00080195 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADORES& TERM]INO.
plsqo _ E' S ELECTRICAL S RVICE000801.95
OWNFR'SNAME: APPLICATION SUB DATE
c✓' 1286 LEEWARD DR 08/28/2000
PHONE: SANITARYNO. CONI go[,NO.
(40A)7P9-5300
DOO ARCIII'I He I'IIisi(Ilso BUILDING I'IiIRMI I'TNT
u
III,DG ELECT PLUMB Nifell.
YN�7' I.ICENSE)CONTRACION'S D17CLARA'HON Job Description
Z. I hereby alline,b:u I um licensed under Prnvkxne of C'hapecr 9(cormmneing
�mNM with Se,linn 7(XXllof Div on3afmc livainc,wand l'ndcseinm C,de.unJ myllccnae
i.in full home and effect,isi
Lian,eClass eN ELECT SERVICE UPGRADE/FRENCH DOORS
C a H Dam Co ... a
ARC111TEM S DECLARATION
F''=O 4 1 understand my piens shell IN used a.puhlic revull b
z=<i ^ '
"' O O Licen>cA Rofe.vnntl
n
OWNER-BUILDER fiver
he CaAI[ONmlle, _ �,
1 hcrchy.(Seca Thai 1 1. exmnpt fan,the Contrncmr's e:A.y r Low for the /
t_> which ing mama(Season MILS•Business and tionlcneium.Gxle:Any all niaunty
ceCp whichraaacclaims aryrmitmmm,I1c1,,lira.Ifor vet dcer-rit in rrepairedelement
no te
prion t L 4 - h mal' I f M1 pa ', fl 'g J a cm
a m fair In ,,I d parvical, be n I he c t d Lio,eaw Law len plug Sy. Ft. Floor Area Pation
B,n,the cau,n Seth111XBolDUei,men,ofthe Bupu , dErotunn,nsktana
or Them h i is cacn,nt detect 11 and the cr farobc ct, [Id ff[wai it lI.e Any violaam
of recline 7031.5 by any ,mel eau fear a pcnnit aanjucle me uPplinnn to a cavil penally
arm,I nmad,aa five bnanaddmwrs(5500). . APN Number Occupancy Type
❑La, ,,net of the pmpeny.or ley employees is ilh wage%as emir sola arnpensation,
will da the work,and the structure is not intended or 31'1'ared for sale(Sec.7611.
Business and 1`na'c—sore,Code:The Collimator Raise Lnw,hien no,apply to in Required Inspections
nx' rad prapley Who build,or impm•'c.marcor,anti who dies such work himself
through his cow n anployces.Provided that such impraventents are rot intended or, 1.01 — FOUNDATION
oBerad for sale.If,however,the building or impreve tem i%mId within one year of
iamplmion.lhe ow'nenbuilderw'i11 have the burden at proving that M1e did not build or 102 — PIERS
mpavf e„parpnx 4,r ante).
103 — UFER
❑ a.Lrnfdepap<rtr.emceew..myfunlmetingxdmBcfrafdc„rwc,arsm s,mctxThe endW(See 1614,Business and Pmlevsdsrs Cadi The Contractor. 104 — REBA R
Lmicenw One cases nal apply e,an owner of papery,who build.,or improves thereon,
and who comma.fir,such pone with a centramar(nr Earnned pursuant to me 1.05 — ANCHOR BOLTS
Contmmor'a Limew Law.
❑I
.,it camnplandu Sec. .B Ar lie for Inmalm 106 — SEWER & WATER
Owre Date 2022 — UNDERFLOOR PLUMBING
WORKER'S COMPENSAMN A;CLARA'I'ION
_203 — UNDERFLOOR MECHANICAL
I lacchy m'fimt a mler penalty 4,r perJmryone ofine fallowing declarations: 204 — UNDERFLOOR FRAME
) I have and will maintain a Certificate of Consent self.in.ure sur Workers 205 — UNDERFLOOR INSULATION
,mutt on• as provided fm by Section 37X1 of the LaMn Code, far the ,_
aliamaneeof the work fnrwhiehlhis permit I,issued. 301 — ROUGH PLUMBING
O 1 have and will mtimaie Worker's Compenemion Insurance,as mquired by Semen .�
3716 of,he tats,,Code,for Inv performance so the work far which his pe•Ilnit i, 302 — TUB R 0 R SHOWER
asucd.My Wnrkm'sCompensation Insurance carrier and Policy oumMr are 303 — ROUGH MECHANICAL
carrier: PolicyNad 304 — ROUGH ELECTRICAL
C17RTIFICATION OF EKESIPTION FROM WORKERS'
COMPENSATION INSURANCE 305 — FRAME
p'hia wOi one,d Bol be complmw it he pertain is It I.one nunduddelmrn 306 — HOLDOWNS
(911X11 ur I...I -
IceniT'y mat an dlf neni,m,noa at dna wan.he Inch min1Xanil i. ted,, 307 — INSULATION
.hap I,,,crtnmy city parson m
n,any um e,m abe
n To cam0
e. 0,,,li,The wa`,ke,d 308 — SHEET ROCK
Conapeosmion[l ws of Cnilbmla.Dam
Appli....to 309 — EXTERIOR LATH
Nunci;'I OAPPLICANT:It;apermaking0u,Cenilin,m or IN, to on,you.hand
heconenuhjcct in the Werker'n Coml,cnwuon provisions anhe Later Cade,y°un,m, 310 — INTERIOR LATH
ZC B,rthwahemnplywin such pravieion.or this to shall hedeclined revoked. 311 — SCRATCH COAT
FCONBTRUCPION LENDING AGENCY
1h
m eme,theralbar his h —
them
the 313 ROOF NAIL
n(Ihe work for xhich this pent,,,is iaamee(seas 3007.em.cal Q Lcndcr\Name
to= 501 — FINAL ELECTRICAL ENERGY
Z” lender'.Andres,
UC Iverify that Ihave mail his applicationand.late Tamale aNice uncommitted s, 502 - FINAL PLUMBING ENERGY
Fccorrect.1.,me m comp,,with.11 city and rummy erdieaur«and male Iaws fainting 503 — FINAL MECHAN AL ENERGY
O U onbldliingcoaalmeeon,and hembemmalrepresem:ui.esethiscity 1.enter upon SO4 — F BUILD ENERGY
Ir] mean t motto Loupe tin n 1
G, OM1 ye I 'o J fy dk I I ,,fee Cly f( pmal against
m ha cla I Ile ,. 1 t peals which 'y in:aty way sam.t said
505 — I N ELECT .ICRC
U Z, city t d S t s ants 1 t —y p M
�•'• AI` ANDS AND WILL COMPLY WITII ALL NON-POINT 506 GA' ""T Date LO W
Issued by:
yLumo L-4
ne cal All ;,,I Wp'' Re-roofs 508T//'FINAL
MECHANICAL
LARDOUS MATLk1Ai,S � L(1SlJRE
Will the appears rpnnt.h,al5r It leha,ardmi,ecaenal T eof Roof /
a.deencdbythe cupenmoMaricipalC„da.Chapter v.Izamlthe Bcwmand saffty YP 509 FINAL GRADE
Cade.Smhm25532NO 510 INAL PLAN�INING
0Ye° 0N° All roots shall b`I gp ecce {o a1�y Q I m� mg installed.
WBl me applicant 4,r future Wilding acceptant use eymipmemmdevices wmen Ifaroof is instal �Y�it�iou Pf} ta�i�+hnYirtsp ehlofS;el-agree to remove
moa hmaMau,air contaminants as defined by the Bay Area Ait pual its Management
ftno,
O Yea °N" all non-point source regulations.
I have red he hamrdous mmerials requiremces under Chapter 6.95 of he
Do,
'mil'omit I lealh A Safety Cada Sections 25505.25533 and 25531.1 amledtznd ha,
it the Wili ingdoes ally M1avaa Ironton,that i,is my re,eleinllily to notify the
munwee, ich m v 1M..Ie,pilar l„mala at a Certificate or
ZS,q,,u
Signature of Applicant Date
ow , arta„Ih i or u f All roof coverings to be Class "B” or better