00090014. . It, .
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CITY OFCUPERTINO• ..
BUILDING DIVISION' PERMIT'
CONTRACT,qqy1WTJ4,%LIc
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WORKS
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BUH.DINO ADDRESS : � -
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PERMIT NO
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OWNER'S NAME:'.' '
PPLICATION SUIT DATE
21604 CASTI ETON SI':.
--0009001,4
PHONE:
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'SAN] I ARY NO.. ,CONTROL NOO
.PITT BILBERT W AND 5ANDgA
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- ARCHITECDENGINEER:
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, j BUILDING PER M IT O
BLDG" ELECT PLU MF.CIi
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I.ICF.NShDCONrRACIOkSDECLARATION
- Job Description'- -
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ph I'" d 1 1 fCh - (conn,
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7yalhrmltrti
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in full forceand efect on3oflr,c Business road Pmfweioms Cbid,,amd nyllcomsc
Section is
m full force and effect.
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ARCHITECTS DECLARATION .
I 1 dl he 'ecbi,ds
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,rand mY plan,sb used pbl'
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EXTENSION OF•C,AS•LINE FROM INSIDE HOU
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a fies,imal
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- OWN- ER EUILOCR DFCI ARATION
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1 hereby ft tan escort, boom he Contractor's Licer,a Law 1 II,'
'ngrea.
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. roll n (S Y 70315,Basne dP t .' .Coo As iq rc ty'
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wb h n: a permit to construct.ft p demolish. or rep U
any I aare
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.,n
al
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'fire'. tissuance, I' .dapplicantf Ip 'u Ile 6 dstatement-•�
Sq. Ft: Floor Area
Valuation
but he is licensedp II thepowrion, ofn Ctramicam, License L (chapl 9
(conmnengwith Section 70flopuflY, son 3ofthe Btsnea and Prole,4on, Code)
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or that be I. exempt theneftion and the reek far Ih alleped opent,xion. Any violation
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ofSection 703e5bYany applicantf a proolit. bjects the applecantl ei,lponalty
-of net ,tare mat five hundred delta,, Who),,APN
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Number
Occupancy Type .'
11 R., owner birth, pmpeny, fir my employees w lir, wages as lbeireolocmnpensalirs,
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ill do h k d tire . tracer, is not intended or offered let cd,(See 7044
Business tried Profession, Code: Tn C t t Live r Lew des not "pply to an
- Required Inspections ,
water of p,.,,ny Wh lila, run,voce, theopen, and It. does inch workh n.,elf
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nrtl gtrl-. :.
ply p that h' t P me I intended at
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3562
Repel for st le. If ho a cr the hu Id'ng p.... cont Ascher 'ihl ,fie y f
s,
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mnple(om the owmibolder will have the burden ofpriivthat he minor buildor•
yl',
1.ng
hop r p p: r I )
❑la portion,ame IY contracting thI Ti ,bit ,
, ... SEWER & 'WAT
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ort nh p tht(Sea4 R" Aj l .. dtCde)Tn Contractor's
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P02 DERFI' ",.PLLIMBIN6 "
.License Lev, does 'I PIfp ny h holdimprovesn
and h des: f such projects wed mraemgs) I c 1 p t the
3�D 1- RO `UMB L NG
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Doll tor's, �t anal s w I ` E&Pc fee his reason
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— 'FInNAL ""nLUMBIN-m
Dale
WOR RSCOMPFNSATION ULCLARAIIONr
NFROY�� .A
AS TEST `P
I hereby affinto orderp -hyrl j y of followin,a t
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" 5417''— FINAL PLUMBI1110,
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❑ 1 have and will n Inaln a Cenifncutc tf Consent m mlf insuro I'n, Wn ke"s
Compdnsmiou„as provided for by Section 3700 of he Labor Code, far the
perf *none, of the work for which this punt, is issued.
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❑ 1 hove and will maintain Werker's Cau, ensatinn Insurancb, m retpiired by Sveunn
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3700 of the Labor Code, far the prd...... fire of the work for which ti t, permit it
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issued. My Worker's Cmnpensation Insurance carrier and Policy roamer m6:
Ovni,r - - Policy Na,:
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m CERTIFICATION OF EXEMPriON FROM WORKERS'
"'COMpENSATIONINSURANCF.
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(Th' e u m fie J h `nnpletcd "1 0 p m is tar fine hu ulretl dollars
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1 omady but in the pear1.,umr,e of the work for which df, pori, is issued. it
shall n t empl Y any p Y r s as to heroine object to the Work...
mpens n'tn Laws bifC lfori a. Dm,mc_
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Appl
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NOTICE TOAPPI.TCAsHE If, ti k' gth, Certificate rfE om ,a'hbiuld
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theta k Compensation provisions offlLabor Code. 'yu nus,
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�phecsubjecto
'fanl ih comply will, p h,c amth pori, hall bel drevoked'
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"'-r, CONSTRUCTION LENDING AGENCY
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I hereby alivm runthere 7met on leading agency fur the performance
'nfthe
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work for which his pacron, tsissued (See 31199 Cie. C)
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Lender's Name "'
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Lend AJdre.'
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1 ,mfY 1mIl have "d this ap,Ecelfii4i .,ad state that (he ab e'information a
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correct. lagree to comply withall city and county indocances aird'state laws reling
1. booldal, ran,, tion. andb hyo,h p tf'' 1 this nt to almoner
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too ah enten .... fed p pn5fr inspection p p .
'd "lymdk
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(We) agree t_sa m
pl l theCny fCpr Kmtnst
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-liab l t m: I dgmec t N'expenses which may it'any way o eme ago nbl sand
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City in cim,ocarrac,of the 6 rom. n this crm t
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APPL L' ONDEI STANDSA tlD H OMPLY WITH ALL NON -POINT
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Issued by: Du[e
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-Signal re rAppheaul/CQmtrau Date -
Re -roofs .. s -• -
IIAZARU MATERIALS DISCLOSURE
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Will �h pplicnm fLure lig so,,rat store or handle h>a nmer'al
darned
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Type Of OOf P
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as by the Cupelnr Mun'c'palCode Chapter 9.1.2, and the Health and Safety
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Coe s ion 25531(.)?.
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All roofs be inspected.prior being
Will lh pleat ft I Idia,ea pm .4a� t il: wlih
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shall to any roofing "material installed.
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If- roof is installed without first obtainm an ins echon,:I'a Tee to remove
g p g
m II 1 o_m I u'd hoed by ,h ByA enA Q IryMnage I'
all new materials for inspection.. Applicant understands and wlll'comply within ]
'F„t
a 11ye, El No -
all non-poinbsource,reguNtions,
1 have peed the hmnrdous If napolclmmets under Chapter 6.95 ci; the
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Califemi.Health&Safety Cede;Seations25505.25533und25534. I understand that.
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ifthe hddi,haen.t carentlyhave a sboant,thatinmY responsibility t amity [he
occupant of the ao,mreme ns which tn of be met prior to Issuance of a Certificate of
t
Oecupamcy
Signature of Applicant " "
Dateelue,
- All roof covering's to be Clas sk Be` or better - -
or tmbirieed agent - - 'Data
• .. OFFICE., "