01050078 CITY OF CUPERTINO "'"°' a's+ rtn �i .•' ..-.,
BUILDING DIVISION .' .. . PERMI , OINTRACTOR,INFORN1
'BUILDING ADDRESS: ., - PERMIT NO.
IC T
OWNER'S NAME: APPLICATION SUB DATE
t 'HONE: , r SANITARY NO. t + CON I ROI.NO
O O ARCHITECTiENGINEER " a, . 'BUILDING PERMIT INFO
to
s*
BLDG ..ELECT PLUMB MECH
C
u
d
i2 Z LICENSED CONI'RACIOR'S DECLARATION Job Description
0
z=
I hereby affirm that led licensed ander Pmvisiona of mChapter CraJ,, d mmondng
Ge3C� w th fall
9f and effect. nnioftheN JI des. .Gds,andmyl'ense. r
W< n full force and elf t ' �A
€W< License f Cl... a' ARBOR. .
1, Conarriall5l'
ed 3 w.y ARCHITECT'S DECLARATION ,f -•
�� I- '1 J ,rdhe,rJ punlic rernN N' r r " ••
N
O O Liemoed Professional.
-
p'd dat,OWNER-BUILDER a DECLARATION -
n
N I Immny.(Flnn on 1 1. asmnpl Barataria Ganlr ds Co e:Any c Low for the .
Z>' following arson.fsu3ian 9(131.5.Business and Professions Code:Any oily nr d,unty -
f'�O which requires v permit,al flat
aher, for
such
,....shsor iepai,any swethre - _
pr' tt 1 y ' .tl 'PPItf hp it I. .'g tit ant.
-
that o .1 e p . I to the pmvismas ofl Contractors Liumar,Lfw tchPt.9 - Sq. Ft. Floor Area Valuation
, (cath nenc erg with seri ot,91xN7 eroiv.<o,°3 orin�Boi usF.ne Prof2Es'o,.coda)
m that he k exampt therefrom one me lov,for the alleged cxcmptirn.Any violation .
.of Section 9031.5 by troy applicant fora permit subjects the applicant ton civil papally,
of not more than five hundred dollars($500). APN Number -Occupancy; ype;,
Ed Un,cissuctroftp p prtY r comejce,with wages us thelo compensation. ,..
will do If, k and the:I 'Ire is not intended or mffbed for o,le(see 7RU1, - — --
rI Business and Proesionti Cade,The Co I car:License Law does and apply to an -• Required Inspections
ownerf property Who build, p lh d h d h workn If
or to gh h' nplyw,providedthat: mp _ t" tintended r 304 - -.ROUGH' ELECTRICAL. -
ch d f 1 Ir 1 theb,Iding improvement ld withine y f
o plI Ino aero namentrprav xd,atneepnetn Isar
501 — 'FINIAL ELECTRICAL E,INERGY'
inp yfnr the on.edwlee -
°I,vs—ri-fthe 1 i 505." FINAL -ELECTRICALcon .
Proper Y mn exclusively connecting who licanmhe Contra ct m
License
the in,ror applSec.y
to a Business and Professions Coec:7 The Contractor's. - -
LI L J t polys prof Property who 6 lid 1 p s(here -
Ce h Iic'I f "h P-1 In w'th a aHrnemr(s)licensed p m I ther '
Cn t e L' r
' 0 pl tnJcrS - pffiPClot 0'" a.on
D5M
WO LR COMPENSATION DECLARATION"
t ,
1 neraby alTrm under penally of VeurY one of the following i calamtions -
❑ i have and will maintain a Cenifcam it Conant to self-insure for Worker,
Compensation, he provided for for by Section 3900 of the Labor Cala, for the ).
performm�ce of the nark for which this permit is issued.'
°I have and will maintain W k s Compensation hicarrambas required by Section " s
3701 of IM1c Labor C le,f (he perl'mounce of the work f which this ,,off is - - -
Issued My Worker's Compensawar Insurance carrier en's Pal icy rummer are: - - - -
• '•carrier: .r� Policy
No,: .
CERTII'ICATIONOF F.XEMPTI0 FROMWOk 'RS' ( -
COMPENSATIONINSURANCE -
(This section need nal be compleNd if the pcnnit is for one hundred dollurs-
_.
1 earth,that in the perlbnnw,ce of•the work for which this permit is issued,I
shall not employ any person in any manner so as to beconta suhjecl m the Workers
C„moansetion Laws of California.Date -
NOTICPTOAPPLICANT.If. ft k gm Carnifimilrol E pl you"hold - -
become subject the Worker's CanTeroadirn p..simeardhe Lalbo,Code,yo.most `
Q Q fork 'Ih comply with train resistants or this peau I shall be accrued revoked.
F 4 CONS TRUC I ION LENDING AGENCY
I broalryeff thin flacce,is a crandractimaleading vg y I.,theperformance
if the weak rorwhich this psamu is issued(See 3097.Cia C) r '
Q
Lender's Name
V z
?.code,',Add .s
,Q�+ Q[Vy
- 1 candy in;[ read this applicationd.-ml (bar the h information
coned, agree to'comply with city d comply 1ariad ,are laws Main
f
to building I tl t uJ h r by curb
. ve P e. this try to Io r _
- -
- ,y Gia
the above )mentioned property f o . P P : + .
•,Fyfy (No)'g' t d ' 'dkph iii
the City(if gist
ran {1- -•
rr Cablf "lab t. t d expenses
which
any a 1 Y ne against
City -Unca of d granting of thisLam t ..• - ✓�
APPLICANT-UNDERSTANDS AND WILL COMPLY WITH ALI NON POINT
soukcE�;�EgG_�_'�TI - Issued;by:,-JO - AIIJ�c�GG t Date
'�-raj,rc��t(C�cd,, .Re-roofs . .
Signaturea VLontructor to
HAZARDOUS MATERIALS DISCLOSURE Will the a,dearro,Face building- p, r c err hainall,morodourairmcfal "Type of Roof• I ". -
a,J C dby the Cape,no,,hluncpalC d• Chapmf 9.I2, oil(he Health and Safety
Code Section 2553211)?
All roofs shall be inspected prior to any roofing material being installed.
d pone m r r n 'I r g p t maq P t e '<e con an' If a roof is installed without first obtaining an inspection, I agree to remove
•nntl and rc,t nk vs by th Bay Are,Air Quality Mnagenent '
all new materials for inspection. Applicant understands and will"comply with
ores all•non-point source regulations.
1 nave rand the huzurdaus materials'regairemcl,ta Im&,'C1mptar 6.95 or the -
,Caiiforno.Health&Safety Code;Sections 25515,25533 and 25534.hundarstand that x _ • c
` .ifthe buildingdoesnalcunetdlyhave acombihm it is,,,respori'min"'onntil'y the - - - -
d �.
ccuprin of the recludireanumis which must be act prior to ancrace ofin Cartili_cata of -occupancy. Signature of Applicant Date-
All roof coverings to be Class:`B"or.better
- `owrecar-�mdzc trgent-' me - - - g_ -
. : OFFICE - .. .
r � r
33
17 Gj
Y WWW
Timf /
` -
PIT
® I 2xV., �. w5iP6 of p°`='r P
v -
�1.r 4
i
�4) Zx 0
h
4
1
L I
(( ^ VYY \
F,
60 it
W �� [-EYC'1 I � 1r::.'✓� r.,.. i Ove C C.
10
10
AU
' ` f
f
i
�rL ;
jFir-
��ano�r'c� or
Re ++er
218"nn�c(1e I1
i n I I �fl
APPROVED
PLO IN ACCOFDANCE WITH THE CITY Ot u S
� � 3 AVZTINO CODES AM) ORDItI{at k�
DAZZ
tlGNI
'L4.lUs set of P,Z% Enj civ-_ -w F _
DA L be kept en t;e , d itis En v ' +r
TE-
wful to m
on Same W._i•_u.- ., mre!,n trem
�
the buddin _ ic.dn.. y , _
The stamp;;-1Z01 :;1: ,-
'SHALL NOT tv �.e i- c;: _1 i; is a,
approval of t"e vi lz.._n of _- �._. _,.•n•
of any City Ordinance cr state . W 3�
OFFICE ,
off
1 MAY 8 2001
D
By _ I
CITY OF CUPERTINO "'"°' a's+ rtn �i .•' ..-.,
BUILDING DIVISION .' .. . PERMI , OINTRACTOR,INFORN1
'BUILDING ADDRESS: ., - PERMIT NO.
IC T
OWNER'S NAME: APPLICATION SUB DATE
t 'HONE: , r SANITARY NO. t + CON I ROI.NO
O O ARCHITECTiENGINEER " a, . 'BUILDING PERMIT INFO
to
s*
BLDG ..ELECT PLUMB MECH
C
u
d
i2 Z LICENSED CONI'RACIOR'S DECLARATION Job Description
0
z=
I hereby affirm that led licensed ander Pmvisiona of mChapter CraJ,, d mmondng
Ge3C� w th fall
9f and effect. nnioftheN JI des. .Gds,andmyl'ense. r
W< n full force and elf t ' �A
€W< License f Cl... a' ARBOR. .
1, Conarriall5l'
ed 3 w.y ARCHITECT'S DECLARATION ,f -•
�� I- '1 J ,rdhe,rJ punlic rernN N' r r " ••
N
O O Liemoed Professional.
-
p'd dat,OWNER-BUILDER a DECLARATION -
n
N I Immny.(Flnn on 1 1. asmnpl Barataria Ganlr ds Co e:Any c Low for the .
Z>' following arson.fsu3ian 9(131.5.Business and Professions Code:Any oily nr d,unty -
f'�O which requires v permit,al flat
aher, for
such
,....shsor iepai,any swethre - _
pr' tt 1 y ' .tl 'PPItf hp it I. .'g tit ant.
-
that o .1 e p . I to the pmvismas ofl Contractors Liumar,Lfw tchPt.9 - Sq. Ft. Floor Area Valuation
, (cath nenc erg with seri ot,91xN7 eroiv.<o,°3 orin�Boi usF.ne Prof2Es'o,.coda)
m that he k exampt therefrom one me lov,for the alleged cxcmptirn.Any violation .
.of Section 9031.5 by troy applicant fora permit subjects the applicant ton civil papally,
of not more than five hundred dollars($500). APN Number -Occupancy; ype;,
Ed Un,cissuctroftp p prtY r comejce,with wages us thelo compensation. ,..
will do If, k and the:I 'Ire is not intended or mffbed for o,le(see 7RU1, - — --
rI Business and Proesionti Cade,The Co I car:License Law does and apply to an -• Required Inspections
ownerf property Who build, p lh d h d h workn If
or to gh h' nplyw,providedthat: mp _ t" tintended r 304 - -.ROUGH' ELECTRICAL. -
ch d f 1 Ir 1 theb,Iding improvement ld withine y f
o plI Ino aero namentrprav xd,atneepnetn Isar
501 — 'FINIAL ELECTRICAL E,INERGY'
inp yfnr the on.edwlee -
°I,vs—ri-fthe 1 i 505." FINAL -ELECTRICALcon .
Proper Y mn exclusively connecting who licanmhe Contra ct m
License
the in,ror applSec.y
to a Business and Professions Coec:7 The Contractor's. - -
LI L J t polys prof Property who 6 lid 1 p s(here -
Ce h Iic'I f "h P-1 In w'th a aHrnemr(s)licensed p m I ther '
Cn t e L' r
' 0 pl tnJcrS - pffiPClot 0'" a.on
D5M
WO LR COMPENSATION DECLARATION"
t ,
1 neraby alTrm under penally of VeurY one of the following i calamtions -
❑ i have and will maintain a Cenifcam it Conant to self-insure for Worker,
Compensation, he provided for for by Section 3900 of the Labor Cala, for the ).
performm�ce of the nark for which this permit is issued.'
°I have and will maintain W k s Compensation hicarrambas required by Section " s
3701 of IM1c Labor C le,f (he perl'mounce of the work f which this ,,off is - - -
Issued My Worker's Compensawar Insurance carrier en's Pal icy rummer are: - - - -
• '•carrier: .r� Policy
No,: .
CERTII'ICATIONOF F.XEMPTI0 FROMWOk 'RS' ( -
COMPENSATIONINSURANCE -
(This section need nal be compleNd if the pcnnit is for one hundred dollurs-
_.
1 earth,that in the perlbnnw,ce of•the work for which this permit is issued,I
shall not employ any person in any manner so as to beconta suhjecl m the Workers
C„moansetion Laws of California.Date -
NOTICPTOAPPLICANT.If. ft k gm Carnifimilrol E pl you"hold - -
become subject the Worker's CanTeroadirn p..simeardhe Lalbo,Code,yo.most `
Q Q fork 'Ih comply with train resistants or this peau I shall be accrued revoked.
F 4 CONS TRUC I ION LENDING AGENCY
I broalryeff thin flacce,is a crandractimaleading vg y I.,theperformance
if the weak rorwhich this psamu is issued(See 3097.Cia C) r '
Q
Lender's Name
V z
?.code,',Add .s
,Q�+ Q[Vy
- 1 candy in;[ read this applicationd.-ml (bar the h information
coned, agree to'comply with city d comply 1ariad ,are laws Main
f
to building I tl t uJ h r by curb
. ve P e. this try to Io r _
- -
- ,y Gia
the above )mentioned property f o . P P : + .
•,Fyfy (No)'g' t d ' 'dkph iii
the City(if gist
ran {1- -•
rr Cablf "lab t. t d expenses
which
any a 1 Y ne against
City -Unca of d granting of thisLam t ..• - ✓�
APPLICANT-UNDERSTANDS AND WILL COMPLY WITH ALI NON POINT
soukcE�;�EgG_�_'�TI - Issued;by:,-JO - AIIJ�c�GG t Date
'�-raj,rc��t(C�cd,, .Re-roofs . .
Signaturea VLontructor to
HAZARDOUS MATERIALS DISCLOSURE Will the a,dearro,Face building- p, r c err hainall,morodourairmcfal "Type of Roof• I ". -
a,J C dby the Cape,no,,hluncpalC d• Chapmf 9.I2, oil(he Health and Safety
Code Section 2553211)?
All roofs shall be inspected prior to any roofing material being installed.
d pone m r r n 'I r g p t maq P t e '<e con an' If a roof is installed without first obtaining an inspection, I agree to remove
•nntl and rc,t nk vs by th Bay Are,Air Quality Mnagenent '
all new materials for inspection. Applicant understands and will"comply with
ores all•non-point source regulations.
1 nave rand the huzurdaus materials'regairemcl,ta Im&,'C1mptar 6.95 or the -
,Caiiforno.Health&Safety Code;Sections 25515,25533 and 25534.hundarstand that x _ • c
` .ifthe buildingdoesnalcunetdlyhave acombihm it is,,,respori'min"'onntil'y the - - - -
d �.
ccuprin of the recludireanumis which must be act prior to ancrace ofin Cartili_cata of -occupancy. Signature of Applicant Date-
All roof coverings to be Class:`B"or.better
- `owrecar-�mdzc trgent-' me - - - g_ -
. : OFFICE - .. .
r � r
33
17 Gj
Y WWW
Timf /
` -
PIT
® I 2xV., �. w5iP6 of p°`='r P
v -
�1.r 4
i
�4) Zx 0
h
4
1
L I
(( ^ VYY \
F,
60 it
W �� [-EYC'1 I � 1r::.'✓� r.,.. i Ove C C.
10
10
AU
' ` f
f
i
�rL ;
jFir-
��ano�r'c� or
Re ++er
218"nn�c(1e I1
i n I I �fl
APPROVED
PLO IN ACCOFDANCE WITH THE CITY Ot u S
� � 3 AVZTINO CODES AM) ORDItI{at k�
DAZZ
tlGNI
'L4.lUs set of P,Z% Enj civ-_ -w F _
DA L be kept en t;e , d itis En v ' +r
TE-
wful to m
on Same W._i•_u.- ., mre!,n trem
�
the buddin _ ic.dn.. y , _
The stamp;;-1Z01 :;1: ,-
'SHALL NOT tv �.e i- c;: _1 i; is a,
approval of t"e vi lz.._n of _- �._. _,.•n•
of any City Ordinance cr state . W 3�
OFFICE ,
off
1 MAY 8 2001
D
By _ I