00060069 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: .
HUILDING ADDRESS: ,RA1IT NO.
�U ENUEOO
(IWNF.R'S NAM1IE:i085`r 00060099
APPLICATION SUB DATE
431:111
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M-Z INEER: l/ L� OV BUILDING PERMI INFO
In u - IiLI SLE PLU U EC
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FF LICENSEDCONTRACTOR'S DECLARATIONMinn mal I am licenced under fCha , l(commencing Job Desert On rrovtanm,o peri PO,f nPolJnn9nnne lhasincca and Prnfe,.in I,Codeamdmy Inverse
, nuorceand eflec,
zoz .,ccn ,l j ue.a 7S$'96S F'� �— LIVING SPACE. , 622 GARAGE
ao Cmm�swr
ARC III'1'EC'I"S DECLARATION
C= g 1 understand my plans shell beused as public record. '
ae�`C JAN,2 2' 2002
m p p LiccnneJ 1'mfc,.innal
n
OWNER-BUILUDIiCLARNI N
I IiR O
1 hereby affirm that 1 nor c,empt from the Con=dor',Licenx Law for the
following mason.(Semi..7031.5,Business and Poso wino,Cork:Any city or county ��'`D�IY
which requires a penml,n eonsl,mcl,alter,improve,Jemol ish,or mien any avuumre
g�w I'im,nil,Iv,aanm.also aquim [lie indicant but sucnpnn,h In file a Signed-statement
that neisheensedpanua.,m the pmvkinn,of the Comment(,License leave(chapter 9 S Ft. Floor Area Valuation
(commencing with Section 70W)of Division 3 of Businw„and Profesime,Code) q.
or that be i,e,.,npl therefrom:red he halt,for the alleged excmpliml,Any vlolrl;nn
Lot section 711315 by nor nppllenau for v pa;rm;t wbjcas,he applicant to a civil penally
ofnatmmethanr.ehundreddollar,(s51,e). APN Number Occup tri;'
❑Las x rof the pro,taf ter employee will,wage,as meirnale
.... pen,
will Jn the vork.mel the I...rate I,nut Inmoded or ofemd for,ale(Sees 7(44,
R,Ismo,amt Profession,Cndv:Tic Connector N Leanw law does nor apply to an " - g red Inspections
,or tr of property who(wild,m improve,rherenn,and who due,such work himself
hrough his own empinycc,.lino drd Ihm.acn nnrrnveffers me on,mlemled ur
olmmd for Sade.If,I we,,,, he bnJdmg or unmormen,is sold within one rear or 101 — FOUNDATION
completion.the owner-builder will have the nmden.f proving that he did not bund m
improve for pappose of vin.). 102 — PIERS
°1.as owner of the property,a,,,e.,dn,i.ely contracting with licensed contri to 103 — UFER
nn,wc,the project tree.7044.Buaines,and Pribilof..,Code:)The m
corar
to
cm , 7.04 — REBAP,
Land
Law clues no,apply an owner of property who build,or impm,e,th m r,
and won eorlows if,,suet, prnjecn,wan,a c.n,raa,nral han.ed pursuam In he 105 — ANCHOR BOLTS
C.ntractuA License Law.
°l am ew•nlpl Yoder Sec ,H K P C f.rmh of son ].06' — SEWER R WATEROwner WORKER'SCOMPENSATIONUECIARn'[ON 202 — UNDERFLOOR PLUMBING
IhcrebymnnnunJepperml,yofperjug(,nenfthefollnwingdecla.I no 203 — UNDERFLOOR MECHANICAL -
�3 1 have and will mmnoda, a eernrca,a of Con.cr[to self-insure for worker, 204 — UNDERFLOOR FRAME
penmboureon. a, preview for by Section 3700
sued( me lancer code. for m` 205- — UNDERFLOOR INSULATION
rfummncen. as workfor which,his
°1 have ane will rnalmmn workers Coanpensam,n insurance,as required by Section 30:1 — ROUGH PLUMBING
37w of the lobar Code.fa,me performance of the work for,which this pens,;,;s 302. — TUB & OR SHOWER
issued,MyW.rAeLc Cnmren,ulinn_In::We ca 'fir Land hit,,mmmber are:
Car.;cr:,(E�no✓Z+�"I",.,,,;`.y ..:L�1C /— /eS38 is 30T3 — ROUGH MECHANICAL
CERI'IPIC TIO.N OF COMPEN$TIIUNIN.URANCE PTION FROM WORKERS' 304 — ROUGH ELECTRICAL_
(This oafim recd co,he completed arse rennin i,or one hundred cinlims 305 — FRAME .
tslBhrm less.) 306 — HOLDOWNS -
I lenlly mal in ane pc,Io name A doe wink h,,wluO,mi,perndf i,issued,1 307 — INSULATION
shall not employ any person in any manner so a,u,become subject m the Workers' -
Cnmpeau,dnnlaw,orcahmmia'Done Applicant308 — SHEETROCV
Not nCI710 APPucn N'T fanernawmg,his Cernframenr Ewmpthv,,you should 309 — EXTERIOR LATH
neemne%object to[lie workers Compensation provisions.nnw labor Code,you must 310 — INTERIOR LATH
O O forthwith comply wish such prnvisiom or this permit,bull M dvcered revoked.
Z _
p L1
F `4 CONS'I'RUCTION LIiNDINGA(IENCV 311 — SCRATCH COAT
> 1 hereby Brom,that them;,a rumm,ctian lending agency for the reprom nce 313 — ROOF NAIL
Ga: of Inc work for Which,his permit is issued ISec.3197.civ.CJ
0. Q Lender's Name
o z '^ender',Aid. 11 501 — FINAL- ELECTRICAL ENERGY
U O -1 ocarrifydbut,I have mund this applilatinor and state For the above information is 502 — FINAL PI_U ING ENERGY
Lx, r- vorm,C I agree,o comply with ml city and romy oNln imc,and n,am law,mhning
O u mnoildir,,nnurend I.andhemnyaumm;,emprescrm,bwofthi,nb,noenter.p)n 3 FINAL ME ANICAL ENERGY
} �
he anonOagre to%aved peryff invi,efluir mnifyadkepurp.ws 504 — FINAL BI I_DING ENERGY
[.. 0. (we)agme w.cost indemnify keep I ,icy in the Way
again.
m Camrnco judgments,cos„nam expenses were t„ay in any W„y acerae:again„call NAL CT R I CAL _
U � ealy m consequence rime gramia,g nems w,:nil. 50. � .
'LICANT UND eRSTANDSAN WILL COMPI ITH ALL NON.POINT Y A ES Date /
,ouR — noNs. ��yy� �7 Issued 6 5”
eS J 7 >
S;gN,mm,,r—e.a,I)c,�m— - Date Re-roofs �ypp — -
Hamfut S ERLALS'.WilCLOSURE ,_Op — FINAL FINAL —MECHANICAL
Will t eC cantnrmmn•.hfedCo a Chant x9.12.handle na,am,,..material cly TYPe of Roof
as refined by me eaveria,.Moa,;a;p,u ores.enamor 4.IE..nn me neem and sar,y 509 — FINAL GRADE
Co11,Section x553](,)^•
°Ye All roofs s all be ii 4*ted flFi5i tnyRhdA1I�JrI{hIErial being installed.
wnl,ba.pp.soun.r future n.ifimd by hep yAea ALFQmlbyIst agerne If a roof is installe0itiv4hout rwar4ftjnjakjEki j�j�ed JDRIVE�
EmilhnWillnheniphwan, infutu ter denn•d by he pay use
puce try M.nagem,l, . fee t0 remove
�n all new materials fg aNITecti] .(APP�4tW@bl3taltlk 1,,Lt
❑res � d will comply with
all non-point sour' ulati
1 have mal me e',Code.ant ion,.regmremmn,sneer 4,1 mi ass of me - �t�1OF BATTENS
-C.I;IiWiaHeudoSSafn,CWy,aveiansurn,Ih25ismo, 25514.1undennify,c 604 — ROOF IN—PROGRESS
ift
Wilding Jceznot currently hanealewnannal;,..ter m.p,msibility u,notify the
erapam nr n,u regaimanem,sun ch ren,.be Anel(dor,d', arse of a eeatircalu m
O vpm,'I
�al-7 p Signature of Applicant Date -
ow�mnra— sae agent- — — - uric All roof coverings to be Class "Br'or better
OFFICE