00080108 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDkI_�So PERMIT No
OWNER'S NA089 APPLICATION SUD DATE:
•
92
';IONS; HHYMOND W AND NANCY _ SANI l'ARY No. CONTROL.NO.
O�p ZO ARCIII'1'r:CT/ENGINEER. - rBUILDING I'L'ItMIT INPU
❑❑ HLUf(4408) 283 9-3-32 IeI.ECr PLUMIJ MECH
Hai
Z m t LICENSED CONTRACTOR'S DECLARATION Job Description
o Z_0 1 heathy aff ire that 1 am licensed under pmvi.ines of Chapter 9(commencing
s_w with Section 7(Xgp of Division 3 tithe Husincss and Prukxsiuns Cale.and my license
<m^ is in full force cad effect.
xx "" c1", a REMODEL — DEMO AND REBUILD WALLS AND WI
u 3
rate (ontmcmr
ARCHITECT'S DECLARATION
-, m /
s-=O g I unJrrswnJ my plans shall tc u.cxl public N.
O
25 1.iartm
men rxs,xaaal �/
a'°'e iOWNER-Ii UILUlilt UIiCLANATION '
I hc..hy arrnn that 1 inn clenan total he Conmm
ae's Lireitne Law fa,Inc /�
�ZQ r"Iluwing reUon.(\tt.inn7031.5.Huxilmxxaad l'mii:ssitns Code:Anycoy orronnry I O
FdSM whit 1 P iti . t It p lik 1 y;i , o '
F- t is y t PPI' - tt np. a II 'g J n ncu
A
prior 11111 lu is1 cnsedp.r,uan.t m provx,as tat i n. ,or',Liecow L (Ctrinnr9 Sy. Ft. Floor Area Valuation
(c...unnerving with section 701)(d or Div kimi 3 of the Raoms..nd Pintas nn.Code) r
or that he is exempt thrrctmm and the basis for the alleged rxentption.Any violation
of Section 7031.5 by any applicant for a permit xubject.the applicant to a civil penalty
,if nntmtretha"five wndreJdollars($5a). APN Number Occupancy ype
01•a,caner of the rt'.or employees with wv their sole exam tion,
pdthe Yres as penes
will nc the work and fM1e oectum i,not tr ctor's Lienticaided a ered"o, for.ale(Sec. to an fit_
owner
and rrt,Who
Gate:Tne Contractor's License Law d«,um apply nt an eyuired Inspections
r of h his ow cant builds or i provided
that
such i pr who rrl s sen wink nor
lf
onhrdugh his two nnploycct Pmvldin tort wco Intpmvcnxo me not intended near or
nrcercth for ser,Jr.ntwemer.me building or impm,mnee L xnlJ caiman the rearm 1.01 — FOUNDATION
es Nt p -n n nb meh t Ip h h na ,h 'Nor 2 — PIERS
.nr 1 I ) 10�
�a
fYf( 1 ny t t yin t t �f, 103 _ UFER -
xdt t at i t 7w+ d 1 � )Tn c t mr. 104 REBAR
Leen 1 J pplY t e d property hn on I r' p cs th'cmo f
.hid woo cams,.. r v"cn pmnect 'thcontractors) Revised pursuant to the 105 — ANCHOR BOLTS
Contraamr'c License Law,
❑lame, fit uadrrScc. crmfmxrea.f" 106 — SEWER & WATER
Own r B �CS�Q n 202 — UNDERFLOOR PLUMBING
RI R'S COMPENSA U DECL ATION
Ihemb 1lirmunJcrpenal.ytl n,nnetlthefnllnwingJevlzrunimm 203 — UNDERFLOOR MECHANICAL
1 have and will maintain a Certificate of Consent to .elGhisum for Worker's 204 — UNDERFLOOR FRAME
msoanon, a, provided mr by section 3/00 01 the Lallor Code. for the 205 — UNDERFLOOR INSULATION
perfonnanse of the work fnr whim this pernil is nwnl.
❑I have and will a.i am worker's Compem:alan Ineu.:use,a,mgwred by Section 301 — ROUGH PLUMBING
3700 nr the Lanni Capcn
Cale,for me 'e,mause A he work III'which ods pm,nl.i, 302 — TUB & OR- SHOWER
bxacd My Worker',Cnm rcn,cli... aamaec earlier and policy a`tt"bvr"m' 303 — ROUGH MECHANICAL
Currier Policy No.:
cI ROFICAT1o9 OF I XCWPI ON FROM WORKERS' 304 — ROUGH ELECTRICAL,
COMPENSATION INSURANCE 305 — FRAME
(Tni..erron need not be,completed if pem,i.is for one hundred dollar, 306 — HOEDOWNS
ISI W)or los.)
1 ecany that in the permor ance or the work for which this permit is issued.I 307 — INSULATION
.shag nal employ any person in am manner so as.n become subject m the Worken'
La _ 308 — SHEET ROCK
Compensation ws of California.Date
Appli,i I —
NOT ICE'TOAPPLiCANr:It.aherat.kinlla.Cenifieate'IfE.empma,ytn.hould 309 EXTERIOR LATH
Z become xuhicelto la,Wake"Cmapmc,00ap....W out heUlb Code,yo"anis' 310 — INTERIOR LATH
C C fortbwim It tply'al....bpnomons ,,dt,Tic it.hall nedcemed ovokul.
i�
CONS'I'RUCI'ION LENDING AGENCY 311 — SCRATCH COAT
> 1 bercby affirm that there is a coasvuatnn leading agency for the perfnnnanl• 313 — ROOF NAIL
of the work Iia which its pcomit is tomid(Sce.3097,Civ.C.)
i o 1<ela'xName 501 — FINAL ELECTRICAL ENERGY
5 Z Isnder'.Address
U O 1 certify that I have mad this appi cation and state that the above anficarroman is 502 — FINAL PLUMBING ENERGY
w F., correct.I agree to comply with ail city and county ordinarom%and state law%oclating 503 — FINAL MECHANICAL ENERGY
C (1 m building consraaion.and numb,iuflmme represemmises of this city m enter upon
y he risme.menfionedpropertyforinspectionpurposes. 504 — FINAL- BUILDING ENERGY
L 0. (We)agree bavc,indemnify aad keep hatthe City ofCupeninnitudiv. 505 — FINAL ELECTRICAL_
fin liabilities.judgment.,costs and expenses which may in any way accme against said
U City ineonoa,maveofhegrmtna,ofthis pmant. POI 50E. — GAS TEST
APPLIC UNDERSTANDSAND .LCOMPLY ITHAL24� LLLN Issued by: Date
SOI IiGU1.ATIONS. S
,,gt tcmnm,r .t Lnn: e :,nr Re-roofs _
n'rraR x(JS MAl ':RIALS DISC use 508 FINAL MECHAN I CAI_
Wu1m I pli'mitrfanncnuimhir«rtmam.no. Ib,ml,Tha wisannedal TypcofRoof 509 — FINAL GRADE
us Jerred ny. a Cupcnlno Municipal C(xlc,Chuptcr', -•unJ the Ilealth and Surc.y
Cove,Section 25532(")'! s
OYes El No All roofs shall be5A4eMe(F�3�'�FVo aFi -t anterial being installed.
WJltheappncam or future hundingrccnpam use«rvipment or device.whim If a roof is insta�10M4virtroth'4 ARbta1�etr it nslmgw..-5 agree to remove
real It...Mo.,air wnmmimauns a thermal by the Day Area Air Quality Management
Dis.r;en all new materials for inspection. Applicant understands and will comply with
0Yc, 1st No all non-point source regulations.
I have read the ha>allons macrial,rc0ui.emmiu under Chapter 6.95 of the
Cnlir,, Is licaltb Fr Safety Codc.Sections 25505,25533 and 25533.1 under,mnJ fhn.
it,hu nuilAing fres nm curen0y name a antn,f.than it i.n,y rcryo.o,lolity.o amity the
cr,m;mt nr ,e renubeacau wm.m eau ne met piinr.n',. carr ora canf➢ewr of
-O""I"' Signature of Applicant Date
�S All roof coverings to be Class "B" or better
Dw ror author Igen late .
OFFICE