01020072 CITY OF CUPERTINO� - I - . _
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: '-
' I'IeRMD NO.
OWNIiR'S NAh1E. — 'CSI
APPLICATION SUB DATE -
. — AKIk. Oil/1 4/.'-�I,71I
ONE:
{ _ SANITAIiI'NO. CO.NTHtII.NO.
ARC{II'1'ECT/ENOINEI R: - BUILDING PERMIT INFO
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z O m Z LICI NSI D CONTNACI'UH S IILCI ARAI'ION, - Job Description
O z_E I h2reby atfnn anal •bead n p v al(..Code a mmenc ,gs k _
pm�w is in S,u , ]fNHpofD', lllhc Pi JI le, CJ Inlylin xu
y Y f J in 1,II line and effect.
zz6 Liemnc Closs Lic.0 o 1 .
wgLLF Dare cammelnr INTERIOR REMODEL
ARCI II'I17 DECLARA'1'IUN '
1 understand my
plans snail M u.m as public mentis
ypl L.. Ilaf.:I Lot
nµNIK If 1111 UER UI LAR AI ION -
m n, by ff ,nm l exempt f „h C , I' 1 for
loThe ,••� D I'
t z Chi
na re i , Section,
It]Oil 5 B . profession,
Core'o y ty ..ane •3 t Il
lTm o ,
print
I '
tl , I h diabolist, p ) .lane
.. ,. ,
d3F ,Iapplicantt IPG a fl t l7, ne
mm I0Canonical mal(� i)( cg�hSenW1jfDYra 3,, te "irs" dprosuceSq: Ft. Flo Area alua[ion
,r Ih.I he it Is, pt here and t he hall s of the al LL cxcn all in L.Any Ablaiun - ? - - x
of Sen tan]031.5 by any applicant lira permit subject.the app]count to a civil Penalty 9 9
am m rbattered '(ssdn) .APN*Nu er Occupancy ype
❑I. work.
t - 11 or ed lilt ice„pau.ai•
will n the k II t 1 no, Jed offered for snot apply
no al "
Ila., and profession,Cods: th Contractor's License Lax Jces not apply m u e ulred Ins ectlolls•',
r nr property who hulls or improves thereon,and who does mch'work lannell q P _ -
ur Ihrnuph his awn cmpluyceu provided,hat such;repro cianna n are nn,immnded or
offered lot sale.If however.,he building nr;mprovement is sold within ane year of 1. — FOUNDATION
unpincompletion,Ncowter-nunllcr will have the burden or proving Ihal ho did no,build nr
,h,r u
s p m,•xtoL.olel. . . ' ,102 — PIERS
La.,�wneronhe vroxdY.nm exeta,;,-torcamm�mg wall iietnted alars'ars no 103 — UFER
I, .
nmt the project Sol]sumu
s,Business d Professions C,alep The Cnmmclars
1 tewe Law ane,eat apply Io a„owner o.pmvtrly who hale.n,In,proxn, he,,ba, 1 Q14 — REBA R- .
and , nm f h p y I, all rm,m(s)he iN11WCAf7_
`u:ml to due
Carnations . 1,05 — ANCHOR BOLTS-
Pa
"set - R , . 1.
x•%v'V/ 106 '— SF_WER tt• WATERS.own (d�g{Kycpn DasenTlouDECLARnr , 202 — UNDERFLOOR PLUMBING
I hmehy nllvna under penally nr perjury hoe of the hJlowing Jed:uutinns: ..
o
203 — UNDERFLOOR MECHANICAL
. 1 have and will senile a"Cenincae or'c,nserm to.elumtme rm warker:x 204 — UNDERFLOOR FRAME
ularme I,o. he pn,vhlt tar by .echo 3n al of he Labor eters. for me `205. — UNDERFLOOR INSULATION
Is detente e.the work our which Ihis pencil i..issued.
IDIhall J Rrhm w 1, Compervaliars 1 : :ml ' dbys tion 301_ — ROUGH PLUMBING .
..37a1 therL b code r 'Ito IDI k r I Rn':perful,j, 302 TUB & OR SHOWER .
sued.MYworkers CmiTionadieni,mranuemiran,lnb,ya,nberam. -
Carrier: Polity Na: 303 — ROUGH MECHANICAL
cElrrlracn'noN OP eSILL ION FROM WO11K13RS304 — ROUGH' 'ELECTRICRI_
COMPENSADONINSURANCE '
Cl his section nem Lou be It deled it roe permit i,felons,hundred dollars ' 305 — FRAME
f5lam ar h,.,./ - .306. = 'HOLDOWNS
1 Ionl;fy ma I..he I,errorom a or the&ark for which R,;.Permit i..rend,1 307 — INSULATION
shall all employ any Person in my manner...or,m beceo,e...hind m,ha Workers' ,. -
camPemaatinnLaw.ofCalEomiaDole 308 — SHEETROCK'
cmarAppliant`
NOI'1CCIOAPPUCAN.1 d nrn k Bah crtnl tentExenphanyoumoulld- 309 — EXTERIOR, LATH
t dlhe L I Code You .0
ou
O O forthwith comply with Bahlabileclallorm perom, hap be dee and revoked - 310 — INTERIOR- LATH
y CONSI'RUCfION LENDING AGENCY 311. — SCRATCH COAT
> I hereby ahlnn than,lerc is a enml[tm,inn lending apace,lin',he'perlbnnanoe -
of'he lark far Itudh min ,all i,i..ued(Sec.3IN],Co,C.) 313 — ROOF NAIL
q I.endnrxNamn 501 ;, FINAL ELECTRICAL ENERGY
Z Lender's Name x
O 1,nnrythatIbme' dun p,fia; dttthat th n fmrt is S0^e — FINAL PLUMBING ENERGY
OF. eonuel lasre', ,nP1r 'm R col aL L nd of 1 do -503 — FINAL MECHANICAL ENERGY
V nbult g :t ,y nye th c rive.of 11 tyt n tp, ..
W titan„ t' It
indemnify
inspection I P e. . '.
U z c,y'ta po niknpn much, fc Pn' gaI'st 504 FINflL BUILDIPIG ENERGY
[r G 1N 1 % t a Iod
.. rn tante. ydg Pullmans, , II pe fen ,'n ,suer ac aya'nm s:dd' 505' — FINAL ELECTRICAL
Lupe Doral, g, air g D WILT.C d.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NUN-POINT GAS TEST h '
SOURCE REGULATIONS. Issued by: SISI°., —
Datef��f
Sagnmmn oo Appbcanv/caahacwr , Data Re-rOOl's
KAZARDOUS MnTERIApat store DISCLOSURE 508. — FINAL MECHANICAL_
Will the applicant or future FuiLhng„ecap,nt amt or nanJle l,avaainus tnaiffei, TYPe of Roof
ax denned by mee,menino Mamnip:al code,cnapmr o.12 mud ma Hamm pmt sera, 509 — FINAL G RADE
Code,IjySliolo, 2553200? o ''tr hip L
❑Y�s C1 No nr TO •ny RI
' . ' Ali roofs shall be iDS�y�tedpF (o I �ilal.bein installed.
WILL nue:apnheammlLma:nodding neeamam use eyoipmam or In,L's,wroth Ifa roof is installce�i4hom fFs!•s iilir -�lirlect i tg� f.•
eanit huuvJnu+air mmm�ilnunrc a.denned by,be Bay Area Air Jnafity,Management ree to remove
"'"ore. - pN„ all new materials for inspection. Applicant understands and will comply with
Lill non-point source regulations.
I have rnud the hvurdnns mwmule}eyuirement.under Chapter 69 or the - -
CunromiaHeal &Safety Cole,Seniors 25505,25533 and 2557A.1 unJermanJ thin
• rice bt IJ' g ,i Hart lyh tenure m tl'. ty Lent hl'Iy, Wiry the -
Op t reme
cc
a
,. h' h ust be , I C i'cute of
Signature of Applicant Date
. owner, ..or - 'All roof coverings to be Class `B•' or better
r .. .
OFFICE ..'