00100183 CITY ODSONO
BUILDING IVNPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERNu r NO.
OwHHR's IIA'030b4 IM 13L.ANEAPPLICATION SUB LATE
io io
.iGNE: - s SANITARY NO. 009W9 1.NO.
O O ARCIIITECI'/ENGINEER: BUILDING FE
RMII INFO
w C BLDG ELECT PLUMB MECH
Nzw 1=1 Il, =1 IJ
LICENSED CON'rRACrOR'S DECLARATION
t 5 v n I nen conn mar 1 an,nscosed under goo,form,ofChapter 9 tcommcncin Job Description
wCw isin$crion 7000)forceadeff Division 3ollhe Busint„arm Pmfu�'ions coda and mylicenso .
L cense force and effect.
�z�< License Class hie.M
an3,� Date 'S DECLARATION BATH 'R MODEL/ALTERATION
r a C ARCHITECT'S DECI-ARATION
w I understand my plans.hall be used as public records .
r_ /)
i p z Licensed Proleaioaml
OWNER
-BUILDER DECLARATION G��
w I lae,h,naso .Ne. .7031.5.Business
from he Cession% o License Law for the
H i follwhichingires.(Section construHusinesnand Professionsh,,,,Any city or county O
— es which rcquis a n pont)nett) srucL alcor,improve,demolish.sur atpoir any amcmrc
i 3 m 'baron its histomas!List)nett ic)r at(ht)visi cath for inch pnni)m 1!1,
a signs(Chapnem
moa he lown,.ad wiff Section Lawor,Code) Sq. FL•Floor Are Valuation
(c dhat he is lie See.ian 11Np1 of Division 3 of the Business and P.dwn,vi CnJel
or Shatis cmngn)aerefmm aIII dnd the basis I'or uW alleged exemption.Any violation -
ofnoSection than by any
addedi dollm,for aprints subjects the agplicmnnecivil Penalty p
'rnmmoreananhvenundmadrulaafsslkn. - APN Number Occ 'an e
r61,son.ne,of the pmpny,or my cmpluyees with wages as)heir sole compensation.
will do the word:,.a+d the avunure is a,,,infrared or allied fon sale ser.]810, - Ij
nndmess and pnofe,shm,Coder Tin...,,
Tire C� ,,1.m •
enre Law does not apply to an "- s equired Inspections
orr of progeny Who builds or imprint,)hereon,and who does such wort,himself
tbnmgh his own mnployce,provided that such improvement,are not intended or 101 — FOUNDATION
offered Inn sell,II:however.We building in improm
veent i,cold within one year of ^ -
completion.the ownr-bolder will have the burden of proving that he did not Wild or 1 2 _' PIERS ..
imp...c for pmgwsc orsale.),
❑I.as owner of the progeny.am exclusively contracting with bestowal contractors to 1.03 — I.IFER
Lensurer the p...Pic,(See Y1H0 [homes,osm ,and Professions code:)The Contractor,
icense Law doe,rat apply to an owaer of property who builds or improves therton. 104 — P.EBA R
co sent romne5 roe yarn rrnJaas with a tommenricl licensed pursuant a+the .1.05 — ANCHOR BOLTS
01 taaeors Laccase,rows
❑ moa n der see ,B&P C roe this mason _
1 06 SEWER WATERowns Dane i��dl D 202 UNDERFLOOR PLUMBING
V kKfiR'S COMO PLNSAl10N IlEC1.ARAT10
1moby aeon..+underpen:myofpommy one of the lollivem,doelamrma, 2203 — UNDERFLOOR MECHANICAL.
3 I have and will nmmmin a Cumimme of consent to wif-inset for Workcrs 204 — UNDERFLOOR FRAME ,
" � alkhihsp` mdr cot Lnnor ct.e. for cot
paf� imewaforwch�i <-ti issue . - 205 — UNDERFLOOR INSULATION
❑I nave and will midmain Worker's eompensa ion bnmanee,as reclorcd by Seddon 301. — ROUGH PLUMBING
370 or the Labor castefor lie gertormance of the work for which this permit i, -
sued.hty Wnrkds Compensation ha,mim d,came and policy number arc: ,302 — TUB ROR SHOWER
Canis,: Pan,N.,: 303 — ROUGH MECHANICAL
CERTIFICATIONCOMPENSATIONOON FROIN.URANCIWORKGRs' 304 — ROUGH ELECTRICAL
obiswero.need nmbecomgWed ifsne pmlt is forone hundred dollars 305 — FRAME .
alnnonless') 306 — _FIOI-DO14NS
1 certify)haat in the performance of she work lar which this permit is issued.I ,+507 — INSULATION
shall nm employ any sereno in any runner so as e+Iweon.I omeer to the Wn kcr.0
CompnsmioaLcas' ItColdmia.Date 308 — SHEETP+OCK
Applicant
NOTICE TOAPPLICANT.Jr,after.taking lois cenireafeof Esompron. on alold 309 — EXTERIOR LATH
Z became subject to[be Worker's Ce iNfori m previsions of the Labor Cale.you most
ZO O mnh.imcomply witnsuch pmviaions or , decimal 3.1.0 — INTERIOR LATH .
,^r 4 CONSTRUCI'ION LENDING AGENCY 311 - SCRATCH COAT
a 7 1 hereby affirm that them is a construction lending agency for ane prfonnencc 313 — ROOF NAIL
of be work it,which this permit us issued)sec 20N7,Civ.C.1 ,
d Q lender's Name
p z lenders.duress ., 501 = FINAL- ELECTRICAL ENERGY
O
O EUa
certify that I hive mad this application and state that the above information
502 — FINAL PLUMBING ENERGY
connect.I agree to comply with all city and county ordinances a state I f ng bun e t dl hereby f p or. fin. lye ) ism
503 — FINAL MECHANICAL ENERGY�. z
L4 he em r d Property 1 'p li proposes,
E. a (We) g a indemnify: . nilke pefemales,m sty of Cupertino'gint 504 — FINAL. BUILDING ENERGY
v VI +nft 1nesse) 1 fx . may n:rywy tgatnaid G
9" �
City;. q lottheg
rami.,onhisprmat 505 — FINAL ELECTRICAL
AP T ERSTAND AND WILL COMPLY WITH ALL NON-POINT
S LRcc' + LAl1ONS, Issued by: - VOr. GAS TEST � Date 1O�)
/d `d -CO
S as ofnppbtanAZARD U N haft Re-roofs 7 ' - �,
unLARLOUs Wilding
DISCLOSURE
hiRE
• wiuthe ytappsNo)cor noMoriwadCode.Chine912.anWhenvmrhwsma¢da1 Type ofRoof 508 — FINAL MECHANICAL
asdefined nr cot 32fa)? .Municipal Code.Chupler 0.I2,and fM Hmlih:dna Shiny
ctWe.seelon 2ss3zaoa � 509 — FINAL GRADE
°Yes v° All roofs shall;pB ibspectRV04i-of-toFahy:rtibffhLIFinaterial being installed.
will tae apprteum Cir return nodding aetupmn use equipment sur devices wnian If a roof is insolje¢withtpul f�obfaok gp;in"Jg qg) I a ree to remove
#if
it haalloua sir cnnmminams ne d sued by 0c Bay Arca Air Quality Munagemtm g
°^e,, all new materials for inspection. Applicant understands and will comply with
Ll Yes
"o - all non-point source regulations. PP
1 have read the haranlnus materials requirements under Cramer 0,05 of did
Culiboma Beal),&Safe,y Code,Seth...25511.5,25533 and 25530.I unde,,mad that
if be building dawn not ewmnJy have a tenant,that it is my responsibility to notify the
an)of mi,a etnems which mus)be nae prior fn issuance of a Cenidcam of
+vsup oSignature of Applicant Date
f0 .37-"
O or inlaid a asst Date - All roof coverings to be Class `B++or better
OFFICE