00100064 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
INIIDIN .ADDRESS: PHRMIT NO.
710 •1
OWNER'S NAI,4.2- ZTANIP-EAPPLICATION SUB DAI'H
PHONE: L;HIAIJ —TPPff _ SAN11'ARYNO, CONTROL NO.
OC ARCHIIEC"UENGINEER: - BUILDING PERMITINFO
w RLW1 LEC'' ' UAIB Stec"
Han. WCENSHI)CONI RACIOR'S DECLARN'IUN
lintnmtrltnr,enrdrndcr wm'Chnt 9(o. JobDescr' tion
�o todj pL rine
r_rw whn swtttnx1B11Dv'.oninrmo Basinr..atm l't rn,.^ttrc to ttd ern.
Y J tee toll i.",Intl cl�jy. L O e+i —
�6 wcl°'^ (� u,.n (O , J BATH REMODEL /
CLL Date connamr
—LL�� r,,+I ++ ARCIII I S DF,C RATIO
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o OWNERdi U ILDER D17CLARNI'ION
>¢=m I hereby n(Sect on 1 inn e¢mpr from the Contractors LiAny v ly o tin rbc _ /
h=a
following remoa.permit
t 703 1.5.Business and Pmfe„ion,Code Any easy or county `
F c whsM1 ts I+c nl,. t 1 Itis- f J lain p y.t hura
ii 3 e� peon r - Iso q th i,mr, t t M1 i ce, is g (Chapter r them
mato I, ,uaft n p ns nn cnlfclrf,L n 1 ' ,Code) Sy. Ft. Floor Area ablation
remnmcmis a wish Serunn rin trim he thasis 3 of the Ihoi , me Ir ioh Any vi CMI)
or that he is 31.5 b therefrom mW the hum Ins the alleged,, hee,h,aha in
Any violation :y
of net nu 7031.5 by anydred inn for apermit,uhjeen the apphcunl aracivil pewlry
nrnmmnre�hanr,.eM1unermd,tRnr.aStlo). APN Number Occupancy ype
01.a,oxmer of me property.m my emvinyec,with nage.as mrir.nle compensation.
will do the work•and the strunum i,not intended or offered for vale(Sec.70,1d.
Business and Professmns Code:rhe arntmcfor',Licenw Law does nor apply m an Required Inspections
of propmty who bddd,or intl+ro,e,thereon, suoin
and who does ch k himwir Wth age his own cmpmydcs.provided than such improvement,are not nnmmed or --
offered far rine.u
rin :horo
wever. e building or improvement is sold within one year of 101 — FOUNDATION
m+mpletiton,the oweer-butider will have the Horden of proving that he did not build or 1 02 PIERS
pm•c pumowo
O I.as nwher ofine property.am coda%rely contracting with heensed contractors to 103 — UFER
"sumer the pmia,(See.70,14.Bos ,s and Pmo%sions Cade,)The Commelmr ] 04 — REBA R
consumer Law dose tmI uppiy Ir �+rpmp<tty who build,or...........th,rcon,
and who cataracts e,r such pm;ec�is with a comrlmmrt,l licensed puruant to th` i.05 — ANCHOR BOLTS
Central Licenw Law.
❑I am exempt under Sec. .B&P C rm this reason' 1.0E — SEWER & WATER
OwnefDat` 202 — UNDERFLOOR PLUMBING
W'ORKER'S COMPENSATION DECLARATION
larml, ilf andr,,tallyol criuryo^e ofdrehllowingLie,Lawine X03 — UNDF_RFL_OOR MECHANICAL
• ❑ 1 have :rad will maintain a Certificate,or Consent to self-inow, rot.Work=er 204 — UNDERFLOOR FRAME
Com,manon, as provided IF by section 3700 of he Labor Code, Ibr the 205 — UNDERFLOOR INSULATION
performance of the work for which this pcmrit i,i,iced.
301 — ROUGH PLUMPING
"
D 1 have and w ill mai main Worker's Conn,mmalion Insurance.as required by Section
3701 of the Lamm Core,rm the n,rR,rmnndc or he xork Ib,Weide this perms is 302 — TUB R' OR SHOWER
.surd.My work,,,Cnmprorwino In,mume darner and Policy a Imbr,are
303 — ROUGH MECHANICAL
Currier. Policy Nu.: - rT 1'l
CIiRT1I+ICA1dONOF EXEMPTION FROM WORKERS' 304 — ROUGH ELECTRICAL
COMPENSATION INSURANCE.
(This wanin need not he completed arms pennn'I,dor on,hundred dolwm
305 — FRAME
0silalm i,,,d - 30E — H01_DOWRIS
1 demi it nt the pcamnrand,of h work I ehl,n f p<•nrrit i,isam.1 307 — INSULATION
. ail t t e t ro rhe Workers
rap t n _ 308 = SHEETROCK
M1OTICI tI' IILICA , u n A gtM1 cur re nr E,mrmt nn.yna.nnam 309 — EXTERIOR LATH
bear 'oh,
d•W k L ,nsm an ,ofdmLanrncodeyoahaal ?10 INTERIOR LATH
p — ttrmwthct silly w'm st mr lh v. rth.�_ t.I uhedcened cvrkcd
Z ^ CONS1 RUCI ION LENDING AGENCY 311 — SCRATCH COAT
I hereby ammo that them is a conswaion lending agency lbr the performance
z > Nobe Work for.)inchmi,pmail isironed!(Sec.31N).Civ.C, 313 — ROOF NAI'_
Lender's Name 501 — FINAL ELECTRICAL ENERGY
Linder',Address
U O 1 certify that neve rL,LI this applityaon and stain mm me above iolimmthon is 502 — F I NAL PLUMBING ENERGY
W. H comely,agree tncon.plywidrall Lit,and county mrdinaoccsand smmlaw,relating 503 — FINAL MECHANICAL ENERGY
O U Io building aommadion•and her,h,amhoriac eprewtnative,of this city to enter upon
a: healrove"rnentionedpmpe^,kumo ,`ti^^pnmo,e, 504 — FINAL BI_IILDT G ENERGY
p. a (We).9mcm,ove.indemnify and keep hmtm,..,th,City of Cupertino alsain,r
rn hanaiti,,,inegmFnr..eo,isareae,prnrr,xnicyrraemeasam,tsaid 505 — FI EL _CT ICAL
U Z j"4"VtTN
- onsequence of the Llano of this
ANN UNDERSSNU DCOMP' THALLNON-POINT ISSIICd by: SmFd — G DBICMOW t t-ofAppficam(Contmclor Date Re-roofsHAr'RDOUSMATER1ALSDISCIDSURE 508 — F L MECHANICAL_ill rhe applicanor future building macupmn store or hardie hwank,as me¢dW Type of Roof
d by be
Cupchi^o MuniciRd Code.Chapter 9.12 andthe l ImIth and Safety 509 — NAL GRADE
Cale.Scerinn 25532(1
0 �g Ili I l-r
Ya El All roofs shill beaiSjZctEd FniPl(4an�10 j'It,rtrial being installed.
Will the apphcamm much,bnildingtw,upunt use equipment miles Lee,nhi,h Ifa roof is instilllEdIt ithcrut E lNSBhaitttH9Rh'Wpeb1 R.lhlgree to remove
emir hazardous air contaminants as defined by the Eay Area Air Quality Management
Di,nice all new materials for inspection. Applicant understands and will comply with
0Ya 0 N all non-point source regulations,
1 time read rhe haanlow materials rcgnircmcnl,under Chapter 695 of the -
CAL.m'm Ihealth he Sufery Code.Srellnnv...^...fff���IIS,25533 i 125534.I Inde swod Thal
M1uilding dila nor cu�ndy huveane sato mY ro��unnibility mnmlfy the
Fla,
mol the myuirnncm, dM1 ,1 rr m hs pons of a C,,malt re of^p heSignature of Applicant Date
+ ranermiar,Ilagenl omc All roof coverings to be Class `B"or better