01020068 CITY OF CUPERTINO - `
BUILDING DIVISION PERMIT' ` , CONTRACTOR INFORMATION:
, � - •;
I1111LDING ADDRE55: � - . - 5 PERMI'I'NO.
1171109 S..BLANEY 1711 01.020068
-' APPLICATION SUB DATE '
•ld OWNER'S NAMI. 1 r �' . . r .
02/14%2001'
•{PHONI SANITARY NO CONTROI.-NO.
OM a ZZ ARCHITCCIA4 GINTER + I I '. BUILDING PERMIT INFO
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• Hl BLF.CT " PLUMB MECII•
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+ LICENSEDial[ CONTRACTOR'S ULCLARATION F +
� ' � .. ..• ,' Job Descry hon
os ' u nyu P tl 1 eCode,r �. rr1 m 9( n.n. � , �.
F y w'nI S , etotanYJ
ce inl of e B I e "+
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3gan an unI ARcl U 117cis DECLARATION INTERIOR .REMODEL -
"FNNFL'�� I , d YII Iall he ocla phl I,an
ce Licensed Prate,a... I ,'
�y OWNFRBOIIDER DCCIARATION
+ I h ny ifflon d l i air,e PI In do,C I I i La.fe,Inc / -
.��Qfollow I,rease,(S ti70115Iboacs%Card ProfiassionsCoLD Any city arcorucy
f ❑ wh h 1 P I I I 'I 'll P cl I'.1 p y structure' e ., u
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3� '],I, d Pat"otardet tic,1- n IIh Contractors LLess'(Chap 9 Sq.'Pt•F'1001'Area ` _ w?Va $[}Q(1'
(,Crna,c hw'Ih Send 700Hp ID 3 (Il 0 a,d Prtus,ns Code), ," - - - v
order he's e c,t I ...a and len basis for lee dleged cxe npl on Any v l fon /y •,_ •
o1:Se..'n,7011'5 by a,y uPpl wnl for a P ', 'ulljetls,he ail ln'I pewlty -
.olo . ..dlq.I.ah ndrcddonaa.($5nn1 - - APN Number - - _ - Occupan �i'Iy �
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El 1.as nwnernflhe Prr ly,or.nyemployees wi.n wage,as their sole cimrevsrion, s•'
will ) thek Ith 1 - . ' I i I ff .. aI mc, oc, 'a .s - .t
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Ba' d P r: Code. rh r . :I : I PPI)is,an - ".? • e d,lns eCCIODS .
rp l nWl Could., P' hat I n hes rchw,rkhed(it
` 3Er90.,0�B.9E1iPP P
y
or gel : ply l rdtld I. h' p ,e vsarenol intended
Brei I II - .1 hard,,,,et r' d en t,'. II 'el'n nncY' f
n. PII m -ill I 41 have n a arprnyneo lh eanalbnle . 101 — FOUNDATION
a 1,62 .— PIERS
+1 fth P I ly 1 - ly at,, f j'idt liecorsed"awascon,t f ,
nn 1 1.h project(S 7044 B ' d P I .- :Code The C t l s 1�3 — LIFER
Lic I' 1 I'Pllyl - ,I Pmryrn wno n, 11 p .th .'1 ah,• - .
and n -r n r rejects w th elorca) I p ., o .. 04 REHAR :
o°II r Ini,. 105 - , ANCHOR BOLTS ''
ownc li.' 'D,� SEWER' ,$ WATER
� "' NI 'uLLCLARn ION - F i
202 — . UNllERFL`OOR •PLUMHING' ll -
nv a, pn�taro a ny salon Cot, r "ins Labor for Inc m� 204; UNDERFLOOR FRCHRNICAL
o l i d 11 ,c I l r c If n r W k 213'' UNDERFLOOR ,MERME
r
.'rr 'nevibaw, kr men.hi, I hued. 205 ` UNDERFLOOR. INSULATION
ole d o ai w k C p i I .. . dlys 301 —`ROUGH PLUMBING ' , .
37(10 or II f r h Coot.ry the Parlor r fl work 1 h h'hisp t'a
m I,MI Worker's Cnnpc Moon I,str nand,Pal hat aa'.
„" 302 — TUB VOR SHOWER
Byrn, PoneyNn: • 303 ROUGH MECHANICAL
CBRTITCATION OF EN E.MPTION FROM WORKI?RS''
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COMPENSATION TION INSURAN li -
. 04 . ROUGH LI_.ECTRICAC' >`
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tTn . al ,needoolnawnPlete11hapern, sr - hnndre<idoflt - 305 ,:--.FRAME "
.(M00) ) 1 - , .
IC liimr lnpr rm it -
306 HOLDOWNS
`.1,an I p1Y an,par,( y ,5tobeean b�n�Iln.neWorker, , '30'7 '— ;'INSULATION -
c, 1 . 1rclr .ul - -
Ain, t - 308 — "SHEETROCK
NOIICI IO AIILICANr It, fl 'k yn C fl t IL p( y IW
.nom IJ It .hew k c p . , 1 ,111 L n Code,y :l - 309 — EXTERIOR 'LRTI-I '
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forthwith co tply with h provision,orae P rn't shall b.decanted revoked.
31.0 — INTERIOR LATH, - .
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CON sril[ON IINf71NGACP,Nry 3j.1 — SCRATCH COAT,
1 h by P II I II .t r d, y sgc y II Dnfor, _
fee'hi",I...p ¢ s cued nee 3)97 C'v.c) _ ys d� `
- a q Lender:Na,.c e 1'3' ROOF NAIL.
Le.e odd " - - 501 — 'FINAL F_LECTRICAL'•ENERGY,'
U Q 1 if;1i IIn."ppl I ` I l l Ih'..h n r '1
w E e,r ..1 s I ply 1 11 City d N d It r : Ir s 502 — FINAL F'LUNHIIJG ENERGY.
Q V lob 'Ir8 t i Ih 'ly' II p If off., rymkmcrul i� —
tthe n r edr rent re, P P:: 503 - FINAL •MECHANICRL ,ENERGY
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. n IlaErf. 1 dsnerm, I ,,, n n n.ym„y v nice, ad 504 FI'NAI. 'BUI'LD'ING ERIERGY
...LIZ C'a-In ao cof the granting of this perrnll. - - •
IUNDERSTANDS AND WILL COMPLY WITH ALLNON-POINT ; '505 --
APPLICANT FINAL 'ELECTRI I� ,r
SOO RCF REGULATIONS.
Issued bY: Date
Slg l rAppliena.reo,Vaclnr - Ore•X ` Re-roofs+ .. — f
Hnzneuous MnaRlnfs Dlscl.osuRL 507.'..-' FINAL PLUMBING
W'111� pprat flar n,J ng a'enPa..n.nearhn al l - d . .neleal `Type of Roof' 508 = 'FINAL MECHANICAL
nsdf dnyt CP . Municipal C l Chal)12 Ith li llh dSfly
C,A s 5530 509 FINAL' GR DE'
w O” All roofs shall be ip ted pia „tpanyoIlmla hal being mstalled. '
wI1 In nir I t -1 If t 1 t agar I -i , I n �G PP
If a roof is installti I out �C. o anup��t; u s�2ec I ree to remove
mll d ur na nl,asdernad by tl Ba,Am,A Qarl)Menag on � p�t ,-
'o vg. ; , -❑Na. - all new materials fafAARpectiSn. ticnn't'B�d I'sta �9Hd1 ill comply with
. all non-point source regulations.
I I", I-A e It 1 , . '1 'qn, ns a d r Ch,Ic,6.95 oPInn
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Calton Berlin lin&Saf ly C d S cu n 25505 25513 and25534.I onderstand that "
"[th t It yJ
( , c I �h �'11 ch n,cl h call r to a Cerly� r "-
Signature-ofApplicant
-, ,Date
l _ / Y
Ownnr ar)"i
Data - All coot coverings to be Class "B”or better
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OFFICE.