01040069 CITY OF c UVISIP ON
BUILDING PERMIT CONTRACTOR INFORMATION:
HUILDING ADDRI?SS: PIiRMI'I'NO.
890 FERNGROVE DR 01040069
I iWNlil1S NAME: APPLICATION SUB DALE
�v �crf�q�,o�/ 04/16/2001
PHONE: SANITARY NO. CONTROL NO.
❑z Z ARCIR IEC 11UNGIN IBIL
til O O_ BUILDING PERMIT INFO
z u G •I UG F.ECT PLUMB MIFCH
v�6 r L — —� -
F> IACF.NSHD CONTRACTOR'S DECLARATION
_z=C I hereby allium mal l am lirriaadinder pmvisiomofcnapeer 9 lrommcneing Job Description
an Section 701U)of Division 3ofthe liusincssand Prols—o on.Code andany Eecnw -
a — i,inmuroraaneeuJ<t. ADDITION 406 S0. FT.
z u 6 Liecnsc Class Lie.M
O a U Dom Cunnaclor
u"3 ARCHITECT'S DECLARATION
C=0 I unJeraund ml plans eh:Jl the wcJ as puhlic mcurJa '
u°l m p p Licensed Professional
OWNGm Hxerapa r DECLARATION
n a I nemh>a0inn nut I am exempt Gose me Contractor F License law for the
z< Rtlluwing rea.nn.(section 7031.5,Hi sinea:md Pmfesaiom Cole:Any eily nr canary. .
o which requires a emat u,conwua.able improve.demohsn.or repair any%tmc(um
a
3= Prior to t :vane L y te happlicantl npenit fl g d.rtrnern
th-u lic is walwd,un,arint to the p I theC t I I- (Chapter 9
(commencing met 7001 n> it 3 otse Business and Profession,Core) Sq. Ft. Floor Area /� O Valuation
orthat l pt hemlaran and the azoi, or the adleyrd e i pI on.Any viola)n i -
bit Section 7031.5nyany applicant frapermit subjects the applicant it)a civil penalty
,if not seam n..five hundred dolbrs APN Number($50)6 .Occupancy Type
I,as owner ofthe Not army cadovec..with wagesasmdr sale compcnvtion.
will do the work,and the nruclum is not ialmdad err..tiered for sell(Svc.7014.
Husdncw and PmG..ion.Cao:rhe Con era..,'.License law aces not apply m an Required Inspections
nrmr of propahy Who builds or improves Ill...m. does used who ds suah work himself
rough his own employee..provided mad,such atpmxmoems are not bteade 1 a, 101 — FOUNDATION
olrered for sale.If,however[lie building or improvement is.old within one year..( ,
omplelioo,die owmr-nnilder win have me burden olproving(hal he did not hutld or 102 — PIERS
improve I'm pwpose aIf,.IeJ.
01,as owtcr of(he property.an exclusively contracting with Hamed contractors to 1.03 — UFER
Lnnsuuct he pioneer(See 7614.Businen rad Profr.elnn..Code:)"a Camracan'n 104 — REBA R .
iemi Law doe.nor apply m an owner..t property olio builds or Ilnpmvos(hernm. .
and whn contracts(or such projects with it contractor(%)Gcenmd pursuant to the 105 — ANCHOR BOLTS -
Contmctors Licemc Law.
..lase nam,ipl unser see. :H dt P c torch,reason - 106 — SEWER & WATER .
e__
202 — UNDERFLOOR PLUMBING
WORKER' C'OMPIiNSA'HON DeCLAk TION
203 — UNDERFLOOR MECHRIVICAL
. I herm,y mYicn under poouLLy lir per ary one al'the nAltev ng dalamtiom: —
204 UNDERFLOOR FRAME
C I have and will n Inulin n Cby Gati of3700 o m.idilleure for worker's
Compensation, he pm„mea ser lir sellout 37IXI or me ewe. for mu 205 UNDERFLOOR INSULATION
isc01cmiecar ouhework nnwhich Rliempensil 6issued.
Insurance.
301 — ROUGH PLUMBING
C 1 have and will maintain worker oCnmpcce(It l ve wall,f r rice ld 1 Section
1700 err Inc lamm cads air me pnemnoame or Thu work rte wn,en mi%„ertn i% 302 — TUB & OR SHOWER .
issued.My Worker'a Comperomme.lntrareCeamcr and Policy numneruc: 303 — ROUGH MECHANICAL
Carrico CERTIPICArF
10NOEXFMPicy NIONFROMWORKERS304 — ROUGH ELECTRICAL
COMPENSA'r1ON INSURANCE 305' -- FRAME
(Tse..ce(ionneedliIbe<amploadifhe mal I,f......ahundreddollar
($HA ?06 — HOEDO($10d)lir Iexn.) J
I r1riry that in sen perfontiancc of he work dor while did,wont m is rad,1 307 — INSULATION
shall not employ any person in any mother so as to become subject to the Workers 3019 — SHEETROCK
Camper-amn laws of C.1fid min.Dam s -
NOTI'In' 309 — EXTERIOR LATH
Applicant APPLICANT:If,alter making his Ccnificem of F.xemp(ion,you should
OZ . beoome number'To IT,Workers compelicutioo pmoidaneonie Labor Code.you mn.I 310 — INTERIOR LATH
O fonhwitn comply with such provisions orthis pomrit shall bl deemed revoked
S 311' — SCRATCH COAT
r Chats them is
LENDING AGENCY
y > hereby whim(ma(mem is a Gonad(Soon lending ogecer rte me„ onuaha 31 3 — ROOF NAIL
II he work fnr which Ills permit I.isxucd(sea 9097.Co.C.)
i c Under',Address 501 — FINAL ELECTRICAL ENERGY
p 0 lnider'endifyth 502 — FINAL PLUMBING ENERGY
V O I eelnf)'Inert I n:wc r<eJ this ity a Iddon any onaltemet the ebur of ;pion g
w F eruilbermhaemlmlrwiseeHcarintiotomymrialt,(Iftistatetow.eruion 503 — FINAL MECHANICAL ENERGY
O u ( building f do any m rep treCity citytoenter upon 504 — FINAL BUILDING ENERGY
r ry) (hc,M tiJP pnyf p 1 rpi'
t o `4 ”, 1 8 ( 1 fy I keep h I.:me City I Cupertino against
UVi Luba( judgments. a pe n 1y any way < s'nalzalil 505 —' 'FINAL.. ELECTRICAL
Z rIy ey ie ie<anh gaol iy orn,i%p t � _
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N;N POS 'I, 506 _ GAS EST
SOIIRCr:R ULATIO.NS�..���L/i � ! Issued by: ate
Sig mfApplica c not Data Re-roofs
nroRDOUSSldc... ..stcon,oslanl 5438 — FINAL MECHANICAL
Will yfluvC P"ime,A\iieii ll Core, upattwueor bridle n bahlnnsmatfety Type of Roof
cubeb any tie cupenbo n �pal coda cll:mtm'9.Iz.:Itd he lmalth and sarelr. YP 509 — FINAL' GRADE '
Intel
al
Come Sarram 255J2N)p N 510 FINAL PL tdNING.
0yeF All.roofs shall be 1 cted
P '��, ,�p� p � t��r� g installed.
Wrdousai,c applicant befiingmcupantuAeaAirQmlityM Management
If a roof is installed 1 out'flrstb'K� uni61"'• `tgilsp'ectidn�agree to remove
elnit barunlnus air wmm�tin'� Ino.Juhnea by llu Bay Arca Au Quality Mana6s'unem
Di°de0 all new materials for inspection. Applicant understands and will comply with
( � ❑Ye. a No P PP
all non-point source regulations.
I nave read(he havrdnus materials rcyuitemcnu under Chapter 6.95 of the
Culifnrnill Ileallh R S'.Jc y Cndc.Sections 25505.25533 and 25534.I understand that
if the building does not currently have tenant.that i(is my responsibility to many me
eccupem of the regoirancnn which must b:m<I prior o-,i,mm 'o of a CertiGca e of
Occupancy.
/✓ �� Signature of Applicant Date _
10wn i d,earBent Date All roof coverings to be Class "B" or better
OFFICE