00060016 CITY OF CUPERTINO -
BUILDING DIVISION • PERMIT' CONTRACTOR INFORMATION:
BUILDING A.DDRES$'. r PERMIT NO. OOZE
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OWNER'S NAT:: _ APPLICAI IOJgI%U&05 I-LOOO
PHONE: Z.'Op BCP �Y, SANITARY NO. COND Rot.NO
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= C ARCHITECTIENGINE:ER:, BUILDING PERMIT INFO
Cq 9 BLDG ELECT' PLUMB MECH
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c zyZ LICBNSEDCONTRACTOk:SDIiCI.ARA'I'ION
=❑ I heachy aRrm milt lam Ile ensed ander pmvismns of 0ionea 9(cmnme"ciog ADDITION Job Description
F=L, •wnh Section 7")of Division 3:it the BnviActsaml PrnRs,eas Cade,and illy licence . .
ac ce f; is in full force and effect. 3
z w re a License Clara Lie.x_ _
a3 u U Date - Cnmrac,
t-- O ARCHITECT'S DECLARA'1'ION•1 �
I understand my plans shall h,used as public mr(nk -
6 a p Licensed pmfe,sim al
OWNER-BUILIMIR DECLARATION
m F—l"a, 1 hereby affirm that 1 am exempt from the ConBnmor's License Law for the ' -
F X< following reason.(Section 7030,Business and Pndcs,ions Cafe:Any city orcounly -
E O which requites u permit to connrun,lite,improve,demolish,or repair any snunure
63$ pncentiNi....moe,alm requi.dirlippli...I for such pardiOo fileasigned statement
mat he i,0eensea pursuant m me prouhaom lir nhe com�acu,ra Liaenm Law(Chmner q S Ft. Floor Area iA0.1111557
(commencing with Satan 7(0))of Division 3 onm
he Bu, ess and rrofe„ions coin) 4' `
or that he is exempt therefrom and the basis for the alleged exemption.Any violation'
or Semion 7031.5 by any appdicam for a prmih+uhjms the apideam u,to civil pewhy
of not more than five hundred doaars(s500). A1.0. 00 - Occukancylrypq
111,as owner of the property,or no,cred.,eea with rages a,their sole compenymiom. '
will do me work,and the structure is not intended or offered for+ale.lsce.7044. 101 — FOUI$fl�ITr�®hlspec[ions
Business and Professions Code:The Contractor's License Law Ams not apply to an ,
owner or propertyow embuildslirimprove,at such,andwhod«a tachworknded or 1@L- — PIERS
m through his own on Wild% pmvidedmov mut fro .anti whn entsdee are h sock himself
if
offered for sale.IL however,the building or improvement is sold within line year'd
completion,the owner-builder will have the burtkn afpruving that he did not build lir 103 — UFER -
improve Rprpo:etrol ) 104 — REBAR o -
OI of the property, lot ly t Ing with licensed contentionst 105 — ANCHOR BOLTS
t t thefirmest(S a s 7M4 Business fie mul
d Pn os Cade:)Th Contractor's
-
Lie Law does not applyt an owner ofprpertr whobuld:(it hoproves thereon. 1.06 — SEWER & WATER
and who e mmon fee our
p l t wall a t rt,)licensed pursuant t the
cents ureumeLa 202 — UNDERFLOOR PLUMBING' t
❑lata esempt under See.-!� —pffiPC.rnnhis mason
Gainer 203 — UNDERFLOOR MECHANICAL '
'Date
- WONKF;H'S COMI'LNSA"PION DECLARATION . 204 — UNDERFLOOR FRAME
In,'renr arfirru ander penally of perintY one srt me h,nnwioft decneandns. 205 — UNDERFLOOR INSULATION_ ..
° 1 have and'whu maintain a Certificate of Consent m sell-inion ror Worker': 301 — ROUGH PLUMBING '
Compensation, m provided fill by Section 3700 of the I.nhor Code, rut the -
permrmaneeoftlleworkfrwhiehthi-spermineilaoid. - 302, — TUB. &- OR 'SHOWER
01 nee it will maintain W..ker+Compeoaarenhumame, regwredbySemion 303 — ROUGH MECHANICAL
3700 of the Labor Code,ror, he perfinm:tme or he work for winch dd,pemm is
issued My WorkersCem,en,afimhlnsurancecarrierantiPolic 5041. — ROUGH ELECTRICAL_
Y I Y nnnhhur tire: .
Carrier: iUhcyNo.: 305 — FRAME
CER IIFICATION(rF EXEM PTION PROM WOR KI?RS,' 1. '
COMPUNSAnoNINSURANCE 306 HOLDOWNS
(This,uutmnneed oohtics..mplctdiratepertnhi,Inroat,tatharedaolan, 307 — INSULATION
retool lit less.)' - 308 =' SHEF_TROCK
I cend,mr he istfooman,rof IN tookl hit n .'p ti,i.., d:I 309 EXTERIOR LATH-
,hell an,enoplo,anyIii,en in any n m'. t b ....le uhjrOito he A•nC
coq r:tat Ihws ill Ohl nfa.D;a. 3.10 — INTERIOR LATH' _
Applicant
NOTICETOAPPLICANT f h -ak yd :C Elat tl' Ire y ho.lA • ' r
hocobjectt dew k c I Ill b Call,y nuall
311 — SCRATCH COAT
O � form 'mc...... n, „do pro,i,ila000rdlikp,nnnshrllb nt,ft v kcd, 313 -- ROOF 'NAIL .
e
4 , � CONSFRucnoNI-eNDIN .AG1t"cY 501 — FINAL ELECTRICAL ENERGY '
.a > by month Il not t ( gain ar),rtlepennrn tc 50r” — FINAL PLUMBING ENERGY
ono weak for Itchen p t`: waeln anal cv.cl
z Led N 503 - FINAL MECHANICAL ENERGY
� z Lcnd r,Addres, - 7
U C 1rart Uba)havereadIni,app0cahmIand file milli,aaOoehnmrmmimhis 504 — FINAL_ BUILDING ENERGY .
correct 1 agree to conhply with all city and county ordinances nal stat laws relating
'O v ha building consmicdon,and heichyand,mi,ere"c"it....on"d this city In coact,v'nf 505 FINAL ELECTRICAL "
} m he albs„e-memmmed property tar impoetlnn purpo,e,. .
a 506 — GAS TEST(Wo)agreem,aeaindemniryantikeepharnifextheCityorGpertinodiain,r -
'a liabilities,judgmems:a I,and cxpen,e,which may in say way accrue agahm,aid '
z
CRY in consequence of the Starting of this permit. 507 — FINAL PLUMBING
SO RICEREGUTATIONSNDSANDWILLCOMPLYWITHALLNON-POINT Issued by: SOIR — FTNAL MECHANIbqL Date
Signamreof Applicab Cnntmctor Date Re-roofs 509 —' FINAL GRADE
HA9ARDOUS MATERIALS DISCLOSURE �i.0 FINAL F'LRNNIN_ G
Will me applicant or forme Wilding eccuptam oulir handle hN
es. ons namormeol •Nape of ROO -
a,dermodhafo
thyme
pmtinnMummt,
eipalCode,Cat9.I2aMmeHealthandSaf`ty 514 — FINAL 'PUBLIC WORKS
Cade,Section 25532(a)^
❑ve, °NmAll roofs shall be inspected prior t -any roofing material-being installed.
Will the applicant or future Wilding occupant use equipment lir device,which If a roof is installed without first obtaining an inspection, Iagree to remove
emit hazardous air rontomiomns es defined by the]my Area Ai,Umdity Munagemem -
Dismm7 all new materials for inspection. Applicant understands and will comply with
I have
EI Not all non-point source regulations.
I hmc read the hmaNws mmedals 505.enema under Chapter fi 95 of the
if ifomil building
lthdu&Safety Cale.have
25505in it i, and lanob I b,o,amnJ mm
ifcubuildinge retmcumeml Ihoveats W et it is nhyrespnceof it mntnianthe
cupam of the requirements which mum he tan prior t issuance of n Cenificae of '
oc'unta,IY. Signature of Applicant Date
Owner or aumndrea agent Daae All roof coverings to be Class"B” or better