00080148 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS' - PERMIT NO
21730 ALCAZAR AVE �' Ak 00080148
OWNER'S NAME APPLICATION SUB DATE
CHANG 08/21/2000'
-� PHONE SANITARY NO CONTROLNO
C z 2 ARCHITECT/ENGINEER BUILDING PERMIT INFO
k = LU E
y z so J
LICENSED that I a Beers d under DECLARATION
so
z v= 1 thereby min that 1 an hrer.ca nmei rcna rein(commencing Job Descrip ' n
o ra prodll..f r P
p v_i[_-m Secnnrecord of Drvr\ion a nd the Busine..and 1'nde,\iom Cole.;uW tl@ygrylytl J� a E®
_m ra"hircc„,d coca I'l"CU' et+a 6.. NEW SFDWL/3013 SG!. FT. LIVING/445 SQ.
O Lmeme Cl— Lm p
X z N )alt Gnnl raClnr
ARCIIIFECT'S IN CLARATION 11II 11 p O noo�
C'= j pl hall be n,ed a, chic record\ MA L
under.mitJ inY .m.\ p •
ed i c O Lmenacd Ponfic,,oral
LL thatI .,I-."DERDEChARATION 80ILDING
W1, 1 heicby.rlfirm that ,uo cuinpl limn the DECLARATION h¢Cnw LnN In
=_^ miloNmg rcaum.(Scnion 70315.Bu,mes,and Pmte,.mn,Axle Any eity in county
which requires a permit to construct,alter.improve,demnh.h,or reWtr any structure
eu prior to its nuance.ahn requires the applic ant for such Penn to file a signed su m o,in
a. m.Ll her'deers.ear:rt.rrantln the pn,vi.ron\n l Ile Cummemr\la,u,cL,ov(Chaplerq Sq. Ft. Floor Area Valuation
Icnmm adding with Seetmn Agp)of Dniann 3 of the Buvnes,and Pntfesvon.Carl
or that he is exempt therefrom and the hash for the alleged exemption Any violation $300000
of Section 7111,5 by any applicant for.permit mb)ech me applicant n,a ei,d Penalty - —
ol not more I'm Five hurd,ed,,flia" 100) APN Number Occupancy Type
0 L a\on nernftne pmp city.or my employees with wage%as their vele eompenamonn. 3571901
N IN Jo the work,and the arumure is not intended or offered for sale(See 7144, —
Bmme.,asl Pon e\\run.C,.IC:rB,Cn Marini,Luen.e Law doe,nrn app%tit at Required Inspections
I,, r el pt npeny W'ho bond,tit rmpmu"thereon,and who doe,.ach work himself
through his o,.employee, provided mat wen improvement,ate not untended or 101 - FOUNDATION
uttered for,ale.If.huwmer, he bmldmg of m,nnement n sold within one year of
e,on,ictou,ate oven,,.nuade!Nat have me lumen of pawing mat he,hn m,I build ar 102 — PIERS
n p cne hit putpmc ul\ale). 103 — UFER
/ Llas/��/ rof the Property,ame,dmod.,emunwung on hcemN contractors to 104 - REBAP.
mrid the prnleet ISCL.71144,Bunme„,sad Prol...r.a,Ctxle.l The Contractor i
Lueme Law doe%notapply to art nwnerol proper)N no bu16 m mrproce movan, 105 - ANCHOR BOLTS
and who contract,for such pmlect\with a conmucmr(.)licensed pursuant to the
01'Intnr.Lt«nI S 106 - SEWER 8 WATER
°lame, tenser Scc �� Bk P'C for rM1is rca.nn
^On,
n` l' TIdD c �Rn��ou 202 - UNDERFLOOR PLUMBING
203 - LINDEP,FLOOR MECHANICAL_
\� Iherebyo1irnttmderl,,*I u yorianhernh„Nrngacefanr "n`' 204 _ UNDERFLOOR FRAME
O 1 have and will inaMmfn a cernfivue of Cn...or to«Ir-m,"ne for worker\ 205 UNDERFLOOR INSULATION
Compenwtion. a, pnwrded fdr nv Section 371) of the Lalx,r, Gale. for the
pert„rntonevot the NVrk I.,,vO,,ltthr.peo,rrtu'”\sea 301 - -ROUGH PLUMBING
O llm,anawtumamtatnWorker,Cempen\anorin,amnee.4voril odnyseetion 302 - TUB 8 OR SHOWER
PW of the Lahr Cur"rut the pensur.t ice or the nd PA for which his Penton i. ,303 - ROUGH. MECHANICAL
cJ f My Labor',Cde,for he In ormumL of the W,k for number are:
Palley No 304 - ROUGH ELECTRICAL
'airier
CERTIFICATION OF EXEMPTION
INSURANCE,WORKERS'
COAP 305 — FRAME `
(TM,wvtm.need not tie enmpletea lfine perms t.future hundred dollars 306 - HOI_DOWNS
(81 W)ur lit,)
I unit .tat lit the 307 - INSULATION
.hall not em , performance of the Ncok Ior which this permit r, ,Led.1 — ,
p yanype—amam....cr o-1.bamewirve to heWcolas' 308 SHEETROCK,
Compemaunn law,of California Date
nppheant 309 EXTERIOR LATH
NOUCETU APPLICANT II,rifer maAmg Ihi,Ccrulicam n1 Iixcmpuun,you.M1nulJ
Z
become.ubjcrt to the iasicrkcr`.Compenvation provi%it)n%of the Labor-Code.you nam, 310 - INTERIOR LATH
O O forthwith cn ply with such pn,vianse,m hi,peon,, hall bechnnoeamvnkca 311 - SCRATCH CORT.
F m CONS]RUC 1'[ON LENDING AGENCY 313 — ROOF NAIL
'
7 I hereby affirm that there is a comwctmn lending agency for me perfnrromme
of the x.,k for which this pi..nwed(Stu.301 Co. C)
°� Car:nddi ,. 501- --F-INAL ELECTRICAL ENERGY
v 4 Ic e„ifymmlhave read this application and state deal the above intnnnation1% 572 - FINAL PLUMBING ENERGY
e� F "once, l agree m cmnply reth Al city and county em nar,c,and\I,,c].I.,mI...... 503 - INAL ME HAN I CAL ENERGY.
CC tobu,Idms,en,imctn,rt.arm lmrchy:tnmmvC repo-countve..n this city m river Uncut F NAL B
the dui,-ommoadd pm,rdy rnr tn.p cores pa p .e. - LD I NG ENERGY
E..
M. (We)agree I—me.mdetnmry and keep harmless th,City fC.,d,n.agaimt 505' - INAL L CTRICAL
Uto liabilities,judgmenn,coin and e,pensa,which may in any way aceme agam.t wul
.�. APIyIJCort.egUNDERlteegmn A ..rmr.I,m nor' 506 S EST
\Pp ICANP UNDIiA the NUS A ' W'tl, IroMP1,l'WITH ALL NON POII\T
` : RFGULATI, t/6 i Issued y: C Date
s�gn.itn,e ul - u.r aetoi Date , r Re-roow.� 'L�JB.. FINAL_ 4 -HANICAI_ -
HA1 RD(USh RIALS DISCLOSURE
wtuttcappheantntrawre g«capantaurenrlmmlmnazWnu.matenal Ty of Ro 509 - FINAL GRADE
a.defined by the C.,,mo Munmma Code,Chapter 4 I'-,and the Health mW Safety
Coll„.ScOu 155:32(')'' 510 - FINAL PLANNING
°Yes °No All ro Jsv:hall IISiltptpecte N an8`Llfif�fr �d ing installed.
Will the applicant of future huddmgoeeupant use egmpmcm of dec”,which Ifa of is insta {yitho n ti agree [o remove
von hurmdon,air conmmroam,as refined by me Bry Area Air Grainy ntmngemau L,
)�"°":' all new material t:,nTe rstan s and well comply with
°i\ 0 N all non-point so �egula[fAtt4.F
I hare read the h:r.ardua,nramnnh requirement,tinder chapter 6 q5 nl he 604 — ROOF IN-PROGRESS
California I faith&Sulcty Gale,SeUmn\]5505.25533 and 25534 1 undcnmad that
It the budding dote,not currently have a tenant,mat it is my responsibility to notify me '
III, resmtement.which mu over poor m owance of a Cenrfimre of
Signature of Applicant Date
/'Nf)—nern�samy�,e ens Date All roof coverings to be Class "B"or better
/ OFFICE