00070142CITY OF CUPERTINO
CONTRACTOR INFORMATION:.
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Buu.DiNG DIVISION PERMIT" '' ^
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BUILDINGADDItESS: -
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PERMIT NOS". "
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OWNER'S N -
c�c'406'BALUSTROL' CT `' ,.
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WATER fiHEATERS+'ONLY' .
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APPLICATION SUR DATE.
,4 00070142 `
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SANITARY NO. ^' CONTROL NO, ..
KINNEY EDWARD E.JR,AND K
Y'B 500 AIRPORT BLO
07/24/80014 "
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, ARCHITECT/ENGINEER
BUILDING PERMIT INFO
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." 415 349-3
74 !'IN
BLDC ELECT:• LU Mr, GH., -
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' LICENSED CONTRACTOR'S DECLARATION •'
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Thereby .off rm that drop I' J de p fChapmr9(, nnoncing
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i wishSmtlon Wl(IOInf D"' n,3 nflheBun nd Pmfess'nnn Cnda, vnd ny l'cenvc
I is in fall tome and'eflet
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Date C.nlrad,Orir
- ARCHITLCr5 DECLARATION
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t 1 a :I eypl ."n ul da p crica
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.. MATER HEATER '
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LicerstP f .- 'I'
OWNER BUILDER DECLARATION
h by B that I pl f Ih C I t L L tar Inc
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' Followingneran,(Section 70315 B. d In.lesitav,'Cadin Aycly Otranto,
i proveh"at, reporany stncwrt
h gisee dnems It nstmat
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pane m i issuance, ossa inquires movi6rps m lire such permit m foe a signed 4atemcm
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� Sq. Ft. FloorArea
� ' ", '' Valuation
dalM1 I e Oed pursuant thep n+nllne L e9
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an f D 3 1 Ih ode)ter
heBusiness
Mth . tlProfessions Coda)
" (mnmmene ng w m Sect
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onFair M1'. pub ( m l
h f (hectI61 pt Ay'Iton
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ofS I 70315re Y PPI'c of RetailobjectsIh ppl II IP Ity
• nrn I [Iranr 1 e d dollars ($s(«I) - - �
- APN Number
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`' Occupancyy Tyype --
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' $0
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will the k dal t : t nladd offered .70.14
Required Inspections -
Business am Professions Code:Thec t ea 1 Law retinal appr an
ownernfpmperty b uthereon,and who does ch work F If
'�.�}f]�.b�19..•�� • _a
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thoughorh.awn dtpy,c Radedtint, . n-pmvcu t'mdrin
olrL' If H,hn the nt p pan's s l whin non year of
the ld
>mplellon, the owner-M1ulldee will have the harden of proving Ihnl nc did nos build or
lhav ho
°mpmvefnrparposegl,nle.). ,.
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- 502,— FINAL PLUMBING'$NERGY'" .
°: nn p pety Iycontracting hm licensed I I I
.506 — GAS -TEST. . '. .. .. ...
construct I I thep J t (S 704a B .s and Pr f : Collet TheC l t Lac L dons I apply to n fproperty n1 Id p
th
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-507 — FINAL PLUMBING
and who contras for ch projects ash a contracions) licensed. and n the
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Cradeenrs L'ce e, L
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°Ian exempt aider Sed. R&PCfar in"nas
owner Dam.._
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WORKEWS COMPENSATION DECLARATION"•
I hereby affirin ander penalty of perjury one of the following declarations: -
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1 I harod 1' will t paint' Carthcam OF Caent It) self-insurefor- Wo k r.
'Cm p "anion, nx pmv ded for by Section 3700 of the Cabo Code, For the
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perfnnnunce of the work for which this peraill is waned. ^ a.
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"°Ihr J will 'nl W k C_npia6 Il q" dbyS to
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3700 ofth Labor Code, for the perl Ia fah work for h h this penis is
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is,diel. My Wnrkcr, CnmpenaaRm Inst ranee carrier and Policy umber ore„”
Carrier: P.1icy - r
CERTIFICATION OFETI AOhW.ORKERS',
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' COMPENSATION INSURANCE
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- (This section need not hecondined it Ih permit isrfor one by dred dollars
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(SIO 0)or, lessJ
I certify that Ia the perfonnown of the work far which this aa ant is issued, 1
shall not c npby cry p any manne : s to becouresubect to the Workers''
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Couppen,aron Laws of Calhocaux Date
Applcanl
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NOTICE TO APPLICANT If. after racking th' Cialificife at E «nylon you flauld
Demme subject to theWorker,i Ctropereenl0d p fthe Labor Code you past
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Forthwith comply with such p or 0 t, retail shill be accord revoked.,"
CONSTRUCTION LENDING AGENCY ?
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I thereby affirm that th.IOrionIt e,pO,, la, the Nufminuar a
anhe work (or wrath this cern i is seared (See.3Bw. em. C.)
Lender's Name
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Lender's Adtlress"
1 certify that I I road this application ' d stale Far li 1 I I' rival m's
pulIagree
r 1 f t ply nth all city t o ry rc a- a d tale l WI ng
rah king rat- c' th by pm. mu cu fa ly4 enter upon
the 1 e a a p pelt, f ce i p a c
(We) hi I, d tTy dh t Cly fCpel agta
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is may
l I n dg I. and ape which ay i u any y uccr against f
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City 91 of tireNmol nN of Thi P I
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ND
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Is ii +
D'Ite'
SOURCE REGULATIONS.
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Si,notancal ApSpheI/C Date
Re -roofs -., • - - ' .
HAZARDOUSYLS DISCLOSURE'
Will the 1pprcu t thounic building crplml h dl -h 1 ulna ani
� 'Type,Of ROOF • -• - ".
es def Sed by the o MI tie'pul Code. Chapter) I_ and the ale slab and Safary
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Cnae, Section 23532(I32(op?
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-All roofs shall"be_inspected prior to any roofing material being Installed. „
W 11 the,par nt Or fichile building - p I p a 1 - e, wh,,h
If a roof is installed without first.obtaining an inspection, Pagree to remove
-mills Mol, av mar utanh u: aefned tY the Bay Area Air Quefty Management
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all new materials for inspection. -Applicant understands and will comply_w,ith i '=
ore, ❑NO
all non -point source regulations.'
' 1 nave read merestrictionsm l q a •nl, an ler Ch pl a9s f me
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Cifilam'a Health&Sanycd Sections 550525533 and 255341 understandmal
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irthe build ng does nmunintly huveale Itkll. >responsibility'l ntilyme
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occupy n oI life mqu reme t, which must b I p I .,u 1 C«rf d of
Oeeapency. . - -� y-.
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nature "."•
Sig of Applicant e Date
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;.d,Y •' All root covering's tobe Class "B" or better
own a namnrzedagenlDate