00050199CITY OF'CUPERTINO " ".
`C5®NTRACTOR
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uull.m!vc mvlsloly PERMIT .
�INFORMATION:t3
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BUILDING ADDRESS:
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PERMIT NO.
OWNER'S NAME:
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APPLICATION su 050199
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BUILDING PERMIT INFO ,
BLDG " ELECT PLUMB' MECH,
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LICENSED CONTRACTOR S DEICARATION
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r Job Description
p
1 h by rt that 1 licensed J provisions 1 Chapt 9 (' m e g
wlhSection 900(8 of Division 3oftheB ss and Profcsn is Codc,.ndmy
a isin fall F d effect,
Uorigne Class Lic,N
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Dole Chemical,
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DECLARATION -
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c._ARCHITECT'S
y 1d'te yll hallbem1:1M1IR d
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TENANT IMPROVEMENT
LicensedP r
r CI AItALON -
OWNER-BUILDrapt
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11 by Il nn Endl e pll theContractor's L' La f the
E toll g ren (Section 7031 5 B ' - d Profession, -Chun: Any tly r .....my
,
o which requ res to perm t to construct alter, inapreve, Earourfirsh. or repair dry structure
prior nt IIs issumse, ulxn reyuirea the npplicnnt for sucM1 permit m Rle a signed elacmcnl
Sq. Ft. Floor Area
YalUatlon
- that he is licensed pursuant mlhe provixions of the Conlrrdor'x Llconse Law (Chapter 9
(eommencingwhb Sectiov 70IXll o(Divisinn3 n(Ihe Raciness and Professonn Code)
or that he is exempt thereftnrt and the basis for the alleged exemption Any vielminn
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of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty,
of am mote Dan live hundred dollars (s507)- .
APN, Number
Occupancy pe ,
❑ I, as ownend'the property, ar my employees with wages as Ildi"ole temper, tion,
will do the work, nn 1 the structure is a., intended r offered fur xold (Sec 7044,
Bairess and Profess Con The CoupleI r . Usurrou Law docs not apply to an
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Required Inspections
` f property Whoh 'Id. r Improves tl rm n, and who does such work himself
_
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er`thrimgh his own employeesprovided that suchimprovementslire not intended or
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offered lint sale. IL however, the building or improvemcra is sold within one year of
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nmpletion. the dwner-builder will have the burden of proving tint he did not build or
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' npmve for purpose of sale.).
nn prnpen[yantexewx c1y 1 t S ,nl nlraet xlr
1.01 -- FOUNDATION.
.'d
s cn�tM1 project (See7044 Rtsimes l Professions Cod,) The Cnt vt-s
1.02 _ PIERS
License Law does not apply loan ownerofynperly whob'Idsorlmpnrvm doemen,
add who contracts rot such projects with a contractors) licensee pursuant m the
'103 — UFER _ .
Cnnvacties license Law. I-
❑latnextrprm,aerse. B&Pcfor hisr,..a-
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1,04— REBAR
owner !!'Date '7% Gd
1.05 —'' RNCHOR� BOLTS
0 OMPENS
R', ATION DECLARATION
I/ 5 '
106— SEWER d WATER "
n n tl :i y ne rinsfollowing -d 1 1 :,
lei
202 —, UNDERFLOOR PLUMBING
of incostly
Cl I h d II o I Certified, f 3Chosen, m. l f : arc for W k 'n
cn an Tor by s ren 3IIH1 of m L.nnr c d for me
'
?_03' — UNDERFLOOR MECHANICAL
madden,
11e
peH n1 work f wn nib p t' issued.^,
.. 204. -UNDERFLOOR '
111 have honoraria'Worker', C p f I : il 111;'Station
3700 of he LeberCode. f thep [ f ark f ch rpermitis
,FRAME
22.15 UNDERFLOOR INSULATION
sated.Mvwtnker-se<mpe aationrsuran ua eranapehcyntan scram:
301' - ROUGH PLUMBING
Cat- Policy No.l
" CERTIFICATION Op EXEMPTION FROM WORKERS'
n�n G a
302 — TUB`.OR SHOWER, -
COMPENSATION INSURANCE
303.,— ROUGH MECHANICAL
(Th'a section email not neatmpleted if the pevnll is for fore hundred dollars
tslnn)nnexn.),,
'
304 — ROUGH. ELECTRICAL
1 eerftfy that in the pmfnrtnance .;,the look fm whim chi, permiHs i,oad. 1
305 — FRAME
sled ply any Person it y . t t - r , t t th w k m
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3Q16 —. HOEDOWNS n
-NOTICE t C rf D c
Application
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307 — INSULATION
NOTICE TO APDL A f ft tn` nit a pl y shrink]
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.� :nivel In w k . c t 'p 1 the L n< -c 1 r meat
- 308 — SHEETROCK -
forthwith comply IIi seen previsions or this pert t shall be domed revoked.
CONS1'RUCTION AGENCY,
309 '• EXTERIOR LATH♦ - ..
LENDING
I hereby affirm Ina[ [heir personation a perst,ion lending agency for the ermrmiand
31.0 - INTERIOR ' LATH
of the work far which his pennhinaarJ(sce.3097,Civ. C.)
Lender's Name
311'— SCRATCH CORY
Lendd,, Address.
313 — ROOF NAIL' `
1 condly Out l his reItis ppf f a d tire th fi mm'
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adare
iyIagr comply to II ,y dmy ' t,[ bremf
.epnos,.enabve
501, - FINAL ELECTRICAL ENERGYmn,degnnrtrudion
M1eroad @nth of this ,I, to er pn
Ie M t m a tied, far prefer purposes.502
— FINALPLUMBING ENERGY
fs,judgment,met d a expensesde lpenh may in
ay.in t51 ny Clyy:1Cpa against said
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503 — FINAL MECHAN I CRL .ENEeRGYCity
incoteg ung beth p
- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -PONT
SOURCE REGULATIONS.
� "Issued 504' — FINR DING ENEaGY _ / .�•o�
1 Nil H6
SignaturenfAppreanvenmme, DateRe-roofs
HAZARDOUS MATERIALS DISCLOSURE' -
505 — GAS TEST
Will the applicant or future building occupant store or handle haudnm material
her by Cuptain.
Type of RooF07 — FINAL PLUMBING '
as ed the M n c�ide Choler, 9.12, .,it he Health Ili d Safety
'Cod Section 25532(x) -
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[tyd� �l��y♦j,��y++'p�{�
All roofs sh irs a r, o aterial being installed. "
ale p
Will for applicant f t building p t t r.e eyp t 1 a nteln
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1f a roof is iii. ed wi tp an inspection, I agree to "remove '
tutu d ant nn[smdol any the Bay Qa1tyM.magm`"'
all new riate�Al9for i 1XRN% R" INtrstandsand;willcomplywith
oYca
all non-poir5boce-re PUBLIC WORKS.
1 havee d the I dieo, ructeli.11y t rt. u let Cfa,mar 695 of the
Cahelou H hh&Safety Cd Section, 2550525533 J255341unde:pndthet
,I(th b'ld'g dm.. nl 0 enaltht is y phllyl noffythe
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pan[ of the re.. r ends nth nth nu print m issu f n Cedificam of
Si at re'of licant Date
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Owner nr u „ ,ell a .. ale,
All roof coverings to be Class "B'; or better
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- OFFICE'. -