00040152[01001Hml
CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISIONPERMIT
BUILDING ADDRESS:
P17RMTT NO.
CONSTRUCTION
INC 00040152
OWNER'S NAME:
+
APPLICATION SOB Dn'I'It
3421. GOLDEN GATE WAY
04/25/2000
5-/O
IU)NF,:
(929)283-4550
SANITARY NO. CON'ISOL NO.
1
ARCHITf:CT/ENGINHIiN:
BUILDING PERMIT INFO
pI,DG 1:1,ICCf PLl1M1ld MECII
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LICIiNSBD CONTRAC'TOR'S DECLARN'IUN
10b Description
nO
I hereby allirin that 1 am licensed under provision. of Chapter 9 (commencing
to
-t
with See,inn 700)tol Division 3 ul the Business and Pmfa..ions Cude, and m her a
In full force and chic,.O/
5 �
imcnse Clan IJc a
TENANT I M T
I.h
Dwa Connaen+r_ _ _C _
ARCHIrEC1'S DECLARA'I'I(N
4
1 understand my plans shall be used as public records
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Licensed Pode,,o nvl
OWNER -BUILDER 3R DECLARATION
hereby touch tMfI exemptfrom the Coal ruonrr's License Law lin the
<
full5 1. Any it, mar umuure
requimon (Sent 9os s, t. alter, Inti cc,demob
D
h, or structure
improve. m,
which requires a pamif m enmmucf. peer. improve.
which
�n
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h ermiit i e a %ir'uny a
p,m ,'. 'I. y ,h pal 'u fl such lin fl 8 dzfinemem
Sy. Ft. Or Are
V•I TI 1
than I. d"moment t ,I c n fin C t +Isl I (Ch: y It,9
(cmmmenc ng nh Section 9o1M) of Division 3 f the Business nd Pn f :. ns Code)
or that he is exnnp, therefrom mod the basis for the alleged exemption. Any violation
mal Sec,inn 98.31.5 by wry applic n I for out (wind subjects thea,,,,. nuu a civil penvlry
APN Number
CC lncy Type
of not mon than Gate hundred d.11., o5ML
covincrol thu propcny.o Illy employe. ssith wagts to fbci—olacntnpcn.uttun.
Required Inspections
will do the work, and the structure is not intended or offend for sale (Sec. 9144,
The Connector's License law docs to
Business and Professions Code: on, apply an
oI' inumay Who builar d hopmves Wetemn, Intl who does such work himself
through his Ian customers. prodded that such improvements are not (mended or
orn
101 — FOUNDATION
offemd for .sale. If, however, the budding or improvement is sold within one year of
wilhave Ibdnteongut hadidnot buld ter
m
102 — PIERS
imnplc.wilde
�promenr paHseoame.1.
103 — LIFE R
❑ 11 as owner of the pmpcdy, ut+; esla.ively evn o,ou g with bo,ow l I notaors m
the project (See. 9wa. Bmines. and Proressimo CtdcB The commcmr.
104 — REBAR
LiIsmael
moa m
cense Law does not apply owner of pperry who builds or improves fherenn.
pad who cnmo-aus ter such pmjnns wire a cmmmcmr(.) Ilcnmttl pmrsaamt l+ roe
lyw.
j 105 — ANCHOR BOLTS
0
Conlmctofs License
o lam commit under Site . H& P c larphis reason
1.06 — SEWER R. WATER
Owner Date
✓ 202 — UNDERFLOOR PLUMBING
WORKER'S COMPENSA'f1ON DECLARATION
203 — UNDERFLOOR MECHANICAL
Ihereby affirm under Penalty orpedaryclic (it the fnm+wingdcclamlon,:
204 — UNDERFLOOR FRAME
I louse and 1111 maimaio a Cor11Geam ter Cmmenl to self-ii.mro Int Worker's
0-9 — UNDERFLOOR INSULATION.
compensation, as provided for by Section 3981 of the Laror Code. fin the
petfarmvnce of the work far which this pi is I ... ed.
301. — ROUGH PLUMBING
-base many rill maintain Worker's Compvnsallmn Insurance, as required by Section
302 — TUB & OR SHOWER
30(18 of the Labor Calc, for the performance of the work for which this permit is
issued. SO ca+;pen.atimnnnnmpntte,IrinamlPmGtynan mer fc'
303 — ROUGH MECHANICAL
carders. [',)he, No.: ul's/f164 633
3@4 ROUGH ELECTRICAL
CER'TII'IGTION (1P EXICMVfiON FROM WOR KEIiS'
,—
COMPHNSAI'ION INSURANCE.
_305 — FRAME
frills ellion med.1,n he am+pleted it the penmif is for one hundred dollars
306 — HOLDOWNS
151 W I or less.)
307 — INSULATION
it is isod. 1
I cenify amt in the perrn.. c,, of fhe work In, which this perm.m
m
nnau urn ennpmy am in y manner no )s m, ney�=ne smh)ee m me Workers
3Q18 — SHEET ROCK
fC li
Compen.mion fCdlinnniq,l)ere _ =`
n„pbeattf --�d�
309 — EXTERIOR LATH
.
310 — INTERIOR LATH
N this
N(YTme Lamphal,yom mnulJ
z
sTO. oche s of the
Worker's Compensation provisions
Mcomesabjeclmmawmrker'.compensafmnp,o.i.ion.nnnehnmrcwe.ytmmust
C
I'onnwhh comply with such powicm, or this .it hull be deemed mcoked.
311 — SCRATCH COAT
71
5
CONSTRUCTION LENDING AGENCY
1 hereby u1Emt that there is n consfatefin I Icnding agency Ia ihe perfommucc
? 13 — ROOF NAIL
of the work fm which mis permit is issued (See. 3109• Civ. C.)
501. — FINAL ELECTRICAL ENERGY
Q
Lender's Name
z
'`adc"n`fd'c"
502 — FINAL PLUMBING ENERGY
I crnlfythat l nave mad this application and. state that the above information is
50? — FINAL MECHANICAL ENERGY
3
Ey
alone,. I agree lou nmm+Iy with all city ;ted county ordmsaes and sae laws relaing
(_1
tobodingconsumed I. and bcmnyambodmrcpresummtve.ofthis city "Ic'iupmn
504 — FINAL BUILDING ENERGY
the ahovc-memioned property for inspection palmus.
y
Woo allmem5:ore,indemlmfyamlkeep hamden.the city ofCuperthooagainst
505 — FINAL ELECTRICAL
(n
z.
lianiducs.jadgmen... costs and co,emxs which III.y ill any way account ag:dnsl said
City in consequence of the gaming of this permit.
-
S06 —' GAS T 6)
'�'
APPI, II NDERSTANDS AND WILL COMPLY WITH ALL NO POINT
Issued by: — '�' Dale r'2r-C�
SOURCMTLI' �LATIONS/� ,
1//`
Re -roofs 508 — FINAL MECHANICAL
raw e
S�k,wAc; pPle+m,ICm ..m t Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant m metre building certmanl.mn m handle harm. mmedal
Type of Rool j09 — FINAL GRADE
Is dudned by the Cupcninn Municipal Code, Chapter 9.12, and the Ilcelfh anti Safety
Crdc Section 25532(:)”
0Yo %No
0. — FI AL PLANN. NG
All roofs Sha ms e • r t �t r our I being installed.
Wil the applicant or fntlum but dial, two pant use equipment or devices which
d�� �t3ILg8t�
If a roof is ins I wit o I o t• I m n ms c Bon, I agree to remove
emit hazardous air contaminants as defined by the day Area Air Quality Management
-,..holm
all new materials for inspection. Applicant understands and will comply with
DY°s P'W+
all non -point source regulations.
I have mud he hazardous mawri:Js equifctncub under Charter 6.95 of the
C.Inumia Health N Solely Cada ScNom 25505.25537 und25534. I unJcrm.nd thou
if the building does not Cunanly have a ananl. Ibm it is my respmoduliy to notify the
mupant of the ropimumul, which natal be not prior n+ issuanc our
Oben
�cate
`�'' a
"J'
Signature of Applicant Date
All roof coverings to be Class "B" or better
sr ornaenmraed ay.nf D::,e
[01001Hml