01050084 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: -
BUILDING ADDRF�L275 CANYON VIEW RD PFRMII NO 01.050084
OWNER STE
NAMEARTER ' WILI_Y AND NAOKO—T . _ APPucnnONsuBDA
05/09/2001 •
PHONE: SANITARY NO. COST ROL NO,
MseQ ARCHI I ECUENGINEF;k: BUILDING PERMIT INFO
F- BLDG ELECT PLUMB MECH
¢U(i 1-1 I—I IJ CI
I I:1
8 LICENSEDCONTRACrOR'S DECLARATION
5�= 1 hcren aloe that 1 ata frter"d ad f Chapter 9 g Job Description
Z_ y o line 11offx o p (commencing
_
r5t J
Matadi allnivi,aen3ormexa.one>xandrn:n..am,.e„de.mwmrrecne REMODEL.
i e fol l tutee nnJ afootp ` t
0 < Data x Cla, P Lie.»� 0 489
3LL Date_S_Slzaaf conlmctor Jf ,10 eoakPA REMOVE EXIST FOLDING DOORS 8
ARCHITIiCF'S DECLARATION
t=°g Iunderstand myplans shall be used aspublic neords REPLACE 141 PKT DOORS.
twit c p p Li¢nxcJ 11..le,ional
OWNER-RUILDGR DECLARATION
O
6'd I hcrc by amen tha 1 vm exempt from este Commaemr,License Law for the
t Q rollowinp n rt(Se,ian 7031,5,13none,and Po fc,simw C:xle:Any city of county
D which requires a randit to con lowt,alter,improve,denmloh,or repair any structure r
a 3 prior to its iswence,aka requites the applkont fur c n le 6 J autement
tna,nei,hanssnl pat.nantmtne pm.;>innr artltee Ic Sq. Ft. Floor Area Valuation
(cnmmcncing with Section]qM),of Uivi,ion S of t alluvia ss
of that he is exempt therefrom and the leis for the alleged exemption.Any violation
oorrstroect nand than nnh,ansfinvye anyapphrfomG,rfopena„snnjecolhgysan11malviLyptnUUlL[y APN Number Occupancy Type
°L as owner orthe limitedly,or my employees with wages a,their sole compnnw,ion, $7000
will do the work,and the,fracture is not intended or a dor rale(Sec.nun, Required Inspections
Busineu,and Pm(c,sion,Call, rhe Commnm's ueen{rpt�tl�1e�•.�1Agp�nn
orr of property Who build%or impro.es mercan.and If 36641 008. 00
net
his own employms,provided that such improvements are not intended or '
offered for ode.Il howe,cr,ate building or nnprovemen,is sold within one year of
�vaplalon.,hr own,f-ilder will have the Wodcn of pmving,hat he and nn,hand nr
t„pm"eo"In,,,.eor,.ale.) 101 — FOUNDATION
°1,as owner orthe property.am exclusively contracting with licensed com ucturs to 102 — PIERS
construct the project(Sen.70,14,Budnns and Professions CWe:)The Contractor's
License Lawflocs not apply man owner of pmtrny who builds or improves thereon 103 — LIFER
and who cnntrans for such pa tx with a contrai licensed punvma to the '
Contra.,,l.marwLaw' 104 — REBAR
O l �ffimundcrpcn
dSB&PC for min rwam
��ccJJ// �, 1.05 — ANCHOR BOLTS
O��Ihcraby
�(�rjuOo
NULC'LrR40NN� 106 — SEWER R WATER
aoneof\hefollowingdelararon 202 — UNDERFLOOR PLUMBING
❑ I have and will amirmm a Certificate of Consent ,o self-if,me far Wittier', 203 _ UNDERFLOOR MECHANICAL_ '
Com,asanon, a, provided lot by Section 37M it one Labor Coda. for ,he
�p'edfonmmaaortheworkIn hidtthi,mami „oad 204 UNDERFLOOR FRAME
9l have andwill maintain Worker's compensation Insurance,m required by Section 205 — UNDERFLOOR INSULATION
37W of he Lahey C„Ic.far he performance Uf the work for which this permi,i,s 301 — ROUGH PLUMBING
ued.My Workefs Compenemion�aI� ce
mmoue carrm
ier and Police number art:
CoforeS"7Z r /VPolicy No: /5 (05=-Sq —cc) 302 — TUB & OR SHOWER
cERnFIc CEsiNOIURccokKERs'
MPNNNSAN - 303 — ROUGH MECHANICAL
('rnisseeaon need not M cmnplmed if,lrc lkmdrs far one hundred dollars 304 — ROUGH ELECTRICAL
(stall,of le,,.) 305--- FRAME
1 certify,let in,he Io fomarrcc of the wml,far which this Penni,is issued,I 306 — H 01_DOIJ
,hall nm anpluy any person in any manner so as to become sobject to,he Workers' n hIG
cmar,ertenon lLov—d Cfffoti O01e
Apthcanl 307 — INSULATION
NDTICE TOAPrI.ICANT:It,.nar making this cerrmaae of Exempaoo,you shoule 308 — SHEET ROCK
Z hewn,sunjcc,m the Work,,,Cn nNo,anal pdavkionsonhe Labor Codet you most
ZO ronhw'i,hcomply withsuch pravi,knoor,hispc.if shall hedeemed raveled. 309 ..— EXTERIOR LATH
ECONSTRUCTION LENDING AGENCY 310 — INTERIOR. ,_ATH
I nearby difmn that them is a conumchis.lending agency for be performance
of bewal,if,, hichthis prm,i(isi„md(Set.3097.Ci,C.) ''311 . —. SCRATCH COAT
Pr Q Lender',Name
D z Lender,Add,a,, 313 — ROOF NAIL
a Iconey mmihave mad thi::nppfca,ianand state matmaabove inrormafonts 501- --FINAL. ELECTRICAL ENERGY
ect.
'�. I agree,o comply with all city and county onlitmnces and state laws miming e
O U toWilding constmaion.and Nearby authorize rcprtscnmtieesofthisday menter upon — ENERGY
y m he move-menfonal pmpanr for Impcet an 02 FINAL hl Rl_ F I_UM B I NG
a. Wc)t tosmo.indemtdf dkaphar'iesstheCi, fC. ninon t 503 — FINAL MECHAN
ngrce ens p ny pe gain, ENERGY
I) Cihila.......taco,,f If, and ex prose,which cony in any way arcme against Suit
citylusot„egoeneeolTANUSrA DrmiIIro ,. 04 — INAL BUILD NERGY
APPLICA "r UNUhikSTANDS ANUW WI'rHALLNON-POINT L
So - FOULAT Ns Issued by: — Du[e
� z TEST
antrt orAtphefM ontma° to Re-roofs ` —
HAZARD( SNIATERIAIS DISCLOSURE
wllmeappncantmramrc ildmg .pam.mrcornaaalen don.mntedal TYpeofRoof 507 — FINAL PLUMBING
ac Jef bed by,he Cupanino Municipal Cude,Chfopmr 9.12,unJ,he tleuhh vnd Snfe,y
Code,5,66a253 + e
08 — FINAL MECHANICAL-
°Vc` rd / All roots shall t551WBpeeteB'0,dNtQ;0RRDLmg material being installed.
Will the applicant orfuture building result u,requipment ordevices which If a roof isinstffllfrywinho♦3t jgjgLb[}iQpgpq�glpFction, [ agree [oremove
emit hmnNnos air contaminants as defined by the Bay Arco Air Quality Management
Dohict] �� all new materiab f4 inspVj,gQAL4P I �typder d will comply with
°Yes all non-point source regulations.`
I have read the hmardon,material,rcyulremcnu order Cnan,e,6.95 of enc
California Haidh&Safety GOdr,Section,25505.25533 fond 35534.I understand ma,
if the huilding Jaen no,currently have if tenant,that i,is my responsibility to notify the
eventful of the requirement,which Il�fy_bawne knee of a Certificate of
r
thup cy. /
Signature of Applicant Date
r vin or uuthunued agent it, .,a All roof coverings to be Class "B” or better
OFFICE