00090075 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT.. CONTRACTOR INFORMATION:
BUILDING ADDR10885 S BLANEY All I• ,. /O / ( �e1 I PERMIT NO. •000910075
OWNER'S NAMER I TTY LAI – APF'LICATIONSy9q�.�!'13/24100
CR. 7 a gya � r LLJ
'HONE: SANITARYNO. CONTROL NO.
C to¢ ARIA IITECDENGINEER: - _ BUILDING PERMIT INFO
.DG IiLECf PLUMB hIF.CH
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Zswa II bytlTtSENSLDCONTRACfORnolmorANfChN >( mmecnb l Job Description
F_C� wins ( 7 nnorD nhei3n aP fe.,inc enyt MUSIC LESSON .AND RETAIL STORE
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is
fllf Tre and dcf/ s � '
ere-e Lc Cho L x
S lit I r AY l�h
3 u H ANCHI rl C'I•S DLLublic or, - -
t 1 underhand my plain mall be used as puhlic ren,N.
y c4
❑O Licenmd Professional •. „"'
'OWNER-BUILDER DECLARA9'ION
u, 1 hereby affirm tha 1 am rmm,d from The Cin ntraam'x License law for the "
Fie
following rent n,(Sect n 7031,5,Himilm,,bad Pr f C I A y ty m my J '
Fp
vaidt ' n Intl.allot.aripboc,dentolish,or oulijoury:rcwre
i 3 prio T 'r' 1 q 'tn applicantI suchpe tt g lstatement
that he is 1 sed put at Thep n of to Counterparts I L (Chapter9 Sq. Ft. Floor Area V;�IfL!$'b67
(commencing with Section 7000)of D'v s n 3 01 the Bus ne 1Professions Code)
.cr(hill he is'exen,a thamlmm and Inc hosts In,the allcycA cxetnpnA, An,scialion '
ofsection 701 1.1 by any upplicani for a permit wdjeats the applicant to a civil penalty
-ofnotmomthanrvehundreddollars(a5fii APNi4kTSV94G22. 60 Occupancy Type
111,as owner lir ore PbTi,,or my eni,lo,ce,with wagon nx their nom anmpersortnn,
will do the work,and the ntorcome is,tot intended lir offend for sale(sec.7614, d
Business and Professions Code: he Commour's License law docs not apply to an
owner(if property Who builds or impn,ves thereon,and who does such work himself 101 — FD'�flQC1 T(A N 1131 VCIIOIIS
or
- n employee,' tl(hill said,im,noscas,ok l ain
offered far sale.If however da,building improvement c old wild. am of 102 — PIERS-
completion,themila, have rp poising did thold nr
'opower p m 103 UFER
�Y�Y�•{`O
-
OI .corer of ate property,am exclusively contracting w th lietabod ceramic, to 1.04 — REBAR 0�
cnnstmet he pmieet(Sec.7044,Bminns and Professi.cm Cnee:l The Comrac m a 105 — ANCHOR BOLTS
License Law does antapply to an owner of proberty vAo builds or inproves thereon, ]06 — SEWER 8 WATER
and who 1wanal,for such Projoes with a ennaaanr(O licensed perwe I mate WATER License Luw.
O l at.exempt under Se.c. ,B&P C far this reason 202 — UNDERFLOOR PLUMBING
Own,, Date - - • 203 — UNDERFLOOR MECHANICAL
WORKER con,rENsnnoN DECLARATION 204• — UNDERFLOOR FRAME
I hereby elf nolo,ponally,olperjnryoneol'the folio ti,eeclanauna,: 205. — UNDERFLOOR INSULATION -
0 1 have and,will maintain a Cerifica,of Camara m oelf-houre for Worker's '
Compensaion, as provided for by section 37. lir Ire Labor Code, foe me 301 ROUGH PLUMBING
pe,Inntntneeol hew.,kint;vhiultthin'coulixissued. 302: — TUB &• OR SHOWER -
01have mid will maintain Worker's Compensation Insurance,asrequired bySection - 303 — ROUGH MECHANICAL
37M of The Labor Cale,lo,The perfonnonce of the wink for which This permit is - -
isnlied.MyWmkerIColliclomimtlmnmmeemoe,am1PolwynanOcra,c: 304 — ROUGH ELECTRICAL
cutric PnftcyN., 305 — FRAME
CERI'IFICN'ION OF 17XEMVI'ION FROM WORKERS' `�
COMPENSATION IN - 306 — HOLDOWNS
o1ivaectionneednothecompletedifthePermhixto;(mehundreddollars• 307 — INSULATION
(sla).crlena.i-
308 — SHEETROCK
1 certify than in the peKointance of the work for which this permit is isiued.I '
shall nal employ any person in any tanner N, to two ,t rji;to Wmkat 309 — EXTERIOR LATH
Compensation a, I Cn1'bmiu. u¢
A,,Ii,.,,( — FefA 31.0 — INTERIOR LATH "
NOTICET APP I ANP.If,after nor 1 los Cenilicae or 1 nnption you should
Z become subject mthe WorkersCompensation provisions ofthe lamnCode. you musl 311 — SCRATCH COAT
O forthwith comply with sucb Provi+inns or this permit shall be deenmd revnk�.
(4 313 — ROOF. NAIL
F, coNSTRUCrcoNLEN'DINGingIneNCY 501 — FINAL ELECTRICAL ENERGY
ai I hereby alB,m that mere is a constructionSec.
lending e.C.) rte the pr,tUrmance
� -lir mu wino rte whim mix pe,tniT Ix ixnnmtsna.3n9z ay.c.r
y q Lenders Name 50e —
FINAL PLUMBING ENERGY
p z Lender's Address- 503 FINAL MECHANICAL ENERGY
V O I come thou owe tare mix ttpphyatiutt and lane hal tita whine mfmmmlin in 504 - 'FINAL BU I1_D I NG ENERGY
W E:, correct.I agree to comply with all city and eoany wounwenn and stay Iuws rclaing
Q C.7 theto abow-constructionopeny hereby
orinoicebor puposentatires of anis city aunm,upm
w mean(WOagdeetosa,pindernfyardonloamx. 505 _ FINAL ELECTRI
A. (w> g I ,i l fy dkeel)la t in
waylity iCrpcn against all 506 GAS TEST
fn
liabilities,judgments,c t d expenses watch y n any way uceme usu m sa A ,
V Z P9u force.air., fmispe l
APPLICANT
'
APPLICANT ULATIOTA SAND WILL COMPLY WITH ALL NON-POINT — G
- SOURCE REGULATION / i/ � 1stiUed,by: ' V• Date
S;gnau o1L (AppliCen✓c tilt xrr / ]Dale Re-roofs - -509 — FINAL GRADE
HAZARDOUS MATERIALS DISCLOSURE '
W16141be n,fi,dran,rumre handii,be, pant s,hanmy na mfoo,mammal 'type of Roof S10
Cl -• FINAL PLANNING
`
as defined by The Cupertino Municipal Code,Chapter 9.12,and the Health and Safety .. F v
Clair.Section 25532ca)7 it 51.4 — d I N% PUBL 1 C� m• IEP� �
Ove, 0No n t All roofs shall be mspecte prior o any roof& §eing installed.'.
Will the applicam lir future buildingoccupant me cq.i,mom or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit naxardrus air comvntinants m defined by the Bay Ann Air Quality Management
Dixmiet'r' . I - all new materials for inspection. Applicant understands and will comply with
❑vet 0 N all non-point source regulations.
I have read the mumm us amterinls momma ems under Chapter/95 of The
Cnlitemia llnmh&Sir",Code.Seed.....25511.5,25533 and 25534.l mile mad that
if the huddling docs ma',umordly have a le6tnt.that it is or,responsibility to notify lire
occupant of The requiTemcna which must he met prior m issuance of a Certificate of
ouenp,tnny. .I Signature of Applicant -„ Date'
Ow me,or amhntnea agent nate All roof coverings to be Class "B"or better
t
l - OFFICE