00080010CITY OF CUPERTINO-
nuu.mrvcprvistoN., PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS ', tf-, ... r e !^ x` PERMITNQ.. '
tt0460'"HUBR RD SERRANO,ELECTR`IC.IlV 0Q108a01.0
OWNER'S NAME .6- ' ' 1 ;1'.
'f APPLICATION SUIT DATE'
'MARY A AND CARL.E.T USTEE 1500 MARTIN AVE "'08102/000
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PHONE: .. _ • " SANITARY,NO, CONTROL NO.
'(408)986-1.570
'❑ Z . ARCH] TECTIIiNGINEER:BUILDING PERMITINFO '
,IA.DG 4 I±LI?CI'^) PLUMB MUCH _
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LICENSED CONTRACTORS DECLARATION
O Z p 11 by IY tl 11 licensed t J p 1 Chaplet J (commencing _ Job Descrlpuon r '•
Not x1hS i 'IUOU) fD 3 free Bn IPr fess'° Qde. anJ my l' 1 11
��,4� . nlf�L•�f,'Gl(� a„�j�% ?0—FURNITURE PARTIT:ION-CONNECTIONS,
3utrader Ill
h Dal ARCIIITFCT SDfCLARA N
°g I d.laarpinaanelnenxelaapnnuereetrl '`FINALE"”' .
ca Licensed P f :. id
I hereby
OWNER BUILDER DECLARATION
following. I OCT' 0x ' 20,01 .
If hit Ip
tl OM1 Contractor', LicenseL [ d I
f5 t 915 B03 . d ProfPf :: .Cal A Y ty r cat) d
i F O wit 1 qp° I t tom lterp J1.
a1 pa' ay I core
I
• 3 m prig t l y m ppfa tf hpr ill J .O r d.Ie ural
l ' - r
mail licensed p a II Provisions f (lie Cultracour s Farrow La (Chapter9 Sq.,Ft. Floor Area NG Valuation-'�
(w e g vi m Sect ]BOOR of Divi 3 f II B st d Profess ns Code), • -
ma�'ne t. exe,n r mmrfram and ren n„sts ror me aur eaeexetn lion. ret °vtaeu,)n . 43000'
P s P v
of not more
than byaandred dollars
l: M1j mlho oppli'nliiudvd treasury
arnamare rear rxa hnmred aannrt (assn.' '. .,. APN Number . Occupancy e '
P Y YP � .
El 1, aowner ork, property, oestye is of intwidewapexa, metr soleeompeasa0dn. 35720036'.0
6
will ne me work, and the ode T e is not intended Li or e Lao roe an o see. to a
Business said Prides ons Code. The Contractor's License Law docs not 1 t R .
to a� Required Ins" ections.
Fpr � , , 9 P
artr of Fropetry Who builds or improves Ihcrcon, and who does si¢h work himself _
6h his mP1 y e P oda (net <.h improvement, toad 04 — ROUGH ELECTRICAL
'offs I lot sole if. h - the faildon, or improvement'.: .to within noya f i t.
e cnmplRa the°wne l lderwluhavem i ernarpre (bar head ambala- 501: -- FINAL ELECTRICAL ENERGY,`,
improve rar pnrpam af,cle.) 505 - —' FINAL ELECTRICAL "
pl as owner o[ma prp ty Isv IY' IaP'6'tll d lit l 'n,v
oni , thep J d (So,. 9194Bmirr,, andP f C dc:) The C t I -
'
License Law downeur,plyn in. normalproperty stfihies p GI
ad who contracts for such projects witha contractors) I' sed pries am in the - —•--'- —_- - _. . - �,
Cot t scat s Live... L. w
°tont exempt unJer Sec .`. ,H&PC fie this renes
.Ow Dm
• WORKER S COMPUNSAfION DECLARATION
I herehy dfrm a usherpenalty of perjury' Z ul'Ihe to] low i ngdeclarations: '
O I have and will himulairra CoTti6iole af,Corwmt If f Wok .
Compensation. t a. P Wed f by Section 3900 f Ole Labor Cade, for ll '
poi flu w.Fiforwhid,lhi,peourni, issued,
3Fl I 700 ' d II or k C p f I. winced M1y Set
3IIM1the
fly Code, f Thep ( of work m,
which (us s
isst d, /M/y��Work��rkersC p '( insurance carrier
�and
�Policyn the are'. - �f
Cam k�17xiN0EWNli�(Pod'yN.',1 Ixf4 07 - -vto
CERNFICATION OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE _
"(This section need not be completed if the Fermil is for one hundred dollars r �• ..
- ($100)I las) - is
1 cerci t a the c miance,nl the work for which this permit is
issued, I <
'ahxll nal m f t t any m �Rr!R hyl�lNn suhjem m the Workers' d
n_O (JVV.e
Caopcnsmia l.a nin. Date,)- - �
.
Applicant
PI?. ' I f
NOIICE TO after nmkmg lbia Cerufiaoeof Excureme, You should t
z becomeh3 t11 C pn:dl p fm'Ih Cd yuan
Q O
forthwith p ch r Lica or
p rmt.h ll b I ed k d. t- .-
z
aCON59 RUCTION LENDING AGENCY -
Ih Il by nthat Ili.aconstruction ld 6e Y
6uf N
E perfarminder
_
of the k for vi perm is issued (Sco. 3099 Civ. C)
Q lend N' e
�iz Lend Address • 1 U;0 I cenif, that l have Acted this o ' I' inion and y,am Ilio'Ihc ahnve infnrmaran Is '
W. N carrem 1a reel,)can th.11 1(, ed t d d.t t I w. r Irvin - - •
F.y 8 p Y w Y un Y - g
Q [� rebs ld'n6conswumn nd hereby awho' F nwhn of thus shy 1, corer spot - -
Y W the M -nfomd ropeny for nPecf P . . -
E„I a (W) 6 I sulk pl I. theCry fC p I against
V� haddli e. )ul ata, d p ses which y t an, y seri. again,, said _ -
U iZl Citym y o In 6 6°fthi. p tit. v
APP6ICA )S AND WILL COMPLY WITH ALL NON -POINT
;'� sourxcE C 1. nn Issued by: ' Date'•
Si6numre li C serer. a 4o4nm
- AR pUs MATP.RIAI S DISCLOSURE
Re -roofs
- esu a In or f buudin6 aecepam stare or handle hadartlous nmtedal ,Type of Roof .
as d F d by me Cupe I 1al Cal Chapter 9.12, and die Health end Safety
Code,S i o u 25532(a) ) .. - , •• '
Dyes_ N° 1 All ioofs shall be inspected prior to any roofing material being installed.
Will the air cat f t b'I 16 p I qn 1 m e : wit en - If a roof,is installed without first obtaining an inspection, I agree to remove r
dt M1amrd,us vie win t fired by Bay useeaa, ra N'r Managementwhich - -
,orivI^- all new materials for inspection.' Applicant understands -and -will comply with
°Yue "- all non-pointsource regulations. ,
- . ' 1 have r - i Nnationals'' y oats ands Cl;aptei 6.95 of the
.Call ifom a He m &S ry C e Sections 25505, 25533 and 25534 W
1 u e xemid mm
^.,
dm Ing Ill have I tth that nyrel n: hltyl ready the t • ,
occup 1 ao t h' m e
l, t h met r to kimono f a Cori Gcalc of
Occu i -
SignatureofAppllcant+'� - Dail _
owned °r mori:ce a _ - - 'Darr .All roof left to be Class"B""or`better
'OFFICE . w,