00090060 ' -..CITY OF CUPERTINO
BUILDING IDIvtsiON.`' - `PERMIT,,;" ` , CONTRACTOR INFORMATION:
BUILDINGADDRESS: ' - 's, ` PERMIT NO.
OWNER'S S NA47,0 L✓ BYRNE 'HV r i a APPLICATION SUB DATE.t
PHONE: BONYUN ' , r ] S SANITARY NO. CONFROL NO. -
O z z ARCHITECT/ENGINEER: _ ' ✓' BUILDING PERMIT INFO
z�C -✓' ,I{` + BLDG ELECT PLUMB MECH
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LICENSED CONTRACTORS DFCI ARArION l t' l .,a. Job Description
nnlicensedy :•' _ -
O Z ❑ - I hereby a0 Int 1- d p . : f 9(' c ng . :)
F=Cw
with Sorficio 700P) f DiNaten3 IflheBu a IP I Cods.imdm,l - -
�,x,�: 's in fill l'rc and,fect. - - ) y - - r•
`o
License GI c " z": REPLACE WATERHEATER
w3'-ti, ARCHITECTS DECLARATION ,
gaC a 01 1understand.,y ill hell tic uaad public unit, � �`/�11I//�1'
u1�0Licar,calP f.. -1
I OWNER-BUILDER DECLARATION I �I i Ill
C I rarefy ffr that I air exe pi f theC t i L E f (far ,1. Ill
(•'�
topcoat (9 I 7031.5,H d Potfa oudickCode A y an,or coral, r
G wlach torture,.p II t f,alte, dcri or at any tornand, ✓ i ,
a3. pr I I issuance,H q thpill f hP li fila6 d,t t ,5 '
thre he is licensed Naloodual thapervi,itur,ofm c t r' Lie,noa I' (Cl re 9 - S Ft Floor'Area' / aluation
.or e g 'll5 I Taro) fD" l It, B .' d❑ C.' C I1 9` J ti '
fSethath 1.npun amen Ih c11gill Any f ^ty `
ofS ion 7031.5by anitawelt torap t hle<Ix te hapll uoaeh_Ip 'hy,
.four noro lhamfiea Initiated
ullm trs($500) • ,. ADN Number •" Occupancy Vy et
ll :„
❑Iasowne,oflhe pr,,4,nr,ny opplo;aes wall gcs as the r,eartonpenrane,
l ti man he cl ee� ', color lato4nRRaad P Oce Core mComaorL,ok Law ply I' - ..R g.ired,Inspections -
xw fp pelyWh b Id: p Ih d h 1 h work If
lh ghhisown ply p deml 'uh' pm t I t dd or
ils . l ,
df ' If, t b ,d g gree �r II it one r 10'6 — 'SEWER & WATER
completion,
f inp .eth h Id , illhadodl b reTrova,thth didnolb 'Id
for puposcol a ).
pWe,UNDFRFLOOR PLUMB I-NG
Cl. . flhe puriplao, n kdroiuvaly' i g with licensed lnaa l 30'1 '—'',ROUGH PLUMBING
construct ttheproject(Sec7044,Business dProfessionsCd )Th 'Contractor's
'
Un ea Law are,apt apply to e„
an ne or pro )whon;Id I ro,u na.maroon, 302 — TUB••&` OR SHOWER
and who contracts:for sach p,cai with Itecmt(.v) : I p suanE 20 the _
conleclors L'cenav l 'I150,2-,— FINAL PLUMBING ENERGY
Oil...expt r
❑Toemtinder Sec. ,B&P C for di ccuno
u t.•
' 50E, GAS TEST
.Owner' WORKLk5COb11'[NSATIONDECLARA'EION 507 - 'FINAL .PLUMBING,
I
t ' .. a
I h bY alfical UnderrecorItY Of prolLay.nine of the Iollinking,doclarations
l
O I la d 'll. bill.' ot
C f I Consent I If for,Wok :
-Con"croaudia,
l provided f by Set theLabor Code,fn II
pert kl M1' h'his p , "c I " 1. - +
❑1h J ill archnoul,Wok Con,ranartionIn. e,us
,i,aacdhy,S t
3100 or(he Lucia'Code,for ih ee,firandep elrl kwhich prnt
,,.ad.My Work,,',Conaperparion hv�acaraa aa�d.rr aid Policy
Cartel: Poll Y N
CERTIFICATION OF EXEMPTION FROMNORKERS
t
COMPENSATION INSURANCRANO E j
(EI' I do lb illi lftl p I', t nhundred dll .4 �� 1
($1007 1. ) - •
t
1 ffr H Ih 1 rl ITh kir h ch O p t d l 't
.hull mem lu _
P Y nnY p t nary nazi u.to Feu n vuhleel to the Wo kers
Comp n,.f nlswx df Cnl'farnv Dnte
t NOTTAppliC ell f. ..
NOTICP.TO APDLICANI.IL ft mold tg❑-.-CuiifcutetCL empi on ym should' - -
' QiOheconeeuhlee , all. In all the Labor Code y,umuat
fonhwmca nilly wish hi ' r Ih pcorn.vhnllhdeclined rovokea .,-
CONSTRUC_TIONLLNDINGACENCV
I by 0 n that there o oionc ' d le ng age y for the pmfortoaace _
a
of the
work for which this peraiii '',.ad(5 3097.Cie.C) - F
Q
Leader,Nine,
z. Lends Address
C.7 1 certify that I arsa lead this ppl I d eatc,hoUla,chasef 'Eon ie I
woe U l apace to croply will,.11 any red couna,ordinancesd I I lows nerair,
Q V
It)h If ,lareloadier,andhereby inalborls,re,patecrocive—filn,ol,to ante[open
[� the above menfoned proMrty for WHostialItunposes. - a, -
�.I G Wk)agree to save,i aderatify laidkeep harmle.v l hefty ell Catarina,al '
L liab'EI J dg t. .I. a d p ::which 1 any way acme aga neo.aid '
City in consequence of the gaining of this central
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOURCE REGULATIONS lssut d by:, Date
Si,prourrol Appliceri/Commmor - IDole Re-roofs _
HAZARDOUS MATERIALS DISCLOSURE , v =•
Will meapprcam aadondoo,mm ;ai 'Type of Roof,
os defncd by the Cupen no Mu i e jml Code Chapter 9.1.2,and the Health and Safely
. Cod Seat on 25532(1)1 .,t - •1 'vl ..
' ❑Y,, a., on I 'All roofs shalILbe inspected prior to any roofing material being installed. f" .
wn the npplifuture building p' t Iry p I e a which If a roof is installed without first obtaining an inspection, I agree to remove
sandh. e ,r cont rf 'nL mdefaed by the Bay Area Air Quality Mun lgenam
District, , - . all new materials for inspection. Applicant'understands and will comply with
uvea ❑Noall'non-point source regulations.
Go
I hr,,read the d toolearials requareacre,under Chapter 695 or the
California Health&Solely,Core.Corre.Sectors 255115 25533-and 25534,1 andCaSesuld that
•` ifculnr of the wvnmc rtemlyha'camnam Tat tinny rrearke ofir tomc
eupnm or the reyuireinen¢which muss be mel pride nr iv.uance ofu Certificate lof "
OecupancY .. 1 - .
_ SignaturebfApplicant_ Date , � A.
Owner or authorized agent SDI(, •-y - All roof,coverings'to be Class "B" or better ,