00100209 CITY OF CUPRRTINO
RUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
IOU I LDING A DDRESS'. I RNII'I'NO,
OWNlsR'S 11.139 ;6 BEEKMAN PL APPUCA' s l AnEl 9
t
PHONE: FIELDENy CONNIE SANITARY 3 .No.
O C ZO ARCEITEC MINUINEER: BUILDING PERMIT INFO
NQ{- BI.IIG ELECP Pl.umn nutcu
6 L:I
O SH2 LICENSI?D CONIRACfORS DECLARA'HON
�,O 1 nerehy rlEmh h:n l am lianmd under pro i-am of Chamer0 a,munendng Job Description
?5Cu with Scmion]IHHI of Divirionl nfthe Bnsinen.mul l'mfeerinns G.le.and mylieense
in hide ll Pri :riot
d rv.
d56U i.iecnr,:chl.._C20{C_SL _S6ovl3
R:5."
);lie—10=1; Commmor_fJ$Q8C20 Sr, c KITCHN REMODEL PLUS GAS LINE ELECTRICA
ARCUITCCI'S DF.CI.ARA'IION
.Qa 1 undcrsmad my pit, 111,111 1—,cd a,p,mlie rcconl /p
L=osce
Lc t .. I //
at
UNh I1 111 R ARATION /
J
Ih by ff all exXc1m the ltf the C t 1 Law for the
CSE hll 6, (W i 91UI51f ' c 11 f.'' t Ay 'l oea"
O do, II t tp" I 1'I 1 I,t-cnr
j y pan I I y me ilio h f 1 p It fI 6 W ilt mmmnt
55 (crit li dtSa tt coup nn c I ..l c Lloior,Civic) Se. Ft. Floor Arca
... ter 1)
ngwnhslh,oif land imb aoonnelu;dOvelol PmrAnyVsercR) I Valuation
n ihn�he i,exctttpt memfmm and Inc bu I.for he alleged mem Ic any vl-fah,
of notion 71111.5 l any melee d r for n permit wh,j«I1 h1ii m u rivll Iwnally
ort,olmorehhanlvomt„dredlolmtsas(al. APN Number Occupan y pe
01 c f'he Pot t! y nIa, with a, [all,- rynslem,
,,It do I A and Il. t t h t I ola I I al (See.70o,
nm. 11 lis... '( dn Com s1 c1. 1 applylaa •:116301. 17. 0R'byuired Inspections
,wonc,ml pmpamy Who frills m Inlpmvc, here 0.and who doe.with work ninuelf
or tnmugh ho owrt mapluyee,.proroad then with inlpmvcmema one nal imitated or
offered for sale.If,however,the nuild'mg or ilnprnvcmenl Ir add willtir o c year of
,otplclion.hoowoenmrddel will little thebhnarn of pmviag hal hadid ori hhdld ill 1.01. — FOUNDATION
rI�IP.e to pnrpole onma). —
i PIERS
QIi_:
01,ac owner of the most am exdmively commaia,n'ilh licensed a rome, uh
imm he prolnet(See.bila,limiacsn atm Profc.lma.Chaml ILfailCmnme,or•. 103 — UFER
Jms."'aw I_a,v d„ev nm apply to nn owall of ptopeny w110 Nttd,orintpnhvux Cher o”, 1.04' — REBA R
and wnn a arao, fur such pmjscI,with n Inmraa,or(,)Iicca,ed pe.... i m tlm
1 amemvnra.ian"Law
0 105 — ANCHOR BOLTS
xemplunder Sec. ,I1APCfnr tbia reason
Owner Date 1.06 — SEWER R WATER
WORKER'S COMPHNSAION DIiC.ARADON 202 — UNDERFLOOR PLUMBING
1 hemhyafnm,amler peaaltym Worry mlc„rme fnunwingdeelamtions: 60a — UNDERFLOOR MECHANICAL
111 1 have nal .,ill amimaill a Catilcam of cotolil to Ndphh,wre It), wmker'1 204 — UNDERFLOOR FRAME
Conlpcisorma, as provided for try Section 39(X) of the UNr Crick. for Inc
perrnrmme, ifinewmkIor„mrnlhis I iIismaea 205 — UNDERFLOOR INSUI ATION
n he”oudwidmaillItnllW..or,cal,Ipen.an....ltlwmneaarremtredbrSaoli^n 301 — ROUGH PLUMBING
170( of me Ltd,or Code,err I pe,k....awe of he work rot wad'ta,......it is 302 — Ti IB R OR SHOWER
too')
cd-My Workers Cot lincroanoo lnrnmace carder rad Policy Hamner arc:
nrrier:l7PrE PnheyNo, 152SSC37-00 303 — ROUGH MECHANICAL
C,I;RUIlCAI'ION 017Ex1;N119'I ON FRO NI Will K 17 RS' n _ p
CONIPCNSSIION INSURANCE 304' '— ROUGH ELECTRICAL
(11ii,>ecaanmetnotheemnotedifhexoralisformmnandreddollms 305 — FRAME
r5loro or fe..') 306 — HOLDOWHS
I artily that in the Petlometa'a of the work Inr whidt Itis Ixrvtit it l"aal,1
,ball am el irlo r any fer.on m any ahmmnr so as m nermae xuIva,1 to me worker: 307 — INSULATION
Cool oottica Lot C:difomia.Dare
Apprcaat 308 — SHEETROCK
NO1111C1i'1 O APPLICANT:It,art....... g Int.CL I filWall of Il ct paint,you shomd
Iumlae rd,;ent la tire Wolk—C,1mpemmionpnwt.ine,of,he Lem,Cala,v,,a that •309 — EXTERIOR LATH
O2 foonwthem.iffy with Irich prn.'i.ionsto this peroolshall bedecnedm'a'ked, 330 — INTERIOR I_.ATI-I
zO CONST RUCTION LENDING AGENCY 311. — SCRATCH COAT
1 herehy tnnan'it thesis n eamNmellon Intding ogen.y tonne pedorriam c
onhe work for which his transit is iswed(See.darn,Civ.e.l 31 3 — ROOF MAIL
0. Q IwmdeL,Name
z 1,eader`Addess 501 — FINAL ELECTRICAL ENERGY
U O Ickrlllythat IhavcIcad this all oIt I late that meOhio,at,ttnat<,nin �- — FIhIAI_ F'I_IJhIBING F'NIERG`!
s correct.I r rce m cam 5i"i-
[)F g rrniaroh, tyimu,oc,aro inaacosamlacmetotatua0ng 503 — FINAL MECHANICAL ENERGY
m i'Kainycumlmed"'rind hcrean"at"rizem...... ircwftnis oily n,enmrurym
I,can„ve-Inelllinncd pnlpeny far illXpcelinll plllpnM�. �
E p, (Wa;tgl'aetosttuo.lodemnilyamnaphaollclsmc(it,"ICupe'irottgainat 504 — FINAL BUII_DTI)IG ENERGY
Z Ilahillfer,yalgnmms,eoa,amt a'Kn a”which UTay in any way accruo ttgaina,aid Z (.it, 505 F N L ELECTRICAL
APPLICANI'UNDERSTANDS AND WILL COMPLY Wrof ALL NON-POINT y. �� _ �E5.,1- Date
SOURCE REGULATIUNS. IS,\'LIC(Ib r_ n""11�' fJ -3�^ULA
Slgnamrc of APPlmmurcoamr,mr Data Re-roofs 507 — FINAL PLUMBING
HAV NRDOUS NIA I ERIA IS DISCLOS URI:
Will llie aPPlicentuotfurinefuddingnccupm rare orhatallO, fon,ntaledal Type of Roof 508 — FT NAL MECHANICAL
'I ed 11y'te C.1......Mmt"Ic"e.,dc,antptar 9112,Bud the Deallh and Srretr
Code,Secllnn 25532 x'109 — FINAL GRADE
pp;'
0Yes °Ni All roofs shall sect rl to
�ry/:!•p p D?114gL PSYApIP�Slglmateriul being installed.
....
Will the upplieam or llnare building«cnpant use cyuipmct ar devices which If a roof is instate( with I iS obt I 1•in-
odtri,rid„n.all,ratill 1,asdcnmd by the Ito,Anita A it Qual,ly NOi agnmmn ,t S.- I�ff-�L 19L1146—§C., l4 ff!"�!3 I agree to remove
Di^'n'el”yesall new materials for inspection, A he art ululerslands and will comply with
❑ave 13 No allnon-point sourceregU1,11ions. PP s I Y
I have feud he lly Coda, nl;tot., 505.2 tnentl under Chapter 'mad the
IfaceIia lemur kSal'ay Cadamea,a.ua 255115,25513 anJ 2553,1. nndvrafnnd that
Ilene 11uilJlgA is, no curtn yhavcatcnnnt,mho it rmY mspomihilllymnotily Oto
mcupn Ih au i11 reOh I Which mu.a he o c,prior m issuance of a Cedlncme of
m
L " Signature of Applicant Date
i0 •"��—oJ All roof coverings to he Class "R" or better
rood,w>,elht Data
OFFICE