00070052 CITY OF CUPER'1'INO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: ,-
BUILDING ADDRESS' - PERMIT NO
10240 BUBB RD . 00070052
OWNER'S NAME: - , APPLICAl Kdq�DA`E/2@@@
DE Also V(l�I/ 1 1
PHONE: • SANITARY NO, '.CONTROL NO.
ZXZ ARCHITECDUNGINE-R.- - - - BUILDING PERM]f NfO -
-pt O CCO \ , - - BLDG ELECT' PLUME NIECE
z 3 Job Description
LICENSED CONTRACTOR 5..I-CI roof
ChoN
OZ,y Iherenytffrn t,wloadlicensed untle p v ' fChpterJ( being -
t� whnseattnonn)orot ' 3rro,oRon nar,rexer �rla,ltadyi TENANT IMPV/ELECT PERMIT •
i is in full filice and gYjI al
cev�$' License Claes_ Lic,#�_ _ -
sLL Dale s.kk-0e Cantmamrdo
_Ny\OL�t�1—
ARCliall.Cf'S DECLARATION /
L O g I nmletxmnd my plans shall be used a public occoviv
wazL'c IIr :: rl
- 2
pp x
OW NPH IDER DI CI AItAI ION
0.50 IM1 Fy Rmthin l e%u' ,l from lie C Inuol Lce . I far Ili a - ,
WC <
following reason.(Section 7031.5 Pastries,mall Prific,mr,Cobb:A.,,iyo,county
f xF a which require,to peard,to ex mwa alter p .c,demolish or reps r any onto
pnm to its i,suance.od.ree,ire,the applicam far such emum file usigrredsmmment
that he is licensed pursminnn the provisions of the Conunctnds License Love(Chapter 9 S Ft. Floor Area Va @
(commencing w'nftho n Section 700(dor Division 3 oRuxinye and Profaxxinax Code) i.j:{- tl• G
or that he is exp dpi Ili f the lin.' Ev l II ged c.camptioun.Any vlolnoon 1}I -
ofSecdnaSoll5byany ppl tf,rapa if uhn NOccu a
athe.. ' al penalty p" y�'pa
aflml norc man five hundred dux($500). - APN Number ne e
O L asawnerat the prof army employees with wages Its their sole compensation. - 35720022. 00
will Jo the work,and the snucmrc is not intended or offered for sale(Seo.-70.14,
Rd mos and Professions Cit The Commctor's Licmue'Law does not.apply m an -Required [gspec[ions
rofpra aWho bnild,urlmprow,meremd,.,,dwoodpe,such walk himself 101 — FOUND��ION
or maren,h lax awn emx.provided thm
find such Indpnrvneat, an nal intended or I
adrerm for.ale.IL however,Ede I...hang or an,mvemem is sold whnid.rne iearaf 102 — PIERS -
iompletion,the owner-builder will have the harden of proving that he did nal build ser
mprove ror pa,,,c oame.). 103 - UFER
°I,as owner of the property,am exclusively contracting with licensed countries to a 104 — REBAR - r
,o,hum the project(Sec 7194,Husincss and Pndeseioas Cate:)The Commctor's
License Law does not apply foam owner of proparty It,,b ld,orimp rnyas merean. 105 -' ANCHOR BOLTS
and who comractx for xnah projcaax whb a valuations) hcen,v:d ptgadant bi the 1.06 — SEWER 8• WATER
Contractor's License Law.
❑late exempt.hoer saes .ndergiirr his mama ,' 202 — UNDERFLOOR PLUMBING
-Owner Date
WORKER'S COMPENSATION DECLARATION 203 7 UNDERFLOOR MECHANICAL
`Iharcn204 — UNDERFLOOR FRAME. -
aad will mwmain a certirtmt.of Consent,,,sell-iomm m:workere 205 — 'UNDERFLOOR INSULATION
compensation, as provided for by Section nal of the.Loln,r code, for me 3@1 — ROUGH PLUMBING
of the work 6r which pemiss
this til is, ued.
01 have and will maintain Worker's compen,vtionInsurance,;srequired bySection 3@2 — TUB R• OR SHOWER
3700of r y I anneal 'f r to peticurrace of he w...lt f r which this pcurn is 3@3 — ROUGH MECHANICAL
ixvued My
yWf]tk�r('x�C��pe:i t l uurance cam e-t nd Party manildrare
carricr�(�sJ�Pahcy sat VU=74 l(� °�I 304 ' — ROUGH ELECTRICAL.
CERTIFICATION OP EXEMPTION FROM WORKERS' - 305 — FRAME
COMPENSATION INSURANCE
(Tnis section need do,be committed if the ,.it is for one hundred dopa, - 30E — HOLDOWNS .
rslEo)ot mxxa .,
. 307 — . INSULATION .,
i'nary dkal ht he pladnn...c nine work Ila which this prinifi,issued,1 308 — SHEETROCK '
shall ren chap,any Pers..in may..ad,,sa a, ,I became,.bjcc,to doe Walkers'
C 309 — EXTERIOR LATH
om ntion la
svws of Colulmih.Dade
NOTICE 1O APPLICANT:If.aver making this cerifu:ate of Exemption,you should 310 - INTERIOR LATH
become s.t jc,l no the Worker',Cbmploonnn provisions of the Labor Gude,you must,
O C Ibnhwimcmnplywihsuchprovisinnxorthispermit,haubadeemedrevoked 311 — SCRATCH COAT ,
z2 .
CONSTRIICTIONLENDINGAGENCY 313 — ROOF NAIL_
Ihercby affirm thanhere isumnswmian lending agency fnnhe perh,nnanee —
ormewoan,rwmtntoixpennitisixxace(see.vn7.ci.'.c.) 501 . FINAL ELECTRICAL ENERGY
0. Le°d"x Nara` 502 — FINRL PLUMBING ENERGY
5 z Lender',AJdrcxs
t..) 0
:w F car PI 6 t of d.ttflt f1o
- FINRL MECHANICAL ENERGY pp503•
hili r m ti 504 — FINAL BUILDING. ENERGY
'O V to balding conxo-amdon,and hereby amhPm represedml.es oftlus city mcater upon '
y w theahove.meononcJproprnyforin„ cranptimoses. 505 —. FINAL ELECTRICAL
E. IL (We)it'll "adanniryour keep htor ess the City of Cupertino again(
h Iiebilities.juJgrts s,coax sena coo axes wok ay imohy way'accme mguinu said 5@6 — GAS TEST '
t.� z City in en qu a o1 a gmnr this pe u -
`x APPLIC T DF 'TAN DWI .CO ITR ALL NDN-POINT
SOIR R' 'IONS :Issuedby: �' FINAL PLUNKING Date
�/
mat 'dof peaanucammcl r - ntlle Re-roofs
HAZARDOUS MATERIALS DISCLOSURE 509. — FINAL GRADE
Wllthe applicant orfoure building rrtupand saorc or handle Inommx.materiel Type of Roof '
as defined by mecnpemnoMuoicipalCode.Chapter 9.12,madame Health aadSafe, 510 — FINAL PLANNING
Cade.Section 25532(0)1 '.
- OYe, ' 0No All roofs shall 561 Asp8ctFdTf %4o Pk4 Ko�jPg WMa$being installed.
Will neap licanlor,rnmrenamnngoaappam n'tolimpmemordavice,which If a roof is installed without first obtaining an inspection, 1 agiee.to remove
emit haeardou,air cuntamileal,a,defined by the Ray'Arca Air Quality M...gemenM1 -
isViclp - all new materials for inspection. Applicant understands and will comply with
°Ye °No all non-point source regulations.
I have
rend a hazardous nratcrials rcratemcatx ander Chnpmr G95 of Ire '-
CaliforniaH•aid' a” Lon"S,,I, ns25505,25531 tmA 25531'1 nndarnmW mat - -
ebullt' gdi ad , read
common hal it tate •spovsiblllty In nrnil'y the _ '
occupan 'the am, ems d tuust mei prior awance of n Ccnilicac of -
oeaap y. _ } Signature of Applicant . Date
ora, n.ed ag, All roof coverings to be Class "B"or better .
v; OFFICE