01030027 CITY OF CUPERTINO - �n'<
BUILDING DIVISION ' PERMIT CONTRACTOR INFORMATION . -
BUILDING ADDRESS'. h ... .. •' PERMIT NO. .
'11650 HUBH RD ! l'Jv ' � 01030027 .
OWNEWS NAME: •"' +. '- L APPLICATION S U I3 BAIT
:JACKSON HUGH- F 'SR: TRLIS"I EE . d• - •. '03/07/2001 '
'PHONE ( SANITARY NO,. CON'I'ROLNO'
O O ARCHITECTIENGINEER:' ' ' ,Y. ' 'BUILDING PERMIT INFO
yy _ BLDG 'ELECT PLUME MECII.
Z yLICENSED C(3NS RALTOR S DECLARA910N - t 2„' 10b DC$Crlptlon
11 'ly B thol sea d p : fCl pis 9( ane K '
vhSection 7000)at D 7 ofthe Business andP s Code,andenyl
it in h°clan.,' °cI w IO/S REPhflCE. LIGHT FIXTURE
3 a um �- L bettor
AR�'CiAHECrsDECLARATON -LIGHTING RETRO FT.
1 understand my plans shell be used as puM1a nee ds r•
a6p0
LicernedP l - 1 ,
OWNER BUILDER DECLARATION
1 h 'h,option tis ,I art ciuba,g too C nl' t . Users,Lies for(he
t' G Moll , mon (Serino 70315,Businc and Prh6ssore Code.Any mytr,aunty
wthwh not,hr,e pchdrit t ..loe,t.a M1 ua,do,e demolish or repair city sbnnure ti
a3� Prtnit, e.l. y the applicant fia suchpe ran to file a signed,stahadent
deohnglkSt 7000r
el
1 :ap I thep n Contractors L E (Chapter9 Sq. Floor Area 1 Val�t�"n
lifD' B ftl B IPrf .Ede)' . ,
or that h lap(th J gr h f thell, 1 pis Any of fon - - / V J ;
.1 Section 7031.5 by any c,I ire,for h pern'I subject:the tppl ,t a en'I p alt,' 71,.
offer Iran t hundred adE (x500) - APN'Number• ' Occupane�.I^�0
011aotexthertd1hepro,side Y ,Ply (h K: . p t {
'isle thek Ila t t t t Idoffered[ n1 (S 90y4
'+ n❑n err ; Code: le C :I I a t o ppq t .,F� Pj j 02 egiytl'ed.Inspections
in r of p apnrw co builds improve Ih such
.lad who does such wink ded or
or ecd far his own nows,eecs. N.Adin @m such iineen,is cols are not intended pit,of -
a0erta far ,B h l mel base t v nt n at `taindal at b Lr of 304 — T ROUGH ELECTRICAL
- onPl i p f ld 'Ill vn the I rd [proving that he 1'd nrn build ar
cmprmc tot purpose ofsalc.),
. 'oI nh,p I > - 1 :'vlr t t K '(hl . v t -'i ata 501 '— FINAL ELECTRICAL ENERGY
,nstr tth P'i t(s 7044Business dP I :Code)rn Contractor's- - 505. -FINAL ELECTRICAL ..
construct
c Law fees her apply l i n n f Property 'h ld ,tfienha - - .
and ho cannot let such p j t: 'td c 'trnemr(s)licensed.personal( @o
+
Contractors License Laev I • -
❑1 pt orders : B&PCf iM1'. co -
O'ne Date
WORKI R S COMPENSATION DECLARATION
yIhereby ffirni rual,,onity at erluYreal the pullover,&I d.as �.
❑ 1 he,c and ill around. a C,nifthen of 37 Ito It - far W the
Compel al n 1 p 1 f by Set 77110 f thelabor Gale farr the , - 2� .
pert mt ace of the wad far which this pen tilis issued,
,
❑I have and will mainmin Wofkcrk Compensvaoa Iniumnce,as required by'9111",a is
9700 of(bo Lebo.Code,far the performance.1 he work for which(his Penni(Is
island MyWakersCoutpereation Insurance alernna Poly trial
-Currier:. Policy No o '
CERTIFICAHON OF EXF.MP HON FROM WORKERS'
COMPENSATION INSURANCE '
< r.
(Ties section need her be c npldef'f the Soon is G e h- Iced de lars
S100) I-,.)• •. s
I A,url,thin m the ps,rhandarecor the work for which III p Ina's issued,I
shall t mpl Y Y D r y,y�nor sA lu hGc'lynu��l I t th' Wu k
Ao lin ( r 1Q2'e�1(I>.dr�('7171if . '
NOTICLTO PP AN If 11 - k K tis t t f E apt n y t nh I - A -
Z becidge stibicet the Wastes Compensation piomenn,inditeLabor Cad ynt on, - •.
�QO Gtin hnnPlywtM1 IV Guns nrd p it xhallMd d kd. , - D ..'•Q �t
^ h CONSTRUCTION LENDING AGENCY - f'
F Iti 1 I by ll ,h the t i Iending agehey for h perfd urn L
�T4 ofthe work f which this pefmit is issued(See 3097 Cis f C) MAR -- 2001'
Q
Le let's state, p -
z Lena AdJ e - .• is
I Ify that I base read I his a,licirlitharad.nu thinthe abuse inft i _
'correct.
1�`;
W E.. co r t I S t nplY tis a II my en county d' and m1 I ht g DJ .
Q V to building cnuldrucia and hereby twho'- representatives of this city to enter upon
,7, W the Ila- - nl t d property for inspection peck p p::. s .. ' . I I
-s F.
Q. Wc)agree to seve,tdlnify and keep h I s the City ofCupertionougairst
Vi Bailable,
V 700.. City Oulu eofth Gant by �ti pmt Ymary yc 6•i nn(: 'A f f:-
APPLIC DERE D. LYWITfIALLNONPOINT ��7°-�
oulcr. L o s -Issued by: Jae ' F1/�7.�n..�ee_. Date 7 Lel
ti/3t g_dttAa-o
Signa re f It,.nVOanbacmrit
Date ;, Re-roofs -
HAZARDOUS MATERIALS DISCLOSURE
Will the appllco t infia o holding dicer,at share an handle brco does m>twirl Type of•ROof
n,deftnW by the Ct rorfino Murne,jual Code.Chapter 9,12.and the Health and Safety -
Code Sector 255i2(a)t, - -
°Y. 9i� All roofs shall be inspected prior to any r•oofing,material`being installed.
Will m (,pI c,t future n Icing p r yap ( d ca whclh If a roof is installed without first obtaimg p n 'an ins g ection,1 agree remove -
curt l d nr Jfntlh,,I 13yAcaA
Qua;:,
Iny Mraigement
}N-Dist t - all new materials for inspection. ApplicTnt understands andywill`eomply-with '-
°v Y. all,rion-point source regulations.
Lh a Ih h d - t L I Its Dna Chapter 695 of the
(Coln Health lth R S f Code,S s 25505 255U d25534Understand lM1 t a a•
If theb Id gd "Iei2hn II t t y dic,inkibilit,( ffy the
acuP V I the re J[ a winor b het prior to issuance 'fC t real f
Signature of Applicant Date
ofe,in aamrtdfw.,,a, � - All-roof coverings to be Class"B” or better�•
u OFFICE