00090019 CITY OF CUPERTINO - -
nUILUING DIVISION" 'PERMIT CONTRACTOR INFORMATION: ;
BUILDING ADDRESS. ,• •' _ - PERMIT NO.
OWNER'SNAMF;: - v - tT APPLICATION SUB DATE- ,
PHONE - SANITARY NO
� 7(KK4LNLL1RJJ(Jlisp.
1022 BYRNE :R- ��
G n Z ARCHITECT/ENGINFER
I IN I'-R 17 F
ee"a _ SIN ELDG .HL QIRCH.
9 ?S I.ICENSFD CONTRACTOR S DECI ARATION -' v ' .lob Descrlpnn
O
OZ- Ili by flrlthat i ounilicensed under provisions of Chapter-9(comme ng ,
11th5"dom 7000)of Division 3 of the Business IProfessions Codland nylicense _
is
iI hall force add coca,. -
To p� �7
ce S a•I- " ntc `�I�yH Co nractar ,
ARCHITECT'S DECLAIt >
I understand In,plocall Shotl be tried 11 iddillecalve
' wa5 I'�
co I c dP f. OWNER-BUILDER DECLARATION 1 ` Wr-t'I'ER PIPI.N V' ,•
m I li reby'ff that 1 pl n IM1c CI nl cl I en:e Law for the
Z a fill mg �' n.(Sea n 7011 9 R FP f. C d A y t ry
�SF Q which requires a permit tocarstract,alter, p demolish,ailep y shaturre
y 5
prior to its issuance,also4 s the applicantfor such croat I.fibc.o,iud,t ctrl
5555-
that he licensed Pro to the proiame,oll Contractor,Loccose l. (Chrove9 S Ft. Floor Area Valuati -
-(oa m
mengwth Seel D 7000) f . 1 of In.B adProf—ion,Cite) q'- ,
drthat he is exempt mon,frourn andth h '.her the II6d rican1t Any voelat
o ".. emehirsot. bctsmeoppr It e,vuplllrfI"mmlivumbeddol (snType
'-APN:Number Occupancy T e
n .;x Y YP ,.
°1 a n flip pcp Pt.me rty y er"I've,with wage,as mi p t
will do the voters, nil the t I t intended no ff.f r sake.... 7.. -
Bas P-f::o Code TheContract . Lc La a 5 l d,t • Required Inspections $¢
,
owner at properly Who l 'Ids or lnprwe.'Ihcaan and whe hes wen xo khi self .P 1
rnng1,his own entploycen.provided mar such ia,priivenenlr are not'Intended or
offered fsafe.If,however the building or im,low,abool is: Id IFn line year of
r completion,II ever-hu lderisll have the burden of provliy that he did et bold or •' �' '
np rpurpose ol..le) _ " 1357'1.5079.,00
171 ronads,afth,property,an ezdus u ly evaluating will h n d o M,a i"
eon- l thP i t(Se 7044,Busines a d Pror to C a T Tn e t t f 06 — SEWER $•t'WATER , s
Lovers,Ltw,docs not apply m an owner of property who lin Ids,r improves the ce t,
and who contracts for suet,pmiwd, with a camratork)licensed paren' om to me X0'2 = UNDERFI_OLIR'G'LUNBING
Conbuctai's License Law. " - "_I ' r- • -
❑IanexenptanderSee. - .BhPCmar this reason , 301. —.,. ROUGH PLUMBING
owner Date . — .
WORKER 5 COMPENSATION DECLARATION -302 -
TUB R
Ihereby afford Linder penalty arpc„ryone(if[he mllow',gdevlaralane t . "+ x.502, ',-. FINAL`' 'OR PLUMBING
BING ENERGY-
506 — GAS 'TEST
C I have and will maintain Cenif7ec f 37M r io nelfinm for Wrokois -
cmmpelr,awnn, as pmvleea r any,saeron e7nn tie Ihe.Lanor code, ran n,a. 50'7 —' ,FINAL,'-'PLUMBING .
,ifonnauce of the work too which In,pennh in issued ,
y.
°l have Lend will maintain Workers Cevil .etilarationce,as required by Section - - •+ e ,
3700 of the Labor Code,for the performance of the work for which this pem i'ie !ry _ -
ssued.My,Workro,Cmmpensation lammncev Lee and Policy to the,arc: r
CERTIFICATION OF EXEMPTION FROM WORKERS',
COMPENSATION INSURANCE. a ,� _ -
(This over ,ad not be completed it lot Pc mit is for L hundred dollars' - „
I certify that Ia the performance of the wmk far which this Indent Is issued,1 - r• t c,
shall t PI y y P 'n' )t n r a l he b�eet.W the Workers p v
Cnmpen.m f C l f DO Q G.�lJc_/
NOTI e subject
ubjefill " re Ill l I P pt Y l most
beef t . bl til the W k Comparison,,p all re t, O d y muq
Q 0 forth '0 amply wrtn 1 p or this permit shall bed ed avuked ' r
$ '
F CONS FRUC I ION LENDING AGENCY /
a > 'I hereby of rin that there :wcio t lending agency for the refformance -
W ofthe xatk far which illi panes sited(Sec 1097.C'v C) _ - q) -
Q I-enal Name
-
U,z Lend Addressor
- _ r
• I certify four I haread his application ada t hat the mose informationi - ,
tycorrect il agree to comply with all city and county ordinance,and he t g '
0 �1 tot, w
building and hereby powbarafves oohs city menterupon • - _ d
,the h mom'aned property for Inspection par. I "r-ui'
F.t Pr
WE)smile to avc. askentrail'yandkeep l I.. the City al C Perin against i
i..i 0 'lieh In ) dg t:,a.,as and c.prna,r,which may In any by 5carde aga set said I` x
C,1 'City in consequenceofthegranting o1 this printer.
• 4 -
APPLIC UNDERST SA WILL COMPLY WITH ALL NON-POINT 9-6-00,
- s c EGULATIOI I _Issued by. . Date
,g o�A"clnti rrJvmor 40 �me R -ro
eofR (r; - r. q-
HAZARDOUSMATERIALSDISCIOSIIRF - �^ '-'
Willtheppfcam future buildingtremoloLou, handle h d .ordered I T]rp0 of R of . ` •. - -
' vs def nod by the Ct pc Lino Mtnlu'pol COJe Ch,pur J 12,dad the Hbnith unit Solely - - -
Code Section 25532m)o - t�'t ' , -
°V`' °No All roo Shall be inspected prior to any roofing materlal'being installed.
Will flue api. o or future building cap I at Lou taroment or deeice, It cM1 -If a roof is installed without first obtaining an inspection, ILagree to remove
,bit h I cont m.as defied by(he Buy Area Quality Management - , .,
Ronne t _ _ 1 ,all new materials for inspection, Applicant understands and will 'comply withr'
° '
Yes °No. - +.
Fall non-point sourc8 regulations,' ' '
1 have head the reorder, ''t I y ens ander chapter 695 of til - •• _
California Health&Salary Code,Sections 2550525533 and 25534.1 allocated that-
.
hat-It bin, llyto
tear I d ll- e h' st b t I r,to.ss f C nJual l -
�_ _ r �� , Signature of Applicant no
- •, ' Date
1//��,•/t All roof covehio S�to be;Class,B." or better
O�+r o”. ors dag ""� Date .g '
OFFICE;.: