00120032 CITY OF CUPECONTRACTOR INFORMATION:
Buu,ntnc DIVISION
ston PERMIT
BUILDINGADI��EKp PERMI'I'NO.
�87 KRZICH PI_ TRINITY GENERAL_ B C 001.20032
Ow'NI.R'S N APPLICATION SUB DATE
t�.]'AMANI 2303 GIANEVA ST J.2/06/2tZ00
PHONE,
(4'08) 313-3694 SANI'ITRY NO. CUNIROLNO.
nee>p ARCHI'rucrIENGINEER: BUILDING PERMIT INFO
e w❑F HI.UG Iil.liC'IPLUME MF.CH
a�W
day
SN I.ICIShatIaCON rancnlRsDrPum,ofTON Job Description
I hereby,afminn that 1 am IittmeJ under provisions of Chapter 9lcmmrcncing
uJ wllh seceon ynnny ornlvwioN onno easiness and rrodessiuss csklu.aml.,.y limner an
,_ SKYLIGHTS y^; i.in lilll linccun Ilc'I•r� �J�� -�
% UContractor
.•Class- jet Lie.p_,3,�99 R3
O� Data/a�_9f�0"75CHITIiC1':ti DECLARA'T'ION /
I understand my plans shun lie med as public necooko
w O O LiccmaJ hereby
irflnal
f1WNBR-BUILDER DECLARATION
1 nrrcny unrlsn mut 1 1.esusin noon he Cmnmerurs Lmrnsr Law'fu he
(_S%2
following loducrrums a amut In Io31.5.Business and Professions CCM:Any a y structure
Fea whirircymnesnpotashreroresthepliers improve.h penniitt me a sig anystructure
5:ea pal he issier...I,also myuirc.he:m,ln,ufor Comm,tninutilausi La,(Chapter
_
(coneusrm,isith „namuthaproInli..of of(beu�mcmorsu.oil11 Lion, ode) Sq. FL Floor Area VBlua n
ort:he,,she,,,g un, Saren uin anorhe bisien a lir me Rosiness olid rumsrtens colt) $1500
or,Timm he,,i.raempt any apple and Int basis Ter the m zs the rsemantIn Art,violation
of not mu than s iv any applicant doll for a peon suniats me applicant v,a civil penally
of not melt man Bve wndnea dollars rss(rB. A PN Number Occupancy Type
❑Losownerut hepl,opcn,,urmrmnployecs'um"lac.it,mei"i'l, n,nrn.naen, 36205036. 00
will de the work,and the structure is an intended lir offcned fur erlc(See.7("4,
Business and Prsfessienx Code The Contractors License Law mks no,apply no an Required Inspections
ter proprny won builds or nnrmees menenn.:,lid who Joel such work nin,selr 101 — FOUNDATION .
or through his own employees,provided that such improvements are ma intended or
oRcrrd lot salt.It,h...never,the building or improwmcm is sold within one rem o'' 1.02 — PIERS
`,eopmdol,,tha owneebninla,will have for norden of proving that lie did nem build or
on, orptip of sam.l. 103 — UFER
01.asref mm
e pperty,am esccontracting.lvely contracting with licensed cummcuum 104 — REBAR
Lonaiuctwthe pmiect(Sec.7014.Business and Prute%ouns Chea"rue,Centauri
icense Law docs bol apply to an owner of progeny whit holds or hnpmses thereon. 105 — ANCHOR BOLTS
and who cmaracrs b,r such projects with a comrac,or(sl rcen.ed pursuant to the
CracSEWER R WAWATERoonmrs Lic"Pou l'aw. 106
01 am usmnpt under Sec. .H&P C rot this reason
202 — UNDERFLOOR PLUMBIPdG
O'ne'-Date WORKER'SCOMPNSAI'[ON DECLARA'I'[ON 203 -- I_INDEP.FLOOR MECHANICAL
Ino,cnyallinhrpenalty olperjnly(one dthe l„uewingdcAwrmions: 204 — UNDERFLOOR FRAME
•, 0 1 have and wdm neimam a Crnircatu of Consent no sall-in...c Ihr workers 205 — UNDERFLOOR INSULATION
Compensation. as provided for by Sraion'370f) of the Lente Code. for the 301 — ROUGH PLUMBING
parlor:lace of the work for which,his perant i.issued.
❑l have ail will noaimain workers Cnmpensunsn 1,cm tan.a,oau ned by Soa,ioa 302 — TUB R. OR SHOWER
370 of doe Litho,Code,too he Tort..r„mace or the work mor whi,to his panni,b 303 — ROUGH MECHANICAL
d.h1y Worker's Compensation Insumuce currier and Policy barber arc:
Comer_Sr� rolicylvo.: /� _ 5_/—eD 304 — ROUGH ELECTRICAL
C TIFICAI'ION Ole IiXEMPIION FROM WO KI: ti 305 — FRAME
COMPENSATION INSURANCE
out,.rein need m,their..mpmted it he pcoa is tat or bummed dona,s 306 — 1"101—DOWNS
($10burle".) 307 — INSULATION
1 ccnify Inst in he r adormanse of he work for which his permit is issued.1 308 — SHEET ROCK
shun nm c upluy any person in uny n„m,cr.so as at hccome subject P,mo Workers
C osiosunonLiwoo Calif a.lime 309 — EXTERIOR LATH
Applicant
NOTICE TO APPLICANT 1L manakin,this Cemmcme or Estandim.roe sh..md 310 — INTERIOR I-ATH '
hnn
ec, e subject mine Workers Cnnpenw(ion provisions of the Labar Cede,you most
O mnnw:m coninywim such provision%or this pion shall the dmmed rcvukrd. 311 — SCRATCH COAT
VJ CONSIRUC'I'ION LENDING AGENCY 313 .ROOF NAIL
> I turnery animt mm mere is conslrucmion mu ding agency for the perbsoance
ofthe vurkfnrwhichthisrcnnitisissued Sur.3097.Civ.C.) 501 —
FINAL ELECTRICAL ENERGY
z 1 Leader's Address
Leader's;Name 502 — FINAL PLUMBING ENERGY
L O 1 aroil, he(Ihave read mis::pprcadol,and lah,than heubnvuinferuoaonis 503 — FINAL MECHANICAL ENERGY
y F renal.I agree m conoply with all cit,and c..stay o il,unms and state laws relmie, 504 — F I PIAL BUILDING ENERGY
O U to budstm
ding conrnon.and numb,umn... ,u neprcm
mrives ufty m po
his ritenter un
} u
the als, mantionedproprnyforinsprcBonpurpow<. 505 — FINAL ELECTRICAL
(We)agree to save,indemnify and keep hmamss tethe City of Cupertino against
Vm liabilities.iodgmruls,costs and csneroscs which Ina,in;toy way accrue agaios(said 506 GAS TEST
z city In c.......ryancc sf nurµramuflms of his coil.
APPLICANT UNDERS'A DS .COMPLY WITH ALL NON-KANT Issued by: 507 — FINAL PI_I_1MB IN Date
SOURCE REGULA Y'
/_t2 Q6 �� — t I CRI_
sisnaurco . br:I n,traam -. Late Re-roofs
1 'r.ARDOUS MATERIALS DISCLOSURE 509 — FINAL GRADE
wa1 dor II gram m mn,n.bull eg uetmam a1..1e.or handle baaanmos o,atrr� I Type of Roof
ms deleted by me CHIP,it Municipal Cale.Chapter 9.12,mod me Uruip,Cad Saba, 51 0 — FINAL PI_ANPI I NG
Cede.Section 25532(alt
G)cs DNP All roofs shaiNklinspecfedWiiir.tdr.Li,�Stobfing6dfiLl2lriF-I being installed.
w'IE the appocanm...future hhldingaccupent use aynipman devices wMch If it roof is installed without first obtaining an inspection, I agree to remove
calf hamrdnus air com
onnn'mas as drlicd nby the[lay Area Air Quality Mm
nnageani
Monier? all new materials for inspection. Applicant understands and will comply with
0)c' 0N all non-point source regulations.
- haread bNous ve the tummmis myuinemm�(s under Chapter 6.95 of the
CaliforInia Ili l(h.F Sa kNy Code,Scctinm 25505,25533'lid 25514.I mWanr ad nwt
illncbuilding,Psairl curt hill
I urn:ml,mhu primyrmn,r all ity,fifit(y l of ,
Cupp nu nl'(hc rcyuimunvnl wblch n I 'I prior Ili Lnuu u¢c of a C�nillcu¢ul
Occupancy.
Signature of Applicant Date
—�-� All roof coverings to be Class •B's or better
Desna er luta..d..a n Da(r
OFFICE