06030133CITY OF CUPERTINO �, IG,�
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1 T
BUILDING DIVISION PERMIT yl1,��Q�
tt��ION' .
BUILDING ADDRESS:
S B I
PERMIT NO-06030133
1098 ACACIA
^R'S NAME:
PERMIT ISSUE DATE
HOMESTEAD ROAD LP
395 DEL MONTE CT- 4153
05/19/2006
PHONE
SANITARY NO, CONTROL NO.
(831)274 -2518
ARCHITECr/FN(TNEFR:
BUILDING PERMIT INFO
-
RI DO ELECT PLUMB MECH
0 0 0
LICENSED CONTRACTORS DECLARATION
.lob Description
I hucby ,IBrm Ih., l am liaesd ordc Paov. a O.P. 9 (--ant
,.IUDr ao,id(m Rnsam,a�n� m //�PwA�cc cm..amrl
urc0 form cod eRett
4tlQ7(�
REVISION- STRUCTURAL.THROUGHOUT
Lit..
COmrcmr U-____
ORIG PERMIT #05090183 -NO NEW PERMIT
Da¢ _RL —
ARCHr1ECrs DECLARATION
1 o,&,und my Pkn„IWI be tucd u` poNic rccerd,
Ihrt,ucd Pwro iaoal
OWNER - BUILDER DECLARATION
1 hemby .Rim Thal I am aempl frum the Cattraetar, Lw Law for the
folbwio,.. (Salim, 703 IS, Bosle,s.nd Pwfa,iou Cade: My cny m cpun,y
which mqu W a pconit on cam.uct albt, impwte, dcmalitb, nor mpur my wunu o
prim bIli i]NU WOIt'GYirt3,bC W[ ic. for hpC.it to fik a signott mW
Isw(Cbapc9
Sq. Ft. Floor Area
Valuation 0
dw be b ha,�pu,wan„o WC Von. of WC Cmuactvr,4—
(eomtrmttdnG wirb SuUon 700M of Oiviabn 3 of IM Bunneu aM Pob(tsiau Code) w
dw k I. evmpt lbemfmm rb the bath for tbo aU.V-d eurapd . My viohuon of
Number
Occupancy Type
Seddon 7031.5 by any a"Icmtfm., .. Subj= Do applitam m a and Pculty of
on, ntme than fiw btmdmd Mboo, ISM
NN
3 2 6 02064.00
❑ 1, u owmr a ft pvpcty. a my auP .). wW waGa u tbeh Sale mmpmvdm,
Re aired Inspections
q pe
twin de the",k.M lbewumme h 000, Mrd m ofrucd Ratak (S.. 7014, Barircs,
W Psafadou cock TEe Cnnmcbra Llm„e Isw dw sot apply u u owner N
progeny who W 0d, a Icopmrts Nceao, W wio dos aurltwmt bvuHrm thmaGb bu
mw cmpboMP,m'id, facole. a.
i.
SaidtodW one yew a(io, P ifarmeawou-
itao soimaBi.om y. of
Iwwew.dteandoG
ahapowmm�u
buildcr w01 Wte Ibc Intblt of PwrinG ,M1a, K dW not build a 4npSaae Im pap® of
co1.,oawaerof,hepmmny,. eoouaai- wib)Tb.amvuacraab
Besshdv
conau,oct pa" (Sec 7014, Bv, a and Pt Cade) The C000wwr,
. f�
. ob Ixti nd
(loo Law dmJpt.PPlybN tha ar..(.w avowdp (Ir ImPNRf ICoo and.
who aovan, fm wvY p,nJ[cu W d1 iCanRYtlNI) 0mt¢d pm.uanl b do fAnVtld,
V
❑ Il Un ctaopl artic . B A P c fm this woo
V
e Du
WORKERS COMPENSATIDN DECL StAT10.N
1 weedy A nt, ondcr paddy NPmoc, W of the folb rtg
❑ I ha.e.tM will m.ku,io aCmilfvm of Cana m,elfln,aR fa Wakr, Compen-
cobm, u p,ovWcd for by Sadon 3W,0 of rb Labm Code, ra the Per(mmuta of tan
taaak (o, which dd, pump i, b a c
1 a,, and wi0 maloWn WoAer, Campeuulw Ittwrwa, u r qW=d by Semlw
3700 of the lsbm Code, fm do pcff amce of,hew fm whicb,hi, punb h,cooed
My Wm r, canpeaati hu aox omim a ad PoIicy ouobu a,e
taTF f(„v,� - Policy 2B41 -6"0200
1A
r CERTIFl EOFE%EMPIION FROM WORKERS
COMPEN!;ATION INSURANCE
r
(ibis sent,a notbe cmipkRE B me paRU h fa oa hvotrr4 Eo"o'(3100)
or k,a)
1 certify that in do perf.. M the wort fm w Na per oth t f I "I am
employ any pe=n in soy romp rw u b brmme,ub5at,o the WorYef Canpencotim
La,a or Callfami> Date
Applicant
NOTICE TO APPLICANT: IL afar ob tlnG dd, Cntifiam or EacmPlbo, You Ouutl
beeonR whom w the Woh a Commosail Porivau of the u Code, yoo MM
faMwilh'pjy wbb Rob portdmu m Ihh mrrolt maLH W n..—d nc t
CONSTRUCTION LENDING AGENCY
1hachy JTVm Ibu IbeR 1. • kr4ol eocy fa de pafwmu¢of
> d, ewart rmwnhbw ,po,nkhi„a"(a. 30r7.Ci, Q
Los N.
on eAd
� M, Aama.9
j1 aNfy tbat I hart rcaa tots aPpliNion mo ,um dw ,hc abort Information is
^ cortm. l atmz to caoply NN all wy and may tudinuta,.M „ue kn teLtiaG to
L bvibinGconwuction, mot rtpr- ,entvi.e,of NU nfy,oenfm upon WC
IJ .I - =n,iaocd pro,r,y for in,pccdpo putpmcs-
ify
Minft m,I
(Wa)grooucote,m,Jcai(YaMY hu City oft,abot
in mlbc
sui Chy
7 and apeme,whiN may In airy nyaarue.GWmcod Oly
inbiliJU,Judrmcn4mw
- Incon,CA ND RST of this paWI
APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOUR U ��
9 ��/
J
Re -roofs
Type of Roof
Si(aa,om of MphanVCOnv Dab,
HAZARDOUS MATERIALS DISCLOSURE
W01 Nc apPlcvt or ratan bmbb t omvp.ru a ac or hma hawdou, ma,uial
u kIn" by Ibe C"Moo Mmdcipal Code. Chaper 1, 11, od Ibe Haub and 5901
nlo. Scction 25537(.)7
GYa ,face
All roofs shall be inspected prior to any roofing material being installed.
If H roof IS installed without firs[ obtaining an inspection, I agree IO remove
Will One.pplianl m fulum Wildi.1 occulvm um equlprow m tkvia, whkb
cmlt hvudnw air cocumianta a d flbod by the Bay M. A4 Qualhy Mmalctncm
all new materials for inspection.
DisttxO
DYa
I hate mad Ik hvaNOU, ma,aiadI.Wbcmam tndef Chaps395 e(thcCdifm-
M. Heal" Safety Code, Satiam 25505,15533 W 255N. I abiwod lbu Bdm WkhnG
dm mly tc a IeyLd, thu It h my =Pboadwhy n twify the oa'Wam of the
m xm"pr tolwummd. yw�9aymwa
Signature of Applicant Date
�r ^ 3 / /Q6
All roof coverings to be Class "B" or better
Owns a•ulltow .,,ml Date