01040075z
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r 'TY OF CUPERTINO
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CONTRACTOR INFORMATION
utvtslON PERMIT
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BUILDING ADDRESS:
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kJOITT NO. k '°•
AV
PETERSEN—DEAN INC
01040075'
OWNER'S, NAME:
APPLICATION SOB DATE • ',
980 .ENfERPRISE::
R 04/`1'6/2001 -
IONE:
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SANITARY NO. CONTROL NO. ^
94-9982
ARCIII'rEC'fIENGINEER: "
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,•,, I _LDING PERMIT INFO'
A ELECT PLUMBMECH ,
LICENSED CONTRACTOR'S DECLARATIONn
.. Job Description '
rhercny alBmnet m 1 a.t Bceneed ander movie..., ofChapter 9 (an„Ioeneing
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wire Section 7000) of 3arme rnanegq lrnd rmrc.gn,nq coca, ann lay Rcenee
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SHAKE TO JILE.
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Dat r i —
se
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sI understand my does hall bawd spbl'c oc n
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Lim_nsed Pmresocial
DECLARATION
OWNE,a
1 hereby u(Sect lune I am ,neem from the Cnnwe TeAd, Law
ciocrai f
ti for the
following mama. (Section ]onstra Business and Co
ions code: Any elty or county
y
Istrsnperm"b improve, d
to Frove,h""bt
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1 fie a o,any dleaccre
alletrud,alter,
,aur In its tolienseLow Ramose
priertoireestelanmyaime mevPFliwof
Sq. Ft. Floor Area.
.. Valuation.
amara :licensed p theConractor
provisions onhn celiusioe L Charterolo
n 0 3 ire Bmoc I r::'onslll
fn,
ba
1 or Ill., to I n i: �,ernm m r d En, basis r d auLgm c pt nor vlelaearn
orI eveiu the om,
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••.$11.840 ., .
or Section 7031.5 by any applicant for a neribir subjects the appbeant to a civil penalty
ornotm,mIhanrrahpnareddol1...19500). -
- „-APNNumber
'Occupancy Type.
El 1. as owner of the pi ,tiny 'a"111,111 war we, is as the I II'll cmmrrnsatinn,
31-16 4MIA
' a Required Inspections. -
me smmre i, nod intended or affemd for sale (See 7044.
will do the work, trod mom
Business and Professions Code: The Contractor's License Law does not r,dy to ;in
awall or property Who builds or improves thereon, and who does such work himulf
rm gh n own employees. provided but Such hapoweloolds life not intended or
' 305 — FRAME
offered f If, however,the building orimprovement i' Id m' one year of
'tompll the wnefnBir will have the burden orpm.inbthe( 'he gid notbuild (it
<
- ;in 307:— INSULATION -
improve far p n . f eal )
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601 — ROOF TEAR OFF
Ins
us IIIaa n tr m 1: Iv f gu,r d . tLYITIo
n t act me pr lit sbc. 7144, Business laie P ac o n, Cwe) The Contractor',
602 — ROOF PLYWOOD NAIL,
Lie 1 des not pp) t conic t property who ba d. improves theon,
and ares forphrases whntors) licensed natural to the
603• — ROOF BATTENS. ,t .
Conb'actot, License Law.
El l an exempt andei Sed , B$ P C for fle,a,vom
- 604 — ROOF IN—PROGRESS
]).it
Owner ]).its
WORKER'S COP
M1IION DCCLARATI(lN
Ih nY affirin- under penalty f perjonYone orth pal low lag declarations:
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I base and will maintain a Cnlcae l Conevert Ila' for Worker's
0-arpor,olunt,
a. provided f r by Section 3700 It file Lab r Code, 11), the
rfthe via kfor h h this permit: issued..Is
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�perintareare
pelt d 'll it W k :C p i Insurance_ q' dny5 fm
Tro f the Labor Code, for the performance f the k for 1 this I rant In
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i"andMy Tarlor.sC ponearima Insurance carrierand Policy arculder
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par�¢
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Carr cr Policy N I'[.O ✓
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CERTIFICAI'ION,OF EXEMPTION FROM WORKL'RS�'
Y.
COMPENSATION INSURANCE.
frhis,ectien need nal he anmdeGl l the domit is far one hundred dollars
(SI(10) a le".)
1 certify that In the performance of the work for which this permit is is,uel, 1
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quill not employ any poison in any manner so as to become subject in the,Wnrkers'
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Compensation Laws of Coeifuraia. Data
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Applicmnt
NOIICEIOAPPLICANI If, ft k bih' C Yt t fL pi y should
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. nummn subject to tile Welker : C 1 t p : fth Labor 'C y nn
roithwim ci..ply w Ih 1 ova, ons or t s permit shall be tl erred mvokad
CONSTRUCTION LENDING AGENCY
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I hereby affi m thin mere is it contraction lending agency for the performance
of the work for which this permit i, issued (Sec. 3097, Civ: C.)
landnr:q Name
- - -
Lender'sAddress
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Il certify that lea J lh''PPlieu nnd t le lh uh h 'nf ml'
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corms I agree In GrmPly ire 1JI Lity an I trey .... I nonce '[are laws adding
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rah Id g' t- I dh by Ih p td' ftl ischymention upon
thelbt d propianyf .ped purposes.
(WOagria, to save. acienteryandkeep l dis,teC'ry offmIsmanc, against
liabilities, judgments, camad expenses which may in any wry action' against said
. Ciry n consequence cribsgrading afthpermit
APPLICANTUNDFRST NDWIILCMPLY WITH ALL Np POINT
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SOURCE ATIO ,1�/kr
Issued by: Date.
Y
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Signor rc of ApplfAppli cnnUConwcYDate� YI
Re -roofs -
HAZARD US MATERIALS DISCLOSURE --
Will frappreenlnrfumreba1dm,,r,,ulwnl smearhandlc hnzmdous material
t
TypeofROof '
as defined by ths cupenino Municipal Cade. Chua¢a9.12, and the Health mud Safety
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Code, Section 25532(a)'I
Elves. ErN
All roofs shall be inspected -prior to any'•roo5ng material being' installed.
Will he me ii,iicant or Fare .Inalbag oa,h,am use e,hipro m or to, cal ishall
If a roof is insialled without first obtaining an inspection, I -agree to rerrj
emmL,it hwarolnos air contumiarm, us normal ny the Bay Arca Am Quelidy Mlmage cord
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allenew materials for inspection. Applicant understands and will'comply with
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all'non.point source regulations,
I have mail (In, humnal, on,rumnmak muder'Ch.,god fi 95 if the-
C.I'f Health & Salary C le Section, 25505 25531 12504 1d : t d that
ifth building d snot rt lyh. arecord, tilttt y p lltyt nbfyth
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cc pat of he re, uidI which nust,b I pi lears7c f fen fc t f
Oce
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Signature ofApplt ant -•t Date
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- - All roof coverings to be Classt"B'• or better ..
,awn roraathed agent qa,n
CFFICEL
c11Y yr'LUMRVINUI
BUILDING DIVISION PERMIT
--
'CONTRACTOR,;INFORMATIONi'.
BUILDING ADDRESS:
-
PERMIT NO.
OwNER'S NAME: _ . _� . .. , .,
_ _
H. . ., �. • , .
APPLICATION SUB DDA
iDNF: '. .'
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.ANITARY NO. ' - C NTROI]N -.I
ARCHITECT/ENGINEER: PHONE#
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[NSPf;CT10N5 - .DATE , LNSPEC.
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LDMG PERMIT INFO
D ELECT PLUMB MECH
TO ARRANGE I 'SPEC -HON JOB DESCRIPTION
CALL 777-3228 M0' Y-FPID.AV?q HOUR P/er4y t f ice'""
BEFORE REQUIR NSPECTION. JOB ADDR' eLeaVe P "' KITCHEN REMODEL
AND PERMIT ARE NEEDED WHEN PHONI' V0,,r er,�If P - I .'"^' =RE -PIPE
RFSIDENTI COMMERCIAL _ OTHE I' - �1 �.vOnf��Or & �SO aB jp'
s
HA7ARDOLSFIRL AREA ' '�.#.
V +4SnI-_ S
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CI YES If yes- I understand that a Class A Saf assemL'bly is required. "' 'Aa. '
ID OTHER
❑ NO Initial I.C.B.O.
i FOUNDATION/PIERS/H.D.S.
UFER GROUND
Q PAD/SFT BACK -CERT
y GARAGE SLABS/PREGUNITE
a
'POUR NO CONCRATL+ UNTIL ABOVE HAS DEENiSIGNLID• ' "1'
UNDERGROUND/SLAB
H PLUMBING
}
'c ELECTRICAL
�3_ DO NOTPOUR FLOOR 1L ABOVE HAS BEEN SIGNED
EXISTING ROOF rOV RING
Number of existing coverings
To be removed To be retained
OMM R IA
❑ NEW BLDG/ADDITION ❑ DEMOLITION
❑ TENANT ❑ FOODSERVICE
IMPROVEMENT
❑ OTHER
PLUMBING
MECHANICAL,
ELECTRICAL
FRAMING VENTS
INSULATION
'.PL'ACF NO SIi REL(NJR UNITI. ABOVH HAS BEEN SIGNED ..
'rYPE OF ROOF COVERING
EXISTIN .- PROPOSED-
❑ Built -Up Roof ❑ Built -Up Roof
❑ Asphalt Shingles ❑ Asphalt Shingles
es ❑ Wood Shakes
Wow? Shingles ❑ Wood Shingles
❑Other (Specify) Cher (Specify)
Provide LC. R.O. Report No.
Provide Mfgr. Installation SPacs.
ROOF SHEATWDIAPHRAM
PLUMBING)Y
TARS'&SHOWER PAN
MECHANICAL
ELECTRICAL/POOL BOND
FRA511NC/STAIRNITI EGRESS
S ULATIONiVENTILATION
OVFR'NOWOR* UNTILABOVE HAS BEEN SIGNED
EXTERIAL SHEAR/HOLD, DOWN
INTERIOR SHEAR/HOLD DOWN
SIIEF,TROCK/SHEETROCK SHEAR
INSPECTION' SPECIAL, INSPECTION REQUIRED C
DATE
INSP
EXTERIOR LATHM'-SCREED
SI (OWER LATH
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NO 1APF, OR' PLASTHR UNTIL: ABOVE HAS 11EEN SIGNED
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SCRA1 CH COAT
SEWER/WATER
1 C - '� �L"C'
TEMPORARY APPROVALS
OCCUPANCY
S
N
PLANNING 777-3308
GAS TEST
GRADE(P.W. 777-3354)
FIRE
HANDICAP
ELEC TRICAL.
PLUNIBING
MECHANICAL
ENER 'l"
VISUAL FINAL ONLY
BUILUING
OCCUPANCY OF BUILDING IS NOT PEIaurrF.D
UFTE, BUILDING FINAI, IS SIGNED BY BUILDING
INSPECtT)R.
CERTIFICATE OF OCCUPANCY ❑
."...". ._"'..,... PLYWOOD: IN -PROGRESS 4>1
INSP,_-.--.-.— DATF INSP 1\., DATE DAY fNSP. i7/!/
'PEAR O' SP[CTION: BATTENS: Fl �{� 'E�1�j�
INSP DATF. �i "OF INSP._
DATEFA
N TE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
oval irAM-M onaTlNr. rnov .00e'Z- �A