01110052 CITY 7ADDRUS;
uPESION ' CONTRACTOR.INFORMATION:' =
DIVISION PERMIT ' - -
BUILPERMIT NO.
1REWER AV 01110052
OWNAPPLICATION SUB DATE
MNG DAI AND LIEN ESTEL A 11/08/2001
PHO - SANITARY NO. CONTROL NO.
R,-6
OO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
,Z LJ I-1 I= CJ
Naa.
m y LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby off rm that Ind licensed under provisions of Chapter 9(commencing
yh withSection]OOO)onact.
fDivision 3ofthe Business and Professions Code,and mylicente
S si REPIPE SEWER IN SUBFL.
n free and ec< Lin faicense Class Lir.a
Date Contractor
ARCHITECT'S DECLARATION
O 1 understand my plans shall be used as public records
r
i ip O Licensed Professional
OWNER-BUILDER DECLARATION
w1hereby alfrm that I am exempt from the Convacmr's license Law for the
y
C Z Q f II g .(S t o 70315 Business d P f stuns Cade Any city or county 11
Si m -which 9apeals troconstruct, ¢ p demolish,mrePmrany swnum _ ._
:64 p tot ,sua ce els pquirt th ppl cantfar hpem,n toflees,gnad statement. -�� � ---- -�� - �---- -----7?
mmM1 srcens'dpurs snit lhep i fth C vacmrsLicenseLawlChepmr9, .,-♦ r: a/V Valuation
in mmenoingwhhS mon]0p0)afDiv' 3 fth BusinasaaneProfesslansCode) �,C,. , & 3:25�'4a� _ ,!.�f.
orthat Mix awropi therefrom end the basis for the alleged akeo prion.Any violation '-' I
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty'
ornot more man Tye nnndrea amlars(gsoo). 10 6ApN NStR & WATER Occupancy Type
01,aserofthe property,or my employees with wages ss their sale compensation, _ IZIDER21 CON P1 JMRINa
will do thework,and the swctme is not intended or offered for sale(Sec.7044,' .p��..,.� r..
BusinessandProfessions Code:The Contractor's License Law does not apply m an 301 - ROUGH P1.RYIruktVNspectlons "
owner of property Who builds or improves thereon,end who does such work himself
or through his own employees provided that such impravemems art not intended or _ 507 - FINAL PLUMBING .. _
offered for sale If,however the building or improvement issoldwithin one year of
completion,the ownenbuilder will have the burden of proving that he did not build or -
improve for purpose of sale.).
,
❑I r of the par apantam excsinessla contracting with licensed c t cors m F�W OA L E
c ewa the project(S« ]044 Business and Professions Code:)Th Contractor's a� �i
License Law does not apply to an owner of apromyemanations)
who)buildslice seimproves thereon, -
.- and who convects for such Projects with a canwcmr(s)licensed pursuant to the. . .. -... 1. .. .. _......... _..___.. .. ._ _.
Contractormueenae S NOV 4, .4. 200.,V
0 pt anee s -.:.. �s,aPcrar lma reaaan ,,
o e��tc �Am , tt
�BRRE�'$ A�NSATION DECLARATION BUILDING
I hereby atiirm u d r penalty of pe Ivry nc of the f 11 ing dedamlions
yr 1❑ I have and will maintain a CeniReme'oi Conimt to sN6inime far Worker's
y^ Compensation, as provided for by Section 3700 of the Labor Code, for the
- performance of the work for which this permit is issued.„, .
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of due work far which this permit'is
i s d.My W ker's CcFpp. Institution and P Icyauqattrsurd
t._ I t, rl �. ,.r. . .,.. ._...,_...
C Pott No. .r'.r ii c;.' .:.,,r •i
r
o iCARTIPICATION OF,EXEMPTION PROM WQRKE L.ti!`e d ?'�.a. hh1,.
L.;
f1'h s scm,on need not be completed if the RANCE _........ ... .. . __. -�.. ..,..._.,.-___ l
_ COMPENSATION INSU
Permit is for one hundred dollars
(3100)at lass.)
shall not employ y person any m co h this '... .. .. .... ,
: ..t m me Koemnn wonder the
ace a Is tied,I
CApplicant,
t n Laws f C hf mm Date the Wo kers'
.r. �c n(Y the pe f is
b Cct LO I
NOTICE TO APPLICANT If,after making this Cenificate of Exemption,you should - •t .
become subject to the Worker's Compensation provisions of the Labor Code,y
z forth th comply with h provisions thisPermit shall bedeemed revoked.o must
hereby g 6 Y. •.
CONSTRUCTION LENDING AGENCY
u I
r
off kfor'whmh this �iisawnawcr on lending het f the Performance f
Le de I Name non that mere e
pe is issued(S 'J09],CIV C
Addre
iarQ" Lender Name .,_. -_.-:. ,,. . .0-_ .. .. .. ....
„I I certify that 1 have read this application and state that he above information is
W([r ,correct 1 agree to,comply,wim all city and county.ordinances and state laws relating,
to building conswction,and hereby andomn representatives of this city to enter upon
p7'W', the above-mentioned property for inspection purposes.
{..r L f (We)agam to moi 'indemmify end keep harmless the City of Cupertino against 1
Fr Vi
liabilities,judgments,costsd t.,a.a which may in any way same against said
City inmow,biise wine gnintim, f,his permit.
;APPLICANT IINDERSTANDSANI)WILL COMPLY WITH ALL NON-POINT' Issued SOURCE REGULATIONS y: Date
"I Sligniume of ApplicanUCantr«t � .Date Re-roofs
' HAZARDOUS MATERIALS DISCLOSURE / D
-; will.me aPPlic t future wilding«a p ,mare or handle ha:erd not al Type of Roof _ .. _.__r ( .. . - _
c as defted by theCuper o Municipal Code Chapter9.12,and the Health d Safety
'
ted s t as3aca) All roofs
shall
without jv
❑Y IONoi ..'I" ' , w p bemg.installed .
tied pnor,to.any roofing material
I t 'wit the applicant,or furore bold goccupant use equipment devices which: ithout fust obtainingan Iris ection,'I,d ree`to'remove
c t M1 mrd air comm and o nts as deft m by the Buy Are A Quality Management g
Cosmic"
all new materials for inspection. Applicant understands,and will comply with
;
1; ❑Yea
o rya all non-point source regulations.,
1 have'read me h ardous'ma,enal rtgmrcmenls -der Chupt c6.95'of the.
California
"co"h &Safety(ud Seuio 25505;25533 and 25534 1 understand mal
"if the building does mol curten0y how a mnanL me,it is my responsibility tdnorify the
occupant of tae requirements which muss be met prior ro iasuence'of a Certificete'of.
'ca
p y, "_ Signature of Applicant- Date
Owner or authorizes gene Date; All roof coverings to be Class `Bit or better
OFFICE . . ..__... . _....._ __ _ .
07/2 /2000 12:28 FAX 4089739719 TM & EL I®002
CITY OF CUPER'1'1N0 m.RMir no.
OUILDING DIVISION NOIEDINGFROJECT MENTIPICATRIN
RUILUING ADDRRSS: ,I All L Nr ON BMITTAL DAT
/ r n
.. k'S NAME: S1ONIIIM M IC NO: Nti
.ice ........ .� ,
' 'I'QN'R Nn Fr'; L '
��// 1� •t' ,. LL rte.. � „�;� ..` r 1 : f /�, "<')4 I'N LI
k16NGiNIT'R;` I vL1 NO; nUDP85f: c--1nJ y �•�NI�- L , 1
BIiILDING PRRMLT.INY'O '
. . INSPECTIONS DATS INSPSC.i i..i c,..,=..�, : IM1,. O RLLU PLO MQN
FOUNDATION/PTERS/1I.D.S. INSPECTION RECORD
JOB DI;$CRIP'r10N—�
LIFER GROUND NOTE: ALL GRADING AND DRAINAGE RESL EMIL& ;
PAD/SET BACK-CERT THE
fir. INSTALLED L INSTALLED TO COMPLY WITH SH)W ❑rllt''HF"N AFNOOF.I.
7HE APPROVED PLANS AND CITY OF ❑AMMON ❑PLUMBING RE-PUT
GARAGE SLABS/PREGLRQITE CUPER'I'INO STANDARDS. Gmwr.UNrr ❑STRIlrrIIRNl.
MODIFICATION
POUR NO CONCRETE UNTIL'ABOV511AS BEENSIGNED. TO ARRANGE INSPECTION ❑IN3'F"WOR M CFRMNRT RT:PAIR
IMPRInNEMENT SWTMMMG POOLS
UNDERGROUND/SLAB �EE .',a.l. .l i'T�[R`•.s n!.:'.? ❑RATH RRM ODRLIREPAnA OEMOU'I'It1N
PLUMBfNG 777.7338 MONDAY TO FRIDAY 24 HOURS BE- pvtTiER
ELECTRICAL FOREREQUIRI:DINSPFCTION.JOBADDRESS %' , '•nl . ",;. !
AND PERMI'I'MARENEEDEDWHFNPHONING. r .,. . .7L•! ti��""`)'^
DO NOTPOUR.FLOOR UNTh,ABOVE HAS'BE STONED, COMMIfRCIAL'
PLUMBING ^'�`• ''`'`�'1`�� � '"" r NRW BLMADDmON ❑DEMOLITION
NOPLRSON(S)SHALL PERFORM WORK ON [1TFNANT ❑FOODSERVICE
MECHANICAL THIS JOB STTF WITHOUT BEING IN COM- LMPRovEMENT
F,
ELECTRICAL PLIANCWITHWORKHRS'COMPENSATION f�oTHEk
FRAMING VENTS INSURANCE REQUIREMENTS.
INSULATION INSVEfa'IUN (::^�('! DATE INSP.
P,LACENO'SURFLOO;R,LINTIIJAHOVB II'AS ,rl::N:SIGNED:
ROOF SHEATH/DIAPHRAM
PLUMR
INC::
TI1RS&SHOWER PAN
cC TRTCAIm0
.IIAN1CAL
0I.RONn 1 -i77
FRAMING/S' SM EGRESS Ow
I N S ULATTONNEN71LAT10N
FF,X;T-Fi]l,AL
NO WORK TJNTTI:AROVR TiAS,RTSCN SI.QN111Y.
ST-TEAR/HOLD DOWN
R SHEAR/HOLD DOWN ^
SHEE7WROCK/SHRE ROCK RFILAR
EXTERIOR LATH/W-SCREED ••-
SHOWER LATH
NO-TAPE OR PLASTER'UNTILABOVE HASBEEN SIGNED
SCRATCH COAT
SEW ER/WATER
TE
MP
O
R
A
R
Y
APPROV
OCCUPANCY
FIA M. ICAL
OAS
FINALS
GASTRST
GRADE
FIRE
HANDICAP
HLECTRICAL -(J
RING U
•: .HANR'AL
%1J ENERGY ._Ir�li •�•p F'OL r, -!:. ...
'VISUAL FINAL ONLY
BUILDING ;r,i;>,;?,:,•±,',:,,�,�';'; ISSUANCE DATE
OCCUPANCY OF BUILDING IS NOT PER' TED PLEASE READ REVERSE SIDE BEFORE
UNTIL BUILDING FINAL 1S SIGNED BY BUILDING CALLING FOR FINAL INSPECTION!!
INSPECTOR. LssvE DT:
env I'�nnme nnonur rnnv