00110087 t �
CITY OFCUPERTINO 4,., ' „i
BUt.ntNc DIVISION - ,. PERMIT' CONTRACTOR INFORMATION "
BUILDING ADDRFSSS: r_ -' PERMITNS, ^
20h'j,4. CAMARDA CT;' 0017.0087 „
.� OWNERS NAME:.` " i" APPLICATION SUB DATE. '
KOPEI_.S 'DAV16 N .AND BARBARA S ?~.' 11/1.5/20000 r
PRONG. '' - SANITARYNO. CONTROL:NO. _
IIrO-ZO ARCIIITCCT/ENGrNIER: „ -' _ BUILDINGPERM[f INFO
p uUl E _ r BLDG ELECT PLUM l -MECH
a U i _ 1=1 ,CI Ill 0-1
o,
LICENSED CONIn.eFOR p IFCLARTeHmOpN8� t
)( ng a Job Description
-. .
wIM1S t 90fHp fD nn3 of lbs Nu IP'ofc..vi GJO,and ilY l' me - t'3 '
q�y f ie m r rce t INSTALL TWQ�.,SUMP Pt_IMPS, dUTPUT TQ LAWN 11
C w Lic Cf:s L w
c, wto Corrosion
ARCHITECT'S DFCLARAI ION 's
Iatdr.l ud my Fluor, hail be user. iuhliercarrtls "
ce
Licensed P
fie, ' OWNER BUILDER DECLARATION
W 11 by aft that I ,t from the C t I License Lati,for the
G r,Q Toll y reason.(Section 70315,Baunec,md P 1 Code:AnY icyvarinaay
CO which naluares a penor to Confront,alter,improve, 1 I,hrepair any structure
_ Y '
a3� prnt t I o II ppIlona' II hpcl ll fl g d Savanna, -
that he license(]pul-mn [lie Provisions of the Contracter,Liviars,L (Chapter 9 _ e
ValuatI 1cin s with Section owdD fm tr iaP I Code) Sq. FFloorrea
or that he ,
n exempt Inc circ r and the ba. for the,Ilegcd e pt uta Any violation- • - .
'at S t n]031,5 byroyapplican f p twbjcctsiliczippliczLnttoact%iI p alt
fn I to r l d as I" (5500) APN Number - - Occupancy Type;,
nl p p ly .y t31 y m g. m 1 p :i :'I Sr40.(4F, Qll?i .
If II J II k I tire Samoan, ,am intended oil offered for Sale(See.9044 „ - is
Ben I Profit C d Th 0 1 1 E L d I apply Iy t Required Inspections
fp pert Who hand,,,, p n a n d 1 workhself + . 106 —,' SEWER &' WATER
r oretl gh h'. ply Inoldf t ' 1 t t-intended or '
offie a I B n i bouncing p r:. " ithi y of -.aO2 — -UNDERFLOOR -F'LUl1BINQ
completion,the I let rwill have the b Jct of proving that he da not bu'Id or
roptrpoFenr 'ale.) 301, - "ROUGHS PLLJMBTNG
owner of(bI ty g ml m..to 302 — ,TUB K. OR -SHOWER "
surer thprojicct(Sec.904L1 B siness and.P- r :' L 1 )Three Contractor's
_
lie i e t ..lyt property n n 31. 1n -502"-- FINAL PLUMBING ENERGY^
r aid h routines f I p a with � contractors)licensed P � t t the
ContrUSUactor 506'—' GAS TEST
ID am orp - B&PCT Ihsrc cin t
cont ''` - DI �J�OV 5177 — FINAL .PLUMBTNG '
W ERIS EOMI LNSA I OF ARATION l
y
I beirely affina for p lky f peruryonef tire loll ,declare, (F
❑ I h d will anairrain U Cruilande if C port l ell home f Worker', -
'� po mpc mdni e to 9
pr d f n
by Set 3700 of theLab., Coda fn the
pe
- ' r) neeof the cook which this Pc s issued. . V
❑11lave and will am Into W kers Compensation Inst rmea as rale ned by Section°
394 of the Tabor Code,for the serf rmance oLdie work for which.breperm...re -
sued.My Worker's Contpenmion Insurance currier and Polley another are:
Carrier: �Pol' Y N.:
,. ,CERTIFICATION OF 17XEMII ION FROM WORKERS'
COMPENSATION INSURANCE
(This onto.need not be completed it Penni)is for one hundred dmims
($100)or1+J
t 1 crude thin Ia the perlormo erc al he ,.,it Ea which(his permit I.issued,I
+ •shall not employ any pcmon In any rcmnner so as It,becemesnbjecl to the Workers' c•Y r + -
Cmapcneuiimt Laws of Culimm'm.Dale
NOTICE
- -
NOTICE TO APPLICANT:Ir,after making Inleovi,orc ul of Hmm "'d you'nail
d,
ardy the suckarSGsionsmuonpmvtemnsn h ..Labor G�da You mull _
Q fnnbw Ih comply wnM1 h pr I ar Ih.pemdt sM1all he deemed revoked
r _ -. ..1
(~ ^„LONVkUC TION LENDING AGENCY _
�i 7 Thereby alrru that tconstruction leadingage n
YflnO pe Lotounce . •., ,
-W of the work for coli eM1 tl permit . kated(Sen 9(19] Cry.C.)
�y I<»tlu's Name i ,
� z Lender's AAAmas
, vy k
V Icer)lythat I test,readd :upplicnan and state thatm b f at is ^ L
corecr I agree n,con ply with all city and county onforaires and state laws rom g' `
Q V tobalding conetmcdon,and berchy autimrrke mprcsentauve,trthis city to mneru,n'
tire ab e C I p p ly For portion 1 1 • . . -
[y LLI (W)agree t found I,antikeph' I .,IheCity fCare T gains) -
Cy I eb 11' s Pull t net .,c.. wl any in any way occur,against aid
7+'� Gly 9 e tI 6 9th':Permit. '.r 1`(�
"•” ,SPP C I A R DSA WILL COM WIT I SON-POINT Issued by: Date V;L-,
��/fa
slgamrcnr p canuenmrmltr T owe Re-roofs
HAZARDOUS MATERIALS DISCLOSURE '
Will dre app) t junior hadmag Hannam smrc nr R m 1 1 trim Type of Roof
m del nil by the Cmped m Mum iipal Come,Chapmr 9.12,and the Health and Solely
Gale,Section 25532(a)? _ - 1.
wes O No _ All roofsshallbe inspected prior to any roofing material being installed.
Will the applicant onfulare building 1' t a.4c tq1 t it J . col mit If a'roof is installed without first ohtaining.an inspection, 1 agree t6 remove."
mdtm :il n SI definedbyll Bay Arco Air''QualityS age nl ♦e
•uisl I - - all new materials for inspection, :Applicant{understands and will comply with '
oYet, 0Nall non-point source regulations.
v
1 hill, ad the Inamida anderous regnaremeak under Chapter 6.95 or the
m atS,l Code,Sections 255115 25533 an,]25534,1 understand that
ote 'cnnymtdcatentfnt,that if smyno,,pnsibirt)+tnnodry, the
11 t 11 US 11,11h mast be met...... issuance or a CenIDcit 1.
°ej y - Signature of Applicant Date -
All roof coveriri �s to,be Class "B"or better -
.Date g
_ "«' OFFICE