06060026 E0CITTR'S
Y OF CUPERTINOBUILDING DIVISION PERMITDING ADDRESS: SCAFANI ENGINEERING INC '06060026
8 BARRANCA DR
NAME: PERMfr ISSUE DATE
LANGE GRANT S AND ITH A 15195 LLA
NE SANrrARY NO. CONTROL NO.
(408) 779-5463
ARCHnECT/FNGINEER: BULDING PERMIT INFO
'BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION Job Description
ui F 1 hcmbY,IGrm Wt I an Ik c,c order Pm.idm.of Cbapm 9(mmm log p
< rith Scmn-N)OD)dDivWan 3afthe Budrev Pmreva«a Code.W mylkew is
o� inrWlf«etWeBea REVISION-ADD 7 ' TO GARAGE AND ADD 1/2 BATH
DDam cook ORIG PERMIT 405010053
ARCHITECTS DEC1ARATION ORIGINAL: BASEMENT ADDITION 1084 ' , HOUSE REMODE
i u I nmorvnd any ph."I W,Bred u Nbik omo,*
Tau
Lkerl¢J Pmfetdoo,l
OWNER-BUILDERrnCooDECORATION
Q c I hcrtby,IRrm that 1 un,Bump u Je Caalran Co :Anye IAV for the
.00 folbwue,.•."r(Seriltodoo W1J, tIonr.sWfho.&,not Code:AOsr Y«wanly
S9I which rts, ,Pmmit m cmgruO pIj impmw.dPCMiL w mrnk mY urrwaurc
.zi prarb,s iavuee,.ku rtquuu Ne,Ppeuu far such Pcrmilb Bk asipled,weircnl Valuation
Nu h s tkcrlscd puaur m Nc Pmisiau of la Ca,uxur's rd¢nm Vw(CNPmr 9 Sq.FL Floor Area
S (commcndo�vWSmian]OOfpalDivvbn]aflleBudrn,ardPraf�lwCock)« $0
_ JW be is esu,,,tburefmm mE the bask f«Ne Ucg d earmpd.Any v .tio.of
SwCm 7031.5by,vyWkant In,,perath mnjm.ibc.Pplkutl 10 a Call P-11Y ar APN Number Occupancy Type
,m ninth Nut Bae Wvdred Callus(SSW).
L u owom of the pmpct),a my wpby«a wirh wiFu u Nc'v mk oampeauCan,
rumde.aruCoom- :w+moon« L4=m arte�rarr.Apply a+,B Of Required Ins Inspections
am,,y o,oto code The Cantrsmah IJmlz Law mm ao.,PPI/m r Zfr r (�
no,O wino buildoA&,j , Chimp, dwho m not imwork oroffmlWwN h4
aw,eaapbYeru Pr , rEs acbCn Is s'menuonool ssr-f marfesd r«mk It.
Iwve.er.lhebuilding«impaanwt(„oldworm o¢Wr or u«np for the oa of �\
MilOv WR h„e Je bmdw a(poNvy tlLl a dId as bJH«impmc for puprrx a
I,u arow a(the propmy.w umladvdy mno.tling W b 6aucd waaClar.b V�
cuuuun Ce p njo a(sec.R)ss,Bminea ad Pmfudo,u Code:)Tb,Cocm Li-
wW I�r COLIr h r m,a ontoof Proper(.Who bundsor Imp m,u Corton,a1.
who cmuacu for wch Pmltou TIN,cmaanartU Bcslsed P'Aa°as m Tine Cmu,clals v
kooa Jw.
(]I�ut under See Bk PCfw Nit ream
out 3-11-O
WORKERS COMPENJArl0 f DECLARATION
I herebyN �r pn, y a(PcdO,y me Of Co faBarin{*+•^^^^
❑I bort and WI amnulo a Cudf or conium m sev.b fa wm es coosc
ubal,u 0mH f«by Sanaa]7)0 ar Je lobar Codc,for de pnrfw M tK
work
for rhkb thine kisiwu4
❑ I boat smd will mora;,W%r .CompctuWoo Item. .u rtgdrd by Savor
3T of the Minor Code.for the ped«mute of Ne wort f«whkh tbiu putmk u isued '
My Wortces corn a dna kma„w arrkr and Polk�y number a2:
Coder: Policy No:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
rnds mint teed non 00 c nplm,d if We permit Y ruoaa hurdud dh W (51W)
«las)
1 ard( lbu In Ce perf«m,ria of Use work for whim Nis parol(4luuc4I"I torr _
employ,nypwmniam,rr., ulobna .1bxi UNe%rimm Compuatbn
I�Avs of crJamia D,•
Applicant
NOTICE TO APPLIC�A T:If, Corrine a es&OPaan.You sbaCd
bewmt wb)m m Ne WWW's Compuu.doe pwvidou Of de tub«Code.You moa
.,O farNwiN comply wiN rah prorid«u Or OL,Pernit"I he dwmed rtAakeC.
zN CONSTRUCTlONLENDINGAGENCY
[-� I lrrcbY,firm NU Com kr ioj.paocY for th(xsf..or .
a> the wrt(«which Una p h Is hued(Sw.3011,Ch'.C.)
0.Q IsMC.N.....
U Z I.cndu2sAm
U O 1 zany Jut 1 luau lad this wliulion W.ate Cur Ce,bnsc kCorwtiun H
U. mor .I&Vr m cmnply wiN dl dry,rd cranny ordltunas"sum Ian rt)aungW
W idinF cowmnion.vin hcrtbY suNariac mFm smouliwa of Nis cit,,.cnly uptn lM
r W ahovu mon road poperty for inspcctim pwporcs
(We),pom to u,e,itdem fY red trop butnkss lh Cry a(Caperdna,piml
FIn Iabilium judgroom.coos and"Pwn Welch my ia,ny nY,ccrue NIUM add Gly
U in consuq¢occ of the Vzoung of Nis pwnit. Date [J�
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
s
:49
.
/i-o Re-roofs
Si 3M ofAW)iom/Cow.n Dau
H RDOUS MATERIALS DISCLOSURE Type of Roof
WIB We ap,If=or fuwrc br W,orcupw amu.b,Mk hrndaut nwarui
I-defined by Oe Cupenion Munkipd Cod,,Cluwr 9.13.W Je He lth rad S,fmy
Cy.vs3za)3 �/ All roofs shall be inspected prior to any roofing material being installed.
❑Yet -J/J^n
Ww J,e,Ppn'.., In.WCdinFmvlwr amegvipmml«d,vla,wnkn If a roof is installed without firs[obtaining an inspection,I agree to remove
7�7
eudaa air cmwmi.u ddBoW by the Bay Art,Al,Ow11ty Mnnabumun all new materials for inspection.
whk oma mtlPriorIn ar,cmif�reorozwmy. Signature of Applicant Date
«mNorirr4 a wl mm All roof coverings to be Class "B"or better