00100159 CITY OF CUPERTINO
BUILDING DIVISION � - �PERMIT .'�> .CON
TRACTOR INFORMATION �;
EUILDINGADDRESS:'' -rte' ' PER -
1 00159
11.150 BUBB RD .03l S '
OWNER'S NAME: " - ^' AP0,IC )1Q��+3tN ..
-SINGLEY, SAMUALBJOANNE , . 3_bS0-.. fa �, ' i e 00.ry
ONE: i SANITARYNO. CONTROL NO.
Q Z❑ ARCHITECTEYGINEER:• y / �./_ _l + RODE N PERMIT INFO
ELF.Cf y PLI HMp M—CI
LICENSED D CON rRAC ORS DECLARATION '- Job Description
Oz I by 0" lht1 licensed under s of Chapter 9 mommcncmg `•
G-❑ i
F CW wins I 90(X1) ID fNe En JI f n,C de IMtyl Ce xe '
I'mf IPL mJ efB� ' NO NEW SGP. FT,. /REMODEL WALLS AND CEILING
g 3nJ
ate
RCe usComeniced
mcDECLARA D
I ndentand ny pl ns shall
ll M1e A as publ c rewNs ` - �' , , I- •
du at4
'd 6❑o LIC d P r tai
OWNER-BUILDERexemDECLARATION
e1 C
],hereby fir had
I Iaexempt f theC 'IL I the
C Z< toll ng (Section 9(191 S Il d Professions Code:Any IY co IY k
She❑❑
w hich
resource. ptmn I I ft p e le I 'hmrm,dr air,,l I r
y�pFo potrt1 q tl ppRluVr hpennitmilled,i,aidisolecandat - `-
3
had hc,, warmedpurandaI he few montofri,Citonat Lie....1 (cn' Sq'. Ft. FloorA p
P
atom g 'Ih Section om a i is m o f theBusiness aad ni re b-Jet 15}>s'llyt$GOn
' or low M1 pt therefrom and the ha I Ih II 6 I pl n Any senat n
offn-t a than n riv nandoet chars n p t g t Ih ppl r a "l penahy '
($sgn) _ APN:Number Occupancy,lope I
36205042. OO t
,17La:owner lone proparty,un,ny empmvee,whh x6ges as merameeo apt,aat o,, - - - .
wJl itth k it l I t I' t 'I d f[r d f ' I (S 9044 -
Ens dPnfe. cod TI' C n I '1 L 1 Ireply¢,.n - ` Re( ired'Inspections
is,Ihr^mr In his i Id' " q _ e n, I s n tended lr «1'01" FOUNDAT18
g p yas.pmvWcd Ihd1ch'improvement nen,,ro in neyearor
cRtmd fon axle.Ir,nowuilde rwi banding ed urden orrfame wahln not veld or 102..- PIERS _t ' •
improvtion, u"cist ficir.cr will have the nymea or proving that lie lint nnEe or - -
• imPnwerodpnrpouor,me.). � - 1031 -•LIFER . . .
y
.,
El 1. ter fah pre,ert,a.,rachoo0y coul,actin, vhl :e l'' t"I ism i041 REBAR
coinsurer,the prole,(Sec 7044 Rus'nc,' i d Disbelief,Crude.)the Contractor's
eease Eaw does not apply tonin owner of property who ba d,or ilnpmve,human, 105 - :ANCHOR BOLTS .
and
who contracts for h pureels with a eontrv_eter(s) f e p rs In oTto the -
Conlramor,LcemeL .106' - SEWER &. WATER - -
t d Ste. - ,E&P C-r for rr don
❑lam excnp order '
2002 UNDERFLOOR PLUMBING
Owner Dal '.. •r - .
'
WORKERSCOMPENSADON DECLARATION- - 203' - 'UNDERFLOORS MECHANICAL
-
hereby ammtana,,,„>ennby'nape.iuryare of hpianowinbdeeiamtion 204 UNDERFLOOR FRAME m
I have d .It amarnut a Certificate or Comend to liell-insuareWorker',' 205•' 111.VIQ�R 1-QL7lf , I +I$Nq At7'I"rr
"'orientation. provided lnr.p`tntg9Jodof,m ostler the
301' • ROUI(it P UMIfiJQI I
• pert 1 0 work towhichuh is
❑Ine v u ml w ke c qa eIn s r ; 312124dI'LIB s Oi:'.$WIOW�Rbr;,r
9900 of the Labor Cod In p n Ith k 1 wl h this wrn is
is" d M k m I :urn d Poll h 303 rAI- ROIH� M�CHAlk( Gt1L'.^r
cdr 'f R� PaliyN : �S d 'I p ?QT�4 w 17Ha.EIreECTRZCAL
CERTIFICATIONCOMPENSATI-XEON INSURANCE ORKI1 I 305 — FRAME { -
(Thin acaon need dial ht completed if pe con,is for rate haunted dollars 3!�� -. HOEDOWNS
SI0F.ncc,d '. - '307 INSULATION
1 certify that in(lie perfonnmee of the work rm which las permit is issued,I 306 r SHEET ROCK «
shall not employ any no,an in oa,manner sa as or become subject to the Workers'
conlpelondon Lew,of Calif aia'Date .309 EXTERIOR LATH
Applicant
«
NOTICE TO APPLICANT If.after making mi:Certificate fExemption,you should - 31,0 - INTERIOR LATH
become a s th Worker',Compensation provision,aftheLalouCode,y , nst
V1 forth ht d, uhuNpmvisi us o LENDINGAGENCYmJ revoked. ,
E O 311 SCRATCH COAT '
313' - ROOF- NAIL .. ;
1 hereby affind,(hat there t c1 on lending agency for the Performance
odd kl 'I' hJ' p ,Is'scuW(see 9099 C'v.C)
rw q Land sumn, 501f' - •FINAL 'ELECTRICAL ENERGY
z0 Lender's Address502 - FINAL PLUMBING ENERG,Y•! '
'iceraymatIbase mad losppl I td sualmilen thealawt,informations 503 .- -_FINAL MECHANICAL ENERGY
W F
correct.1 agree to comply withill city ando I)ordirl and state laws belating
O U tobuilding construction,andhereby an0or pesentativesofthis etytoenterarea
Uit rteam'z,'
,
4 - FINAL BUILDING 'ENERGY ERGY
no mlmore,fpenin p po .
(Wed agree I d Ty dk II l theCityIcp f iI 505 NAL. ELECTRICAL
liabilt e ' nthhvy:n ,nr YaccruealsadIChy nsgeceofmcgrangorthisp
506 (3-0 TEST > . 1
APP NT ULATIOrANDS AND WILL COMPI WITH ALL NON POINT �' ) "
at
S xc REcuLAnoNsld_ _��_ 7- _a/ Issuedby�07' -- FINRL PLUMBING Date
Si• anculApplaccurnCreationartar Date - Re-roofs 508
HAZARDOUS MATERIALS DISCLOSURE i 9r-- FINAL GRADE
WPIth wo
pprntrfuturebuildingoccupantt torten h - -1 mJered TypeofRW "
asdefinednyth Caperfoolviounicipal Code,Chapeorty12.anlil Health and Safety510 — FINAL PLANNING
Cole Sect O
2559 a ) s , .
Dyes,- C]No
•:.All roofs 5dlT4bc-infe Nftri(PUfUn�Eo �
orlal being installed.
Will the offttutebuilding p t .s, quip tt r :which If a roof is installed'without first obtaining an inspection, 1 agree to remove
mit h rdm s air contaminates as defined by the Bay Arco A Quality Management
t„trtmo 4e. ono - all new materials foryinspection't Applicant understands and Will'compI 'with I
all non-point source regulations..; .
I hava m:J the hnzvNaus mater nl q t enw oder Chupmr fi.95 I f the
u' '
C."fortia Hoallh&Safcp Gale Secfots255115 y5593and255}4 ltndercmndthm - t^.
iRhe blf did.Joe,ratcurtenlly tr,vemetvnCdat it gory resp n.ihility to notify the s " -
occu ant of there unto, wh ch ntusl'be niet pr or to usuanw of v Cen'hcme of '
wp.ny. , _ Signaturep of-Applicant �� `
g
Date
t amnor adeno .n - ,
t All roof co
' t s '<<� Dam venngs to be Class "B"or better
OFFICE