00070099 CITY OF CUPERTINO' °• '• ,,
Hun.ntNc DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS' " ., _R, ' . r PERMIT NO00070099.
1010 CAROL ;LEE DR I!.• . Yf 0
OWNER'S NAME: - r.. . ,�'•� w, - APPLICAuOpL1/IJpb/2000
SHIAO •t', YJJ 1133
HONE'. .. ,'
' .�y,.;, � SANITARY,NO. CONTROL NO„
MOO ARCHITLCF/ENGINEER . �, , ., _ , BUILDING PERMIT INFO r
w MAC 13LEC' PLUMB MFCH
LICENSED
LICENS DCONTRACTOgRS DAT1O
' ' 'I •1 Job D
esc^
n
tion -..N
OZIM1 by R v10In licensed ud PimicarfCh 1( g
se
withSection 7000) [D n3nflhe Ru ad Plvfex:rnCode,and ny l
mmee k fulf r e1 qee ELECT UPGRADE
. Lic ClauLure.
NDat 5
u
Contra I
ar
ARCHI FECT S DECLARATION
� 1 de¢tand m)pl :Anil he used as Pahl c ren lda
OWNER-BUILDER UF.Ce Can ION
'1 hercby 0(800 mat 1 om eaempl rinm the Conuuar Cm License Low for Ihe' -
t'j,d fall D ui. (e m ]031 5 ,t : d P t t,d A y ly Icounty,
AZOwhichif rp requires " till p_ li I'I na i Y.t mere
�Bm put I I m C 9 th 'ppl If Ip a t1 signed statement - - - - -
. tenth licensed issuance,
a Ih .......nn fd Contractors L n Ln Coe) S Ft Floor Area 'Valuatio i
(commencingwith pt the Section 7000) rhe 3 fit 0 . dProfessions Cnle7 _ q•- v
ar fluat Sputum 70311 by a I and onfor lr 'f thenen- pl .Ay Ffn :-. .i ,. .•
'If notmn]Oinfive Ydred I[ "'tell euhledstheapplicantI nil p'o'ny. - _
nr not note Ina,five hundred dollars($son): .•�APN'Number - Occupancy Type
°kas r:rrthe properly,"elny camployces wen waocs a,meb sole varepeasnaon, , 31E23Qti31.. 0[Zr , _will do the work and the stFar --
le NaThe is not intended a en a Law
.ale rsea.'ru44. .. -
'
Business and Professions Code:The Con¢ucmr's License Law Jnuv not apply mon "
npr Re tared •S '
of emptily Whole Irisl r'improves at suctandwhor amen wmkhed or e ��AL
30'4 — ' ROUGH EL �,
ova"
rangh his own however,
that such impm t is sols ore hal intended or r -
cfreredPon,thesnlo nt building mpr0,en.nt... a e id areyeareta 501. — FINAL ELECT.RICRL ENERGY
completion,forIheo orb"IJ will rosette hnrdet of provto Ilia he JJ nal bn'IAo "
prove far u cofrl ' —
a c..
%npra prp� ) ''505 'FINAL ELECTRICAL.
°Ins avamer ofth p-Pty at c toxo th lensed wnvnctn tn' u ' "�
corselet the p ject(Sec 7044,Business and Professions Crile)The Ctmlracnv's
, _ I e
Lancind Lots d :mannIlly l a fp Pny whohuld improve,
e
;aid 1 ner ( h ] IlltcsI dP hh
Goml I ':Li W
Iorder Sec.' pyPCf thsm
- ..
'
..
-
Ow - Date
WORKER'S COMPENSATION DECLARAI ION -
Iharchy,firm under penalty of perjury one of the fall gdmlermiota:
7IF d 'll 'mon C fl cn fC en to I[ f Wok
Qn p :fon, as pro Jed for by Section 3700 of the 1'nor Cale„for the". .
parmare ate of the work for wmi
hich this pert is ie,owV- ,I _ - - _
rr °IIG,ve and"will mountain Worker's Compensation Insurance,r,,�ipuidlhY Section
3700 of flatterer Code,for the performa tae ol"the work for wh ch this permit is
ssoed.My Worker's Cofnpensmion Insurance ednicland Policy number are:
PolicyNo, '-
(EW FIFICATIONOFEXEMI'I'ION FROM WORKERS' . . '
" • COMPENSATION INSURANCE 1 _
(This nal 'erA not it thep mil is I"Drone handraddellan,
IS IDD rr leo
I C06'
nee of tforxheh lh'p t ' .uedl'halln ty me ys to h ublou m the Wnrkc S'o d C mm'st fF pl y .h IJ•k C t p I I. I h I b C d y Z on',amtch Pr ons o IM1u pepart shall M1e deemed...akeh
4 CONSTRUCTION LLNDINGAGENCY
aiIb reby ff mlh nh vu li II Fno tbencyf Ihe perfnmu me -
Mlhe kf hchth p ntts's'veJ(See 30970v.C) _
.: Q Lend :....
b z Lend Address il
0c
Vwy 1 certify that l lwe eJ tLapplicirion mal,ml,but(he'I t tions
W pry ,correct,1 count,t comply with all city and otomy ordinances and state lows rclulino -
Qf,) 'tu building wnstructime and hereby authorize representatives of his city to enter upon '
the oh menu neap <N tyro,'on,actima P T e' - - - ,
•� y (W)agree t onve.'Id nn'fY adkeep In theCry fC pen gist r _ -
l4 linhmnes)udgmmn I J pens h myb my-w y' go'nsl said
V z -Cityneoasey,mm (he emir.; perms. - -
OPLIC LARSTSND 1 PLV WITH ALL NON-POINT, ,Issued by: a - Date
AP
i
a(. of Ap ie nntrn' ,.Dnlcy a Re-COOPS
HAP OUS MATERIAI S DISCLOSURC 4 '� - 1•
Will heapplcat f t e,halding c p t t ,h mel ,nd smatedal TYPe of Roof
is defined by the Capers" Municipal Cod Chapter!)12,a d Ih He'Ilh and S tray: � v ,
• Code Seen.,25A2(a).
°Y °N - All roots shall be inspected prior to any roofing material being installed.
Wdlr a pl" t rf l r h 'IJ' ooccupvril um rqu'pl nl 1 :'hien "
pp If a roof is installed wi[hoiit first obtaining an inspection, I agree toremove
emith Nus nlru,mnnn nts a>,AeC ted by the Boy ArwAir Ql Quality Manugemem i g p g 5 ..
District" " all new.materials for inspection, Applicant'undersfands and will comply with ,
-. °Yes' r "❑No all non-point soui�ce regulations',
n
,I In,, nl th 1 r 'm' q ls 1 Ch1, 695 of the -
C It H ho b @ Sar ly code 5 I nor 25533and 25534.1 muirrs6id that, - '
if 1]at bIdot) ' of Ily hove, Int" my :p ll'ryt IfY the ' •, -
enpnnl of Ihe ref me uv wine o net Pc ono ssuence of a Cen'femo Of i f-
oscpp, a
Signature of Applicant Date.
O rOraal elft " aDate All roof2coverings to be Class."B" or better
a'
c OFFICE