00100066 CI'T'Y OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BU1LDINl'.ADDRESS: PERMIT NO.
(OWNER'S NAME.' ` - APPLICA9'ION SUIT UAn3
[A/
MOT; + —H` - - SANITARY NO. CONTROL N(1.
O,x R ARCI 111'17MENOINRHR. BUILDING PERMIT INFO
r fit D(' 1?LIiC'I' 1'hOMR NISCH
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h 'z LICENSED CONTRACTOR'S DECLARATION Job DeScfl tl B
ZO Oy hereby ullinnIWr Ism I len II od later Is Is i e Hall ler CII:pnnr 0 monnncneina p
v~ Cy ,111 Snamr700l".' 3ler R tP r:' Code,",in"lieeaw
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It Oar I R nsn DI).DELI ARATIGe
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,, -1S 70315I11 f 'll AyaY1O
AxC❑ h n 1 p l dll P I I'I ..Tenetne
pr', I s I d .IPI II 11 n II El mlwl
I: l e II d 1 111 ll T I I I (cLpero Sy. Ft Floor Area Valuation
(u, a �'IIth,0 7000) Til l IR Rosiness II Ctde)
ord Ill I.. I' tall I,hedv aptIa itAny
eyd, Aa
of Sect r t 7011 5 b)m y appl u n h r u pemtiT.uh'Icde the uppl¢vm m a eivll Ixnally
nf11ol male 111,111 Tile handled dAEar,($500), - APN Number Occupancy ype'
❑I,a.owner or the sep,rs.ler It,entploym,will:wngce uo melr eNe cmm"enaalion,
Hwill do in,work.Lnd the otraenaA is nal intended or alrrtcd far sal,(Seel 70TEtlsiress and plot....on,Cndel me a mmaars Mmnoe Lew does 110 apply Inas " -"' . '• 'equired Inspections
orr m Properly Who mtude oT inmro,'Garan.still woo doe.eoeh 1111:holonir
Jm,Ugh m own emIIII) .Pnwmed mm sneh Hal aneeloLlns are It alleaded ler 101 — FOUNDATION
offered fnr,a:dr.II;hoth
wever. e hailding ler improtcnwithin t,nl is (1110 year of
mplelion,lh0 owner-huilderwill hate The tarnat orPlt ing That he did not mild ler
�an"'nelnrP.1len.lade.). 11212 -- PIERS
❑I,ao owaeronhe pnlpel y.all e.elnsi.el,conlrs,ong wiTll wee,od nnnlrcetn�to 1.03 — UFER
Lmslm0l the Prgryrt(See 91)13.Itnainne laid Professions CAd,,)The Cmnaolor.
tOn"Law done aal apply It,an Aw11er of prnpcny who wilts orin,pa,.e,merant, 104 — REHA R
cand who vvmlrea, Cor.nen Pmlwl.with s contraemt(n) licenved.pasrinn lA Inc
altlrne.aE.Lieamn Law. - 105 — ANCHOR BOLTS
❑Iaate,elnplal,ll e IAECfill lIII, "oorl 106 — SEWER R WATER
Owner
WORKER SCOMPENSATION DI!CLARA'IION 202 — UNDERFLOOR PLUMBING
111116,affiral andr1lai Tip rlate 1 1111 I'llolill,delklatialT 203 — UNDERFLOOR MECHANIf.AI_
❑ Ia d ll C n 1t of .1aIr walkers 2'04 — UNDERFLOOR FRAME
Cn 1 1 Its hi,ovided fis by Sel 3701 of' the ].it Col mr the 205 — UNDERFLOOR INSULATION
,rror .u e,f the link for which ilia,pamdl I.l,.aal.
❑um,eand"Ill�mdnanitwa ern eamp,11endat la alloaY, .ley
awrc�d nyseclion 301 — ROUGH PLUMBING
3700 or the Iahar call,,far thepehoaa Tiro,IT dte wark for emen line ,nit is 302 — I'UB 8OR SHOWER
d.My Worker's Cmnpens,mian In'...",rnrricrrmd Policy wether are:
,n;o4517M£ &I PnnnyNo.:0/4--00-Q(bl 303 — ROUGH MECHANICAL
cERrIPIcAr10NwEXEMPTION TROGWORSENS' 304 — ROUGH ELECTRICAL_
CoMPI?NSATION INSURANCE
305 — FRAME
I11le.reli(1n null aw he cmnrElerl If the permit is for lea,nn11dand,ta1ler.
rslo0l ler lase) 306 — HOLDOWNS
I...IN that i11 n„p"tinUal lel me wad;Parwleeh mi.permit is Mind,1 307 — INSULATION
that not mnploy say penal In any moaner_at IIs to huome suljem to the W..keel
Coarpat.mialLe"uhCiflifahrnale 30B — SHEETROCK
Applifalll
NOTICE 10 APPLICAN'r:u:aperoolan,l[Its Crafil ffil mtmn.yonamwd 309 — EXTERIOR LATH
Op nearme a sal leto the Wako,"s Cr... one lfr n proviliaas ler me Lahor Calc,yon ar It
l lwahtonally wHm.ark110—inn.ormNprrntnshill bedecm.. ntled. ,310 — INTERIOR LATH
u CONSTRUCTION LENDING AGENCY
311. — SCRATCH COAT
I,rkher niml drat m,:a :Tin ad(Siolt 09dins nseaay Int ata perrannaa" 31 3 — ROOF NA I I_
one,work ro�,mdm,ode Po11O a�I.Io.Uet rsre.3ne7,civ,c.)
c o 1`niNeray 501. — FINAL ELECTRICAL_ ENERGY
p z Ln Idm's Adll
o I el,iffytl that read this-IIT t 1 I le ,1 512212 — FINAL PLUMBING ENERGY
c F R.1 b' I Ila d e d' ' I tins 503 — FINAL_ MECHANICAL ENERGY
O O ear.to Id'I atnnln cran,ly hereby 11,,. . sanyodrolant,antani,ei, I aryHaeme-neon
�y heanane•me11d,n,d properly TarrallocRnit°harpoon,. 504 — FINAL_ BUTI_.DING ENERGY
y
(We)"Ile lost d lyandkeel)msthecty fel roagtnst .
Um Cahn . i dg 1 expii 1 -y tarry y- Sam. paid 505 — FINAL ELECTRICAL
7,.. Cay 111 enlnegpene,anrme gond ex ar Isis 1lIdl a _
PLICANT DERSTAN WILL COMPLY WITH ALL NON-POINT Issued by: 5016 — GAS TEST
URCE LAT .TNS y Dale
Sig /d�p
n. nreTTheaa .t11AZARraaa, Dom Re-roofs 9 8 — FINAL_ MECHANICAL
IIACenlroOUS NAT RIALS DISCLOSURE wll tea allpuwalor meta htNdmg a,rnpa"Are Al llanAn na„Ialoasnlmen,1I 'Type of Roof GRADE
cI'll by lea CLpenino nwnidPal Code.Cla,T,r 9.12-,1,it mo Healln Dail Safnv 509 — FINAL
oda,Seenoa 255320EP p
El Y,, 0N All roofs shall be5i1fQcted IFHL R;Tn�i{i IlMAial being installed. -
Wil[hn,,leamArfimaebaddne,011epanTLoewaHrmemardo-.ieelii If a roof is instal le'With6MtffhWfR1ainRdR1T(1Cpil(RIVWgreetoiemove
Gall hwanlone III aonmlmnamv m dermad by the 19y Aren An Quality[,innsgnmmnl
-D1crlap all new materials for inspection. Applicant understands and will comply with
71 Yl CI No all non-point source regulations.
nave read 1111 Ivlenolous nmterials will el
rarea is tmdel Chapin fi 95 of Inc
Cnllf(1min Ileahh&Set,,,Code,SeUdan 25505.25593 lead 25533.1 undanlaad her
if the hai dingdoes ,it o ll• Ry Ilan a lewnL l Thor it is my re...... iilylAnm l)'Ihc
cmlpam nrI a retIt...n l,{wnI mel he and pl'inr m Lxuancn of a Cenilievm lel
ooe Inco (// _ Signature of Applicant Date
�b All roof coverings to be Class "B" or better
)wart a 11wn,rla d agora nth:
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