01030128 (2) CITY OF CUPERTINO
—BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: - PERMIT NO.
OWNER'S NANIE: Q� APPLICATION SUB DATE
(/ 01030128, I..
PHONE: - SANITARY NO. CONTROL NO.
pMV,AWWl) ':A 403/22/2001
q o ARCHITIiCT/I?NGINFBR: - - - BUILDING PERMIT INFO
Mw I I BLDG ELECT PLUMB MCCII
see ' IJ -
- LICENSED CONTRACTOR'S DECLARATION ' ' f - "'
z 'f� wlhS'It1 n Err hat l licensed a p . fch'm r(.,nttmt,e ag .Job Description
Z4 ' - -
K l: ]0001,fD " 3 Itheli .. II .,
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.0Imyl .nsc • ..}
-<� ni li
f r daffect. a
nor 6 License Class
a O a O Dale Guntm�nor
Yn " ARCHHIICf'S DECLARATION FEB .� 2�Ors '
5t S 1 nndcrsmnJ my plans shall nc useJ as public rccoNs L ! QDD 1 B2Ba SQ.FT.�- L IVING•»SPRCE,f,
a� p O Licenced Iii ..innal' `
OWNIiR.illJll.DER DECI.AltAI'ION L't x 400 GARAGE.
I hemhy:Irfion that I am exempt from the Contractor's License 1, DIN
• s
'following reason.(section 7031.5.Bu.dnexx and Pmfessinns Cale:Any city'
E F❑ which re mics a permit w r...ho t.alma impress,demi or repair any slrv�re
B prior o its issuance,also requires the upplicunlfur such pemtit to rile a signed statement - -
thmheislicensedNestinuothepension.,of the Courtrai License U.(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Prtife,siot„Code) "
lir that bo is axeatpt marefronn on t the basis Lou the alleged eterat nn Any vielaimn
of Section]031.5 by any applicant it,a permit x.bj,ds the upplieanui ocivll samlty
' APNNumber Occupancy
ornotmmethan five hundred dollars(150x). " . -
'°I:as",.a,of the props.}, ,,my employees with wages as their sale cnmpens umm, -
will do the work,and the structure is not intended or offered for sale(Sec.7OM1.
Business and profession,Cars,*He Contractor,License Law d«,not amply to an -Required Inspeetions . f 186591.
owner of prnpeny Who hdild>or improves thereo),and who does such work himself -or thr ugh I1,own a npl "I pity del that a m e)want u: not intended or
_ t -
ii fend fi r ale Ir,however the hl IA'ng p ,na,is Id w l one year of
ore lemon, he owner- inter wiu nave the bnNen of proving that he and Dol hood or '37542011.,00
improve for pugxtse
1rO 1.asowner oftne pro enr•am exclusioet,retesting with licensed commonest. _ '
constructtheest Sec.]B44 Buiiness and Profession, ads. The Contractor's
C
r� ( ) - 10I — FOUNDATION'
License Law Hots non app m nn owner of pmpeny who builds or improves thereon,
and wn t Is r w tn' orL,i licensed r rsr a in the 102 — PIERS
°r B&PC ha this most) 103 — UFER
/ • 104REBAR
PDal S �e
S COh1GN51 �IATION - J
105 — ANCHOR BOLTS
nemhr affirm arderpernallyef,jor,one offibe folhavia,ded unions:
1095 — 'SEWER & WATER=
° i-noin and x111 t stain it ten kine of C n •nl ,, o,ll'vuro Fir W ki
CampeuuT,n a., penvided Ino by senun 3700 of the Irbe, code, for the l 202 — UNDERFLOOR-PLUMBING.
p .
,ficonunee ofthe work for which this perm.is issued. 203 — UNDERFLOOR MECHANICAL -
01ha,emtd wBlmaimai.Wmker'senmpenmtinn 1murmaa,a,mquiminy Seennn' - 204 — 'UNDERFLOOR,-FRPME'. .
3700 of the Labor Code,for the prrormnce of the work for which this permit is
issued,My Worker's Compensation Insurance carrier and P icy number tire:
205 - UNDERFLOOR INSULATION,.-
Carrier: `�' . IPodeyNo: 301. .—' ROUGH•'PLUMBING
C17RFIp1CATION OF EXEMPTION 17ROM WORKERS' _ ril
COMPENSATION INSURANCE 302 — TUB &.OR SHOWER`':...
❑bis section need not he cd.tphded ifnhe penttil is for one hundred dollars 303 -- ROUGH-MECHPNICAL-
�iltrolale,..i - 3B4 — ROUGH ELECTRICAL -
I cvnil' thin in the limnunce of the work fun which this I is issued,1 N
per pend
.Ciml not ation L yny person io any nature,ao a,n neemne auycet in he waken' 305 FRAME-y
' Comlmnsmiun Lnws of Cali4,min.Dunt
'A,h I - 306' -' HOLDOMNS -
NOTICE TO APPLICANT.I ICANT If. It 1 g th C rt1 t t f pf y should
Z n n
b in the Workers Cnar,ii,ri provisions ofn La1mr Code.you must 307 — INSULATION
00 fienhaid,comply ifli...1 p ,this parook n 11 na leaned raola,d. 308 — SHEETROCK • -
,V�l CONSTRUC PION LENDING AGENCY t
y11 R ,n t to and nb k Hey f.. he parlmntanc.' 1. 309EXTERIOR='LA
ofth rk I I wnmh th w pvrmu lsIsmail[se .3M].CIV.C.) TW
p Lauri,,Name
y310 INTERIOR LATH. .
p Z .Lcnder,Addmss - - - 31'1 — SCRATCH COPT
V 0 - 1 rtil"dont I havercdmisapplication and state d nh b fnnotionis
list Fr cnma I bre to c reply m all city Laid musty fi u t and-late'I x ret t ng 313 — ROOFNAIL
0 (� lmhumlllnb nn t dl -ly nth vvempr c t Il,n,nl lbs city h enterupon '
y w the base na tt o ad pr pen f .sped an purpn,a, -501'- _ FINf1L 'ELECTRICAL(ENERGY:,
py Iy (Wu)ogrucrosave, Jemnify and keep harmlex�the City of Cupcninn ugmnst - — -
lir lin liabilities,jmlgttmots,cost and expenses which may in any way same again.said 502 FINAL PLUMBING ENERGY
U z City in consequence of t granting of Inns perms.
APPLICANT UNDER DSA D WILL COMPLY WITH ALL NON-POINT 503. — tFINAL�'MECHANIC ENERGY..
souecO RECULA Sks/�/ Issued'by: ' — 'pr-�
ngna `or - I'm ,m ' /Dane— Re-roofs
1eHAzn Hnou,MA'FR,.LS DISCLosuRE , .'505 — FINAL ELECTRICAL;'
Will the applicant or future holding mcapaot,mm or handle haarddm material 'pype of Roofs 506 — 6AS TEST -
asdefinedbytheC.WmnoN aleChapter').12,and the Health and Safety t _a
c d s t 25532(a)? 507 FINAL PL INA..
❑Ye. All roofs shall'be},acted �uQ�yt/p/ n .(�t(j�J1 bete installed
'Will iI SPI' I 1 m ren' lig pa lu,ceyu pmeaotdM Management
em chi - If a roof IS insiallCil`CSithoUt E, [OD i� f ion, I atgree'to remove .!
nnlh 1 ,,rc Im I If
ad by the li,y Are A Q 'Imy Manage nen �,pq N , g
ui m t:• ' all new materials'[ctrtrlspeclf01. li stands and will comply wish'
❑Yes " all non-point sour5WL111lati6-ri7 PLANNING
1 ba a rcuJ the h 1 teals mquumenti under Chirac,695 nr the 514 —' FINAL PUBLIC WORKS '
Calf 11 Imh R S f ty Jc
sin,
n nm,25505,25533 and 25534.1 understand that
i(the bolding does not c entlylave a tenant,that it smy repnmsib try a notify the .F -
occupant of the calumet as which must he mel prior to iswmnce of a Can i Bcate of - -
Dmnp°Hey.' Signature,of Applicant , Date-
SZ9 a
witeautl Ized igen, nate - All roof coverings to be'Class"B•• or better
OFFICE - -