00060017 � M
-CITY OF,.CUPERTINO."
BU p Is PRY, ,ERMI•T" . - CONTRACTOR INFORMATION:
BUILDING ADDRESS:r' ., . " J PERMIT NO.
* OWNER'S NAME: ' r - APPLICATI H
PHONE: SANITARY NO. CON'IHOI.NO.
>nrt eeZ ARCIIIECTIE.NGINEERr HUILIIINC PERMIT INTO
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LICENSED CONTRACTOR S DECLARA IION Job DOSch tion
os�� u,mnyalrr9mtl r 7 under, c1m -91 inn s ADDIT""ION P
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vol'se 1 7PONofD M1 dmeE IP f Cade.rod nyl » •.t
ce O DateC ntractor �,n
m L`, y ARCHITPCT'S UCCLARATION v .y
O I m,derswnJ nY pl ne shall he med..public records
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OWNER BUILDER DCCI(ARATION
al1, 1 hereby aft (hat I an, pl foi C t ti License 9Law lot the -
Z hollowing reason (Section 7031.5.Buscreawand Professions CcAAny city or county ,
5a' D
which requires it pering t6 construct, II p ded r h T ystructure .',. ," R;r
i 'n 1.us issuance,rkooka,cirk,the applicant fih he. twfilatOi,deddidearicid --'
that he k licensed Pur ,t (he n- rdic Courairork Libraise Ea (Chance 9. 'Sq. Ft.'Floor Area CS
(mmmencr,wth Section 7000)of Di anile itrthe Hiever,,and Note ss'oas Code)
or that he ix exempt thea rand and the basis for the all,cal exemption.Any violation,
ofSection 9031.5 by an,a,pliwadl far it pairaiiienniec,s the opplcaui t6 aev'I finally
of I lm than five h,hared danars($500). - jA r - - Occupancy Type
'El l..owran al'but Property,arny triple,at,with wayes a:then sole lara,edo,liai,
Will do tire work,and.the t...ation,is at intended an ofer6d f I (Sao 90W4 — -
Radius,, JP fira,cansCod Ific C i- t I Line Use"run rpp)yt a i 1 nspectlons `
rafPnPer,y Wil builds v m d n age 1 B work _ - – .1Q - — PIER .
. I ars,h gh Pulsated providadint. h' pact nal: en nodded r - -
off red for adIf,3 thebuilding p Id :Int ,an y f 103•- UFER
cn plpiln ❑ b ild will have the burden of Pod stn that rdnnbl ld r ,
at farparpase r: