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01020053 CITY OF CUPERTINO• p' -• ;`` nmt.mrva'mvra101y,,- - pERMIT - CONTRACTOR-IIVFORMATTON:t BUILDING ADDRESS: '4 PERMI'1'NO. — 10159 So:BLRNET ti{ L, 01'020053 OWNER'S NAME: ' 6} SkD 2©6 APPLICATION SUB'DATE - DEVEI_.ORE INC. 3�j 210 .5 02/12/2001 PI IONE:' - SANITARY NO. CONi'ROL,NO. qq I. )v 0 0 ARCHITECUENCWHE.R: - BUILDINGPERMIT INFO 'BLDG FEECf PLUMB� MECH, H a LICFNSRD CONTRACoOI...... over Chapter Description - z - - Job ❑Z„❑ Ilion 70by dere matInm oohs Blunder pad PronxurnsiCode9(conununcing' - r�r�Cw withS i ]OOlq of Division Sof the Busernes, utdo"l'wnve - aY� hr dstfrf� WELTER LINE C C¢ Lierase Class- 4f 3� Ltc# 3 ' a U Dole Contractor ' w 3 w h ARCHITECT"S DIiCLA AT N ❑ - Irad—land y plan.shall he used as public,cords t ac }, o OW NF It RUII DPK DFCI AI2Ar10N r •�� I beach, IL I pt tr th r C tC L for me =r toll g nua.(SI�(5 f ]WI4B ' ,"Ind ' rt n.CJ ACounty a ❑ which 4 P I construct, "'p Ic f'h pri,any: udurc • - , az prat t I 'th 'ppl'cant for hl n nsigned ltenent 'hit he is I .. l puraccutwifepowisi ifen Controoresi Ei&cnsw L (Ch pter9= Sq. Ft. FlOOCAreB anon (torturers,a,withs I 900) I Division 3 ift business11fof..fir,Code) nrtral hes enpl Rowboat,and the basis to the alleged exentphon.Any violation of Snmanu.90315 by any applicant fora pee=r suhle is the applkmn to e civil penalty dfnm nook than five rowan deBena($50P., - APN Number' Occupancy Type 01 f the poap 'rY or ory elarploi lot d to car"a"alia, • - will do(he k I the t t no, intionded or offeredto,sale(Sce.]044 - - Iia t]P fic.ordi Core I he Cia t,r e L eel°e Ease des air,up,ly Ie an Required Inspections - - - ter or pro Eery Who builds or Improve,theo ern,and who does such work oni,,lf or ihrm,gh his own empluyces provided that such in,provmmmae are nor Intended or 1.03. — LIFER. offered for sale.If,however,the building or improvement is sold within ere year of - completion,theov,ner-hnBdcrwnlhavehenurdenofpmvinglmJhedidnotbuildor 10E — SEWER d WATER intpmveforpurpcsc(ifkaie.). - . . .1 507 — FINAL PLUMBING ❑1,as owner of the prcpary:am exclusively contracting with licensed contractors to U,Viet the project Isco.9044,Business and Profusions Cur,I The Conn'acua' ,enin To,does not apply Into owner of propcny who bola or impnwcs Itcream, - - and no caobmte for un,li.,ro,ea, will,a mntmtlia(s)licensed pumutml to the - Contracmr's"LurnscLaw , ❑Iame_xcmplmdcrSta. ,B&P C orlhia reason - -Ownnr 'r Dates WORKER'.COMPENSATION DECTAItA'1'ION + - � � Ih by farm I Pally tf pee Y fire toll gd I lion- � t t .. O I have will unitarian C nlfat f Curve-at to self-antoll f Wok is Courptactaiii us panvided for by Section 3700 or the Labor C le lot the .perfnnnvnce of We wink for widch Ihie wail is issued. ,. , 711 have and will nreaduin Worker's Coulee inion Ineuiranre,as recriord by Section s - 3700'IF he Leer Code.for he p ionr f ON,viak let I' h this parnit is toned.M Vp kale C pe :r In.utatooA:al Y 'h^ > t'-( Car Policy N V Oa _o� • - CERTIFICATION OF FXF.MITION FROM WORKERS' - ' COMPENSATION INSURANCE ' (This s,crourerd not frees orale rd ifthc permilf,for one hundred dollars($100) to,,) - 1 eertfy that In the peiformoncc of he.work ter which die permit Is'Ise.d.I }' shall lies tnnploy any pasties in any ora so a,io hecome subject Io the Workers _ Congenital Law,,,l Colifnrniu.Date ra Applicant ' - NOTICETOAPILICANTIIaft tnkingd C I'I ''lett! pi y houfd .. bac t .uhj ,1 theW k 1 C :1 p if the h C l y test r Q � forthith conply w'Ih ,hp ons firth pennlxhit l lie le,,d rcooked . 7 o f a CONS _ Ihrhy ffmlh llh imcfon lc td'ng ugcney foe the penfommnce. ofire k forwhichth p roes is issued(Sec 3097Civ C) - -�s .Lend :N t _ ' V7 prude. Add... _ e• . 0 1 easily(hill Ihave read lh:"ppl I and state that db tiouratiflor W E, courrec, I Rice to cariply with of city and county ordinances and slacePaws Mature Q V so building ,asera,don,andluehy atmo,ze representatives orB city it)enter upon � t1] Ahe ahtvemcrournlproperty for i nnpceflot purposes ' - Fa. - t(We)agec las itdcnnif)andk pharnd...the0ly fCpertinotonaust •, VU01 Ilnhihtiu,judgmm�ts,cost.and expense.which nay in any way aeeme against said `2 City in conscgncnce of the granting or ants permit,APPLICANT UNDER AN D WILLCOMPLY WITHALLNON-POINT I (` _ Date s URCP Issued by: e . P IN/Conquatur Date Re-roofs IAZARUOUSA1A'1'ERIALSDISCLOSIJRE Will tho applicant nr lumre building occup rd.lore fit handle hnmMons malarial Type of Roof _ yr .• s m defnW by the Capeninn Municipal Cnde Chaprer 9.12,and the Healed nnJ Sdery- _ _ > Cuda Section 25532(t)P - • � ; a Cl Ve' El"f r r All roofs shall be inspected prior to any roofing material being installed. Will mcappfcamn;mm,buildingoccupant use eyaipinetuordevieeswhlch If-a roof is installed without first obtaining an inspection, Pagreeito remove emill J m t: ,t lndby theB'yA 'A Q 'f1yM gcnent District? all new materials for inspection. Applicant understands and will comply with °Y` Cl No all non-point source regulations. Ih' "if the h N I yy cm'ntl Chapter' 6,95 of dm - Calif ria Heahh&S.fety Co I Sec' Kn3n5 2553;nil 25594 I undersand that - 'r - ior finebu3drr,,b,inmuu veate I Thad yep :'b'I'ryt inuily(he t in paof mbe I trust met pit r to issuance or. u Cffcate of Oce Signature of Applicant Date to anor, col agentDem• All roof'coverings to be Class `B"or,better- 3 "+ OFFICE