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CITY OF CUPERTINO
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BUILDING DIVISION PERNUT i,CONTRACT0
INk'O.RMATIOI�I Y..
BUILDING ADDRESS:
S B I
PERMR NO.O 6 0 3 013 8
22032 ACACIA WAY
'R'S NAME:
PERMIT ISSUE DATE
HOMESTEAD RD LP
395 DEL MONTE CT. 4153
ns/22/2oo6
E
SANrTARY NO. COMROL NO.
(831)274 -2518
BUILDING ERMIT INFO
BLDG ELECT LECT PLUMB MECH
0 0
LICENSED CONU ACTORS DELIARATKIN
Job De$Cri tlOn
p
1 bercby afnnm tht 1 m Ik<nsod udM Pmviuoo. of baper 9 (ammoncing
vlN sawn )Od) of DiWbn 3 MNC B�nu+ud Prpfaimt Cock. vW my x• ^.e. It
in fd1 faa am effm.
REV I S I ON - STRUCTURAL THROUGHOUT
Oa L'I`"
COmracwr
.
ORIG PERMIT #05090181 -NO NEW PERMIT
aaw
I
ARCH=S DECLARATION
1 uodcrvaod my pluu shall x incd u palic ram.4
-
1Javcd Pmf=.W
OWNER- BUILDER DECLARATION
I be -by M. Nat I am uanpt fmm tx CO.h W& IJceoso Law far We
fdbwiaL rosin. (Satan 7031.5. Busbtus and PRfenlmu Codc: My my m cauuy
whim rtyui. a permit - cavlry L a Or. ftzgr , h-a W m -pair soy v —
prior W iu imurce..bv tundra WC applieam for m1b permit to fun a ilLZd vOnOrnl
IJanso Law 9
Sq. Ft. Floor Area
Valuation 0
tut bOI, llcerucd Pavan In tx pMOVW0na Of tx COnuacnrl (Chapter
(emtmuaing wiN Section 7") a Di Wion J of the Budneu and Pmleulnu Cndc7 m
Nat be h -inapt thvefmn and tw huh fa the a14O4 eaonptlam My Nolatlov of
pEN Number
Occupancy Type
SeNat 7031.5 by my apps Mt fa. MrO t TAjcas the apps L In. a W"y a
not mac thM Bw W °dR^ ddhr (5500).
3 2 6 02068.00
❑ Luvweer al Ne ptopuOy,amy employ —w'uh v�nudte'v mle emnpeunBm.
Required Inspections
q p
w din taeW. 1k' an°° e" n>< n 'Rd,WO.°'dmnr°rte'°dfnr°le(S.`.m .Bnd""'
W PtafesdaOa COdc The Caawwm . Llmsz law dam tnt apply W ao Ownu a
prop ny who WI,,, a IrproRS 1xmWn, and wEo doesysh work mmw for through Ida
Owv mpjoe pMvaWtad tM vnh Imprmemau art tMinlended woQrrzd fer tale U.
kowavcr, the bidding Or Imps, inn h sold within one ,,•r Ofe jrb ioe.dtcowrv-
bulWer. ha. tit burden a "m c that In Ad tin WW Or irx a fm prpoe a
tile.}
❑ I. u owrcr a! the P ^R^ /. w eadvd JI mnvaalni with BvsN mhuacros n
-nation the la^jas lSa. 70Ca, Buian Md Prdfmvaru Coca::) Tae CauOamah U.
cove Law dery not apply n an owner or pr9Pcrty who Wllm a imPOn�s N .' Mod ,
who contract. far suck Mjems sold aOmt,.- u.(,)fi n d pvu••• m tae COauanOYa
\ \
(Jana law.
v
❑Imlcaa,,t Sec ,Bd PCforthis -ame
a Dnc
WORKERS COMPENSATION DECLARATION
1 hereby a1Erm under powly Of perftity one a the 101 m n dOdMaidnx
01 wK and ari0 maMM, a CeNr aCOUCm n relf -imm fawmtces COOPM,.
udm. u pOM, C Ter by Sc.. 3700 of the Labor Code. for the perfar-.nm of Nu
soak fa whkb mu permit is iaued.
rj 1 ba,< aW wW maiNam W.W, Carpmmla Ivurma, as r q Wmd by SeNOn
_
3700 a the Lawn Code. fa the perfamaea ofthe soak fa wluti this peMait'a L
My Workets CempevulOa bO,On n and Policy rt n tie:
CaOrIQ P.1k, Nm:
CERTIFICATE OF E%EMMON FROM WORKERS
COMPENSATION INSURANCE
.
rnnis Ua eedatxooanitImd If to permit u for One hmtrN dollar (3100)
v kaa)
1 artily tM W t O perf.m N the soma for whirl thin perch L. L-ucd. 1 "I om
=play any actvn in My maorcrw as n bsome aubjwt W tR Waterer' COmpwube
law. Of California DaR
APro
NOTICE TO APPLCANT: If, afer making Uds Cerdrt Of Eaempwp, you shvuW
became abjm to Ix Wake(. Cm N.,iOa inr v Of the labor Code, yOO mot
farNwtN comply with axb pravivmn R thin pmmil "I w dasrd tmvtcd.
CONS. ON LENDING AGENCY
it. c aF^7IQ tc perfummc of
Iherbyichthi tMNei V a
(Secu307Ming
tmwak fa wakbtM permhuiruM (Sec. ]097. CI.. CI
LcMria Name
'
ludcfs Mdtm
�
D I amify that I have rod this wplkuim and sun Nat tic a laferrnat b
cover( ( n= n comply witb all city and count)' ovdia and fate Ian Rhdeg W
WBdieg cons Lion, and( mby auO =mpm talirt oftho my to enter uptm Nc
alnve- mrntutmd lu.,My for tvleeriov fxapmcv
Iwb) agRe W sam indemnify and keep Mmleas the city Of Cuprni. agai-
n liabilidm,*Z=M emu aM expevo whim may Nary ny aceree akuml said City
in caury Of the fradat Of NIs faUMIL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS
Re -roofs
Type of Roof
Stgnauvc MAppb HAA �DOUS MATERIALS DISCLOSURE
WO Ue appliaa err fmuR Wilding o.PanL vac a bandk hazadom material
as dCBant by the COpenbu Mm pal Code, bapw, 9.12 and lit Health vd Way
'mot' 532(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑Ya obn
If a roof is installed without first obtaining an inspection, I agree to remove
MI meapplicant or hm R WWinc Oaopam Mac wW,� a d,. whin
em0 aamdom air cmna is as dcrmed by the Bay AR. Air Quality Mana�cv
all new materials for inspection.
Distrkz7
❑Y,$ [D NO
I ha a Rat NC harnLm novcrhls Rquucmetu umkr Chap. A95 Of the Califo,
da Ih " Wery codO, S=Ona 25505.25533 and 25531.1 undo ate tkv I(tc Wilding
d mA r." hare • ntwa Nv It b my R'O.Owiy in mdfy the Oauputt a the
- 'ubrO.r Inkhme°x°e PH. Wi. -- Of'e°tr°tewDa.PR .
Signature of Applicant Date
All roof coverings to be Class 'B" or better
Dwaer a aaWrbed.pem mm .