmvhich m.YmmY w,y,�eagmtw Said Gq
Z A PLIC O of Nc Runduga AND WILL
^ APPLCANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE R7�p
I' i9�06
Re -roofs
Type of Roof
Sign.tum orAppUcuuConuaoor Doe "
HAZARDOUS MATERIALS DISCLOSURE
Wld ft Vdic u, or fomrc buOWog occupw mxe or huldk havNCU matoul
m dcfined by do Clerritw M.rdc 1I Code. Caper 9.11 and the HoIN and g,rery
. Surma. 15532(.)?
All roofs shall be inspected prior to any roofing material being installed.
❑ Ym
If a roof is installed without first obtaining an inspection, I agree to remove
,, wn the applieml m ramm Wllding acawm ere ewipt«ml er a w whirb
emit hvaNnu Or cmumirunu a dcfmm by the B., Arta Air Quality Maru,omcm
all new materials for inspection.
Dbuict7 }j
I haw read the hanNC„ mvuimsmn t^'^"^. mMkLCIuPm695 athe Uldor�
nia Codc.Satiau
Rho
unit myrmd15531.1tmQaay thr OifueEa
does Tel cuneny luw a Imn. Nu h u my rt,p ®GIitY b ratify de aecupmt a Il<
not cum tty
mean M. netPm>rbluvuocar. ar
Signature of Applicant Date
All roof coverings to be Class "B" or better
Own or,uNariml ugcol _r Oam' .