01030148 CITYOFCUPERTINO a �t':< ' `• "**y a an °'* $ '
• BUILDING DIVISION �PERMIT
CONTRACTOR'INFORMA'�IONr
BURENGADDRESS: _ _ , - 1' _ • ' PERMIT NO.
7731 .CARRIAGE CL , 01030148.
OWNER'S NAME:" APPLICATION SUR DATE
JOHNSON. HAROLD,,W''AND Bf iRBARA Eb,L I.— - 03127/200].
SANITARY/NO, CON'IROLNOL-
0 ARCHITECT/ENGINEER: t• - BUILDING PERMIT INFO'
�0 - '
a C BLDG ELECT` PLUMB 'MECH•
Z LICENSED CON IRACTOR S DECLARATION 1
z S N p-p ' In ereny,rrrm to I E d e l 'chain' 9 I' s �; Job Description
F��ry with Sacarn911001nrD vi,ln9of the Bu .ane ProRssin.Coee;andnyl' en. .
'1 Is m r II barren
effect.
.< Lie : CE � Ls.0 - � � .`„ADD IT-I.ON- OF FAMILY. &-MASTERt.BEDR00M
OR” Date - Contractor - Ic • 'Y
WWWaW ARCOTHCrSDECLARATION ENCLOSURE OF FROh1T F'ORCH.
°—'O 4 I understand iny drAs:hall be usisda,public etoms '
is Licensed Poufts,ional 17VALEG ' s. P _ ..
es OWNER BUIL DLR DFCLARA11ON Y-
on 1 hereby offirrin that I ain exturelps front the Contractor's Liceasc Low for the 1 - ;
�P follx' 6 reason.(Section 70115 R res, adProfession,Code An, ity or courp,y1 �L( '/P J p Lq���
SO h l 1 Proud,I.'and"'l,"I' P di:h P a . count Gly U
d3 Punin do it, I 9 'the applicant f,,aach,,nrit toor E a signed deterrent
but he licensed p t t It r f due c t t Liecow,L (Clu,oh,9 S Ft. Floor Area -Valuation .
(n g thset 7000) fD 3 of tire B IP dslid Cdel �� - q'
,rchat h 'S i Inb , and th h go h alleged pt slid
ImranL6 ING
.•. - - _
ofSection 70315byany applicantf a perinit. bjcts their, noacv!p rdly.
o'not d nfive hand rw dollar,N500 . , - PN Number - _ Occupappybno
El It,ad be y plyecswith ed or offered
v mmb h '• ,;
" w'll I thek d IM1 Code:
t E intended d n rat r - 7o an - -
�; ' Bin I e f:.'r C d Th Contractor's L' L es I apply to a t , C d Ins pec- M, '
3�90G04�G�1¢� P ,•
owncr of property en l esslds P- d ah d who does each wink h or ; ;
rrt through sale,
ply provided that h p 1 , E tintended -
fR I f .If,we 1 d holding' P t Id 11 of Yee f
rlt the w rl II 'lila theharden fI gth,hed'Inth 'IJ r ^ 1.01 — FOUNDATION—,:
l P: Isll
]IC — PIERS
w
of the P ecIY m l :' lycontractingie with licensed E aram 103 'LIFER _
int taw!he j E(r 9toa B . ade 'e, :ild )o c Imcrora - ^
LIC E e l - r pall wn I r,(,Perry h Id imp a th reot a - E
and h Tincts for:,all Projects with vmum(e)1' d pnrsu int m Iha 1'041 '— REBAR .
Cnmmdrn',Lscnsc Law, t - t
❑Iaa,eser", ,it B k.PC fe,the rersas 105.'— ANCHOR BOLTS �-
owran bate `�G Lod ' ]0G SEWERL8. WATER
WORKER'S MPF.NSATIO 8- AR TION - '
X02 _ UNDERFLOOR 'PLUMBING
1n hereby n do n I r la ren bd i t_ _ cos. — UNDERFLOOR 'MFCHAN.ICAL
Alla '1 'II t CeiNal fC Consent Ithh of Workers
"
crit p r . p d d r br s t 390a f n Lal ,n Cede .f the c'04 ^^'UINDERF'lL'DOR:°F-RAMS '`+`.
if ace,nfilewnkr wilehlbs.emtrsssued 205 — UNDERFLOOR INSULATION` ' .
on - d Ii mit or k a,mp 1 . - q ' dos den 301; — 'ROUGH;'-PLUMB-I-IVGt, '
39111 'tie L'llcour f Oto'-1 turn rice of the work lot whim this by
i is , ,
mace.Mywedcr,cof,,nearnn]a...Lacccubic, adPohcynumberLt . 302 — TUB. & OR-.SHOWER
c Rier: : r P : � - -- ROUGH:.'MECHANrI CAL--
. -CERTIFICATION OF EXEMPTION Psey No:
303'
FROM WORKERS' _
' COMPENSATION INSURANCE s04'' — ROUGH ELECTRICAL
(Thi:.rdi ineed anbecmnplebulirthe peimitisbar ace induceddoe°r" 305 —' FRAME
'AFX!) I .f - y r
I acuity than mm,dparlocalof the work for which this return ssued,l' ,316 — HOLDOWNS ' y
shelf not a nhmy any person r a: account,subject to the worker; -
Cnpcn r i,aws ofC1'f nh Date- - 307 — INSULATLOIV;
Appl t
'
,,08 -� SHEETROCEfr,
NOTICE TO APPLICANT if,afterkng this Certificate of Excuption,you should It
beelinev reth Workers C 1p t a provisions il 1h frC dm
e.yourst
`Orani dmonnfywth hp - ..userEnsmintshallbeg nd ltee 309-"—: EXtTE'R'IOR`l LATH':-.e- .
Z 310 — INTERIOR LATH
CONSTRUCTION LENDING AGENCY' -
'H o ray 0 ,Eh ul a rat ed.307 Ce.C,) for the peaforna se .
a � nrineworkrn.wnch,is � . 3.1,1'. -' SCRATCH-.COAT::,
p nr't'a',nr ed(Scc i0Y9 Cie.C)
yqTender',Nate + : ,, 31,3' — ROOF" NAIL
Z Lend r.Address • r. ,.f„ e- ., 9."
501.-
correct.
0 is -FINAL ELECTRICAL"ENERGY
UO 1 rafy ill.,l b� dth: lf, f ] ordehuh 1 � fnunot'., r
c. F correct Iag t rly with a iy. ecountyp l int Ia la,g 502 — FINAL 'PLUMBING ENERGY
Q (� lobaldb :I i Ih by 0 p tl rinn�ty to Later .. ' t
tire ul n Ip Pnyl :P r prr ': - _ - - 903 ' F'I'NAL- MECHAN.ICAL'ENERGY
Rwi
(We)agreet - d 'pe dkeEn Its, lot tryst tRtagainst 504' — FINAL BUILDING E'NERG (/
VJ liabilities,1dg r E d le ymany ayaCrueo. . g d -
VZP,AMICAN't
:9�cnca dEh bvm ng of Thep rmu. t+n /�/l CF -RSTANDSAND WIL6COMPLY WITH AI.L NON-POINT ISSUed by\-I °` 5OS '— FINAL ELECT RIy `` :Zuic nrAPPIIc HAZARDOUSMATIiRIALS DISCLOSURE Dau Re-IOOfS P .507 '7 -FINAL,PLUMBING'
Will the'prheam future nodding o,cuprof store or handle hazardruic carecalhazard Type of Roof
asdet Ibyln caper M 'pa!Cee,Chapter9,l..IneiheueaRhandSafety S08 FINAL MECHANICAL•
ray ov 25532(a)? ❑stAll roofs shall be '509[ed FoINA n GRo DE t al bein� .
�tsfecE pprhq, y,cp_ I, g installed.
Will[tic'applicant f t building occupant e equ l t crest...which If a roof I6 installefl' Ont r5 O Int i! on 'I arnmee to remove
chtl cnnb ins dent by theBy Area Air QalityM agen n q
o,ln t ' all new materials foifkpectif I }ic Eld�':aO {i`dill comply with-
El
ees Ll No all non-point source regulations.
>' 1 _ a
'
I havS read&SM1 tl a Ira! I nent,;nd C.1 runb95 of oldithe -C�lif
ifit Idinthh&SafetyCaeave ons25505255s thy ocS5l4.I tnecrsmnJthin
if lM1cnuilding docs nil curtenay hweumbtenant,
ba, rtlunynespandibilirym,ficL,the -
, necupant nC Ne requirenuna�which mint be mq prion..issnunee ofa Ceaiaemo of '
Occupancy - ,
Signature of Applicant Date.' *
aumo.ivee ag t,. ?a, ' , Allroof coverings toIts
is
'be Class "B""or better "
OFFICE