00060087 CITY or CUPERTINo CONTRACTOR INFORMATION:
[BUILDING DIVISION •. PERMIT
BUILDINGADDRESS: •' 'S'' " A , 1 - �" 5 PERMITAO'
OWNIdR'SM270 CALVERT., DRIVE:iy LSCHMALENBACH APP ICA
E. .
' PHONE: SCHMALENBACH SANI'IAR NOI
C O ZARCHITHCTIENGINEER -- , BUILDING PERMIT INFO
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6 w _ 111. - t " v 3, _ BLDC ELECT .PLUMB MECH .
' LICEN"SED CONTRACTORS DECLARATION
Z ' a1
_ - �10b Description
�ZCPcreyfrn licensed under perunmeg
i with S i Align) IDivision3 of the tl ss and Professions Code and ivy hearse.
ist[llf c andec -
.,. •r I'. - ,
a 6 Lic rt Class Lic H - e-
°K Data •C t cmr•. '
3 w ARCHITECT'S DECLARATION• WINDOW .REP
LRCEMENT
t5= lande,,hand toy pleas shin be used a:p M' liberal -
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OWNER BUILDER DECLARATION Ihereby'B In Il of J C t I L I f the
Tau g (Section 7031.5,B . d 1 t :Code A y ty tv -713
7 'which ventures4P t to construct,'ttle,inflator,dnl'h,or repair anystructure
a � pr t I q al the st,bran,f :uhPc ufilrit,f,red,ou,nout
thathe islicenwil pursuant nothe phovilions of the Contractors License I (Cn pl 9 S Ft. Floor'Acea �✓aluation
mand --
feonenengwithSet n 700(oof Dvi
' .en Sonne Burne PFfiasCade) i- 9'a -
nr
that he is exempt therefrom and the basis❑n lie alleged exempt oa.Any violudivi — .. -
ofSection 70315bYany pirair,fora txfruit subjects the applicant to a c'vlpanalt, p -
of not mm
ore an Eve hundred dollars(5500). ,APN Number OCc e
❑1,As owner Of the prope,is or my amployacs wan wages os Ncir sole mmp�nsmion, • -
w11 do the rk d the.1 t i,alu-notiLial,il or victual f r.41 Ser-7044,
Business and 1 r : ale .c d Tn c I ' t r- 1 b r, L due,for apply Io as - _•3751.8019:_0*quired.Inspections
rp pnyWn nils p llo and wh cn kn :ll , _ •.
,arm gh Ill,ivvjcvip ddtlal:rich' p ,heli a.,intended orl '
offered for dc.If,firfacler,the building p we neat Id 'thin one 1 f
n pl l the n 1F id have memme,orPto.' gGrat he did nor fault on 101 7 FOUNDATION .
i...rc f" rp.:e f:ale), - :.
10c2, PIERS
'OI rorthe p penyo exclusively 1oa11s lu u 'licensed conlm1 a4�
co ,1 t Itic Pio Fall,,7044 B I Pon:.1 n:G.Ie1 The Cont t 103 —. .UFER
ua . I d I- we,ofn p ty whebulL p ,verne oy. .
dad n t n Ieject,nwm t I.,(r) d -scant I In 1- �,-1.04' — REBAR '
LI t t tp�dcaraB&PCEarth i. 105 — ANCHOR BOLTS •
wI Dale' 6 /j��� ` - 10F. — SEWER R .WRYER • ':
O SCOMPENSATION ECLA ATION 1 ,
202 — UNDERFLOOR PLUMBING;
hyafmunderpenahyofperjnrynncoftnefollnw,ngciodamdom: .A g Q03 - UNDERFLOOR .MECHANICAL -
❑ 1 have d T ma n1,n a Cert re i r c :n, lfe 1 Wor err - 204 — UNDERFLOOR' FRAME'-
G p n:t 1 n asp J d for by Selina 3700 of theLabor Gxhe ,f the performancennnework r biehmi..p 11 Itaed. 205 — UNDERFLOQR,, INSULATION . ' -
❑Iha 11dwnIuOini nWelkersConP i 1 . r9nrdbySei 30,1 ROUGH PLUMBING
3700 f Ina I:mor,Cade,for the perfor e, f the'work I which this pe t s '
> .raed.MyWrakerrcompan,aennbnmmne eranaPoly n 302 - TUB & OR 'SHOWER -
carrer.'' •�. ,Pole;-No.: r 303` ROUGH MECHANICAL.
CERTIFICATIONS OE E%EMPI ION FROM WORKERS'. +' J
COMPENSATION INSURANCE + '-•;304 — ROUGH ELECTRICAL
Olik a"ran n e l l be completed nn p „it is f hundred doll305 —'FRAME
- (Mac Herr) �
I lei fr'ban
r n p f tan nh k r n n m''p- 'I issued,1' -306 — HOLDOWNS _ .
307 — INSULATION
in Corro t p,L any P cry na alt bwr m fi h wan the Workers "
Ct pe t L xOfC if p .Date� ' �
Applicant - ` 308 = SHEETROCK -
NOTICE TOAPPIICANT If, ft- Ann,J C nl t l Reful lin y h 11. r -
he subjectl d e k c p .a111 P!o-In of the Labor c,d y t 309 EXTERIOR LATH ;
O•Q ratm nannplywm uenp 'liar na In e 'Lnun I ea.akoa.y FI '
�.. - 310 = INTERIOR' LATH ,.
CONth re is a cON LENDING AGENCY
C y fr�mllh e lending ege yr ma raimance' 31.1 — SCRATCH CORY" ;I
�" C -ol'm kr n'enm p nt. cruel(S' .3097 Ci,C) - --y 't
a p Unders Addre 313 ROOF 'NAI12 1 `
-� z Led All 501` —1 FINAL- ELECTRICAL ENERGY
v'o certify mann dlnsapPr d:I-I tl ttl b lnirmi 502 — FINAL PLUMBING:'ENERGY
W Fy m ect l 6 1 ply Ih II 11 a d my N' c and 't to l -Fel ting' +
0 V -1.Nold-g :I ( dhrhyaponerepre. atl of this city to enter upon -
thenW,.,ao,rarinspeci p p : R 503 FINAL MECHANICAL ENERGYpis ( ' oak pn Ir=�nnaety hep anoaE ' .'. 504•;—�F-INALMECHABUILDICAL ENERGinbl fe 'or e h h ayn ony ay' rue ug,in t d
Citj cni ng ai Inperml t I APPLISA WILL COMPLY WITH ALLN N-POINT 505. —;;.FINAL,. ELECTRICAL souac �, OV i Issued by: 91AR RAS TEST
Date '
sib t e;rAppheni onitaet,F" :. Date Re-roofs 507= - FINAL PLUMBING '
:HAZARDNUSAF TERIALS DISCLOSURE �. a -
Wlmeapplcat futurebuilding oanpantrm otI al hl m mule I '"TypeofRoofS08 —,'-FINAL MECHANICAL
av JefineA ly theCuperi no utuCade vacation
t912 aanthe Haanhand Sfrl 5 r -
cog•,EdW, ss3z(nu aNt, , - 509, — 'FINAL7 GRADE
All roofs shall'be inspected prior to anyL roofing material being installed..
Will the Fl 1 or rutfutune buildingoccupant use wnrt ntr e ,,Mich' If a roof is installed without first obtainingnan inspection,'I agree to remove
emth lotsa re.11 ants os defined ny the Bay AreaAr Quolty Manogement
District' all newlmaterials fol:'inspection. Applicant understands and will comply with
°Y ` s Edall non-point source regulations: .�
I e to a hazardousvalcria6 mquircirrievild Chapter 6.95 f,n _ , 510:'— FINAL PLANNING +• -
Ctfirn 41 des f ty C d ti25505 25533 an 125534.1d t-d Ih t
inh h IJ gd I u d, 1 tp.,fii, Y 1 _:hltyl thtl • • -(Ss
ev p t a the vgt'rc ts ar
h maul he ud pr or Ill issuance of a Certificate of -'
Oa a
' - � � 6 ',OD � Signature of Applicant '' . " i Date,,.
All roof coverin s to be Class `B" or.beiter '
ow ranthl r'Lw agent Date.. i g ..
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ti 'OFFICE
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