00090172CITY OF CUPERTINO
4
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PERM] I'NO.
OWNERSNAMIJ I
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SANITARYNe -„ 'I
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'HIILCUENGINHER
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' .Y + - s'. _ " BUILDING PERMIT' INFO
ECT, PLUMB MCCH,Job
7HONE
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Ltto dit DCON.RACIOR tiDICLARA9ION
Ih by ff th ll I' d d fChq,tcr9 rcmmeng
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IN GROUND SWIM•:ROOL AND -SPA• IN REAR
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ARCHITECT S ULCLARATION
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WNL,I BUILDLRUECL(RATION
- ng (See 70 - yaS II C 1 I L f 'he
following a. (S B nd. Professions C do A ycty anly
s off , ' « ..•
1 POOL
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wht M1r4 re t� II i I h Ip Imh.h r PrY5tuae
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pn, I l PI' tf p It fie g I,tt I
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', Sq. Ft. Floor Area -
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- Valuation �,�•.,
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thdln l l rt m rn c t', r I L ccnpt 9
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(eo wnh Seu 7000) [D 3 nn R dProfession, Core)
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Orthat he is esompt W f d d b, l th all g d I n A, .1 ion
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of Seat On 7031.5 by n Y l5d t Open p 1. 11 111 applma 11 e d pv ally
of not more than five hnnd<d doB,a($50H)
"' APN'Number
, cupancy Type "
❑1 - fth poverty unnyanploy 'th g :all 'r.l npen:m nn-+✓
��5.� �'�
.„823000
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will 1 e k I the 1 1 l 1 intended or nlretul Far wle (See 7tWq,-
Bn and Professions Colo, The Cdnhauor s License Law does' not apply to vn
p
" - -Re cored Inspections
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'e th - d h .. n - k If
w p pow
'Y 5 01T 0 .P �" ••
%19. 0¢'
e l c
In,d, I p t t t ed
rer gh his mply
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offered far Nastier, he
then I ve y p- t Id within y f
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co,plt nth hll ill thhl approving lh that did th ld
the wne ld
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mr r p m - IF i
.. b•, 103 — UFER�' l�
❑I a« wnertrmep p tv. 1n ,nwx +ly t t g mr
construct the project (Sea 70TE BI s u e P ofvselonx Cade) The Co.VUUOr.
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1,04' — RERAR
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lceme Law does nnfapply to an,v m' of prd,dy who bola. ,proves Wo o
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0 H I C
� W f � PO L/ OND NG
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and who °nvucls fu - h p ,Jm1x'wnh a nnlrnungs) I 'ul puts u mLt the
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etot`and
301' - ROUGH f- 'I_l,- IMEI:[NG'
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❑ 1 cmpt ndcr ; R & P or I s
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- ..304 •ROUGH ELECTRICAL
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Un1e
,' y R ,R'S COMPENSA ION DECLARATION.
502•,.— FINIAL PLUMBING ENERGY
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Inarchyamrn; , do, penelly orpeJoryone nllhebo0awingdeelefadons:
503 . —'.,FINAL. MECHANICAL-. ENERGY
71 In I II Certificate fc Consent a 'r f w kn
L 506 — ''GAS TEST .0
Canopied t p J d f by Samoan 3700 I' 1h 1 b 'Code, fn the
perr, „eenfp,eA for Mod)hl,pe,nt x Bred.
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51,0, — F,INAL •RI_ANN�ING'
❑Inave:ndwl naatanwnrker's'COnpc. r 1; ... nc ,t64rircdnys mm
�Ji,- — FINAL .FOOL .
3700" heL n of 'I 1h I f fth' kl h'hlhep 't
wt ker e msnrn le fr cr adPnheynan,
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S1F✓'.- '.•FINRL_. EIULLD'TNG
cafe " ^:.' : rnr r N - t�
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/ ATIONOPEXEMPTION FROM WORSE
COMPENSATION INSURANCE +`:,
(TN' t n d t b co nplmed r the perm,l s fn hu idred dollars
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IS (for less) a ,. `6
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' I oc Tfy that in the performance of the work for which this permit's i.vsued,.I
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shell no ( employ any person m any manner c° ax ta.bec°mc snhiect m the Workers"
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Gnmpelawrie, Lowe of California. Date
Applicant :,
`
NOTICETOAPPLICANB IF ft dandling th. C IC t fE pf n y 'h Id
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become sub]co,1. he W k C p "l P- ofd Labor C e y s1
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lorthw th comply with h p aonx Or tb: permit xhall be decided revoked s
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CONSTRUE NON, LENDING AGENCY
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- II hY tf lh uh t f ding agency for the Dulnnnasce
ail
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of t he work hawh ch this pnea O, swcd(SC 3097 Cut. C.)
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Lender's Na re
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Lead .Address -.•
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Iccn tydull lr tend (I pitheatnn and smmthat tl h 'n¢rmminne
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aor ecf I ag t1 comply with all city and county oM name d fate laws totaling
I,, h Id' g n.bualon, and hcrcbanborze representatives fth: city ni ea,,, upon
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r�the
he f Epp tyf ''.pci pp
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(W) g t d 1keep l -: the City fC put g st
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handiti ,rdyme : and sD :. h ch dry an fay. y ..red ag ,r d
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APPLIC UNU .RSB NDS AND WILL COMPLY WI ED AL O ENT
soURC L IO s
Issued by: To 2 I!�ti %•7y(7CGr Date ;
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tgnam f ppliwn r - - ,: °Da
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•Re-roofs -
H D US MATERIALS DISCLOSURE
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.. Will the apple a I' b I hng re t w • or 1 dl has nloua mai,ri d
a"
T e of Roof
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asdl dbyth C,wrf 9uie'pat Cheaper 9l2, and th H hh ndSfety
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Cod Section 25532( 1'
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All roofs shall be Inspected to any roofing being
•
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wB tire p,I t fat n de g p , so wa pn nl d x wh n
prior material mstalled.I
' • If a roof Is•installed. without first obtaining an inspection, [agree to remove'
AIIIII&L
emitl un is as deft by the Bay ArwA Quiny Manyge t
Dist r
o'Yex
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all new nitaferials for inspectiot. Applicant understands'and will comply, with
all non -point source regulations: } '
' 'w under Com95 tithe I h a
Cal]fomie Hulpf Belies Cnde Sed om 25505, 25583 add 25534. that
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iflhebu doexn tlyh 1 ttlatiti yrea hltyt tfythe
t rcq hch nn.t6 at, p' loins c,rf aCertifiene al '
ct"Up?
cy
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Signature of Applicant Date
-• All.roof.covenngs [o be Class "B" or better
owner r nt
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