00110007CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING REVISION PERMIT
BUILDING ADDRI?SS:
PERMIT NO.
6
' RS
0141 10.7107
OWN'IiRS NAME;.
_
APPIACAl]ON SUB DAP I!
ONE:
- � GAMPI-IR
PR
1
SANITARY N C R L 'O.
c •. /
27 —r . �
Vc A RCH rmc'I'/HNGIN HER:
"'
BUILDING PHRMIT INFO
O -
BLIXi ELECT PLUMB MI:c 1
w
IJ I—I I—U 1=1
j LICLNSIiDCOKI'RACfOR'SDCChARATION
Job Description
1 herby slit irm mal 1 an, licensed under provisium or Choana 9 (mmunenciny
with Sedan Al00) of Dlvisio t nfthc It re" melt, msiune Co I my license
Is in roll force Roti efrmr.
Lmema Gla,.. ���7 Lie.N _W__11 �.a� .r�, .,I
Date _I
TENANT
IMPROV
�Ak 111 CI CI S DBCI-ARAl'It1N`�`'"�—P"E-k"'
g I understand my plans shall he used as public mond.
OLic... td I'm e,,it nal
OW NHit-BU1L111iR DECI.ARAI ]ON
1 nereny union that from the I am exempt frothe Cunrnmmr', Users. Low ran Na
,,ion, Pro.,nion, Codc Any city or county
rnllowins rtmnn. (Section 7031.5. Business aProm
D which ¢quirts a permit to construe,, almr. improve, demolish, or repair any structure
prior to its issuance. dsa myuims the applicant for inch pinion to rte a signed statement
Ft. Floor Area
Valuation
— that he is licenseti pursuant In the provisions of the Contractot's License I,aw (Chapter 9
(commencing with section Talo) of Division 3 of the Business and Prnre<+ion. Cock)
.
or that he is metnpt them]rom anti the basin for the alleged exemption. Any violation
of Section 7031.5 by roy apdmon fine permit sub;ats tee appy mil m:t doll 1re'nalty
APN Number Oc' Type
or nut mere Elton me humnea doll." (SMO,
pancy
❑ 1, as swner of,hc pro,rt, or my employees with wages as rneu sole compcnsmin.,
will) d k d the is Iintended O d f I ISG 7(Nl,
1 d
os
G' ( v
tions
Business dPmf:: Cd Th C t a : L t pplytami
owner I p reny Whosold—, e. themJ M1 J, h k 'hose mself
b' IJ,Sr'
- �eyuiredllnspe
I
or th bhl: PIS P JdtM1 ... l t t
t frmul Ir Ili h l I' 6 P : ld lh' y ar t
,,((
�j
' i�
conplt Ili h ld III rl h d tp bthrl d'I Ibuild t
� -�
l?li_
PT R
❑I. as owner of the property, mit excimael) contracting with licensed conrect,rs m
103
OF . 1
crammer the project (See. ABJ, business and Pose ensionx Code:) The contractor's
] 04 -
P,EBA R
Liana lame does not apply to an owner of property who build.. or improve. themor.
and won contract, for seen project, with a conmanor(s) licensed proonnt to the
105 —
ANCHOR. BOLTS
Cnnacann, hiccnw I.aw.,
❑Icon.mplttmlc,Sec. .It&PClot lIii, mron
106, -
-
SEWER 8 WATER
°°'iter Dat°
202 -
UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARATION
203 -
UNDERFLOOR MECHANICAL.
Ibench, alnm,order enir,of ru nneofhemile-insdecimations:
204 -
UNDERFLOOR FRAME
have and willmorta;n a 17crulkam of consent m .elf-in,me or Worker's
cm„pennrtmn. Its pinsider! I by sedh,n 37191 of Ie Lubin cede. fir me
20,''.-1 —
IJNDERFI_OOR TIdSIJI_AT.TON
pet -C mance of me work rot whim anis permit n issrcd.
301 -
ROUGH PLUMBING
enution Ince, a, myuirtJ by Section
❑ I have and will mainuin Worker: Campsuran
boo or ❑,e "Nor ewe, rnr me peHomnanee or me work rot whim this permit is
3112 —
TUB 8 OR SI'IObIEP,
issued Aly,Woorfkees(ss Cou,se�nyuyttii�onn1 Insurance carrier and Policy arm ,�a rye:
Cmrier:�1 trill l'' k1tl,Niey No.:QQ
_^yp3 -
ROUGH MECHANICAL
_at(�
CERm,CAIJUNOE1 1: PTIONpauMWOR :RS'
3tj �l —
,
ROUGH EI_ECTRICAI.
COMPHNSAI'ION INSURANCH
305 —
FRAME -
(this seaion need not M complete if the permit is tar one hundtw dollars
31216 —
I'IOL.DOIdhIS
ISI W)or lc,n)
1 cen'Ify that m me pcitorn ance of the work or whim this permit is issued. 1
307 —
INSULATION
stmt mit ell,ploy any pursal, in any onuacr so as to lwcoinc suhjecl lu lire wurkerss'
308 —
SHEET ROCK
Conyamnmion Laws or ealilbmia. Date
nppli`'°300
-
EXTERIOR LATH
Ncyrlce'r0 nrrlacnrvr. u. slier nl:aiug anis cemrcatc or Baelnpm,n, you mould
became .un;«t ,, he winker, com,mdian pmem.., orthe Ula , code. you mrd
31.0 —
INTERIOR LATH
forthwith colnply with such provisions n, his permit :bull be danced invoked.
311 —
SCRATCH COAT
n CONSTRUcr[ON LeNDINGAGeNCY
I hcmny ancon mat mem is a comtmaion Iendns aency forme nermnnrare
313, —
ROOF NAIL
of he work ILr which this pmol, is issued 'a. 7ti97. Cie C)
1.amdcr', Name
501 -
FINAL ELECTRICAL ENERGY
I.cwer's Addm,
502 -
FINAL PLUMBING ENERGY
I cenify that l have mad this application and shim mot be amwe mfonnmmn is
<ortnt. 1 agree m cmnply with all city and county onlinance, and state law, mint,
503 -
FINAL MECHANICAL ENERGY
t, bull b t r dh by' tb r p I'I': fm' ityt up,m
y then 1, l ,I I'I p r
5021 -
Y
FINAL BUILDINGatye
y (w)', : 1 'ty dkeep 1 less 'it, cry tc p r ibtina
n rend, ) 1k, nt nay oa,y y msasanstsan
—Cn
—
FINAL ELECTRIC
4aense of to a l r nl , r.
APP KrUNDHtST I S ND WI C 'LY WI ALL NON h /
SOy
1�fp
ISSDed b 1W e_
y —
GA�Wj ]„ f.�C
Si ru e n lieunl/Con acYnv pian ,
s pp
ugE
BAZAfoure Mnnaor,u,
e
Re -roofs
508 —
1 PLUMBING
FINAL MECF'IAhITCAI_
state 2. ba'anHealthan murmid
whi nit nr I nom
Type of Roof
ndthandle
Mrairi al Care, Cham
a Cu,anr
a, de. Sec by Inc Municipal CnJc. Chapter J.I2. and me Ilcallb and Salcey
509 -
FINAL GRADE
32(a)!nn
Coda Section 255321e)!
ove^
All roofs shalFb�linspec(-eJ�3ii�irtcfdnPWITrCif'material
being installed.
WE he splicer, or future building ocapad use cyripmcat ILriles'iec, whim
If a roof is insTh11�t1 wittl�Jtflfir�h,.olitlSiV$dgL�fi'i
idJ(i2$IfdtI, I agree to remove
emit huntnlnus nr anm^minan6 as leinthe Bay Arca Air Quality Marmgcment
Indian
Yen
all new materials for inspection. Applicant understands and will comply with
all no int source ye"po,
1 nave man we haaaulous „rateuls req retnonts under enarmr 6.95 or me
/���Califumia
Health k Safay Cr Suri ,_255(. 255Aand25y3a.lundcmmndh,t
/�)Tf
/
M,'I boy Jsasnmcurter y a cnanl I ai,nmy nsponninilryr)notil the
Tf the requirement x t prier to iswamr R CQ1ti� ”' l of
l/ / 6w
`I
ku icy' r
I
Signature of Applicant
Date
'/ —_ II /-1�
I
All roof
coverings to be Class "B" or better•
IX}ag—, )ale
111111
— OFFICE