00060178 h' CITYtO CUPFRTINO
LIFDENPggRMIT1 C0NTRA�11L01*ANhVJPA*A91& INC ." 00'060178•'
BUILDINGADDRESS: i - .qe PERMIT NO.p -
MULVEY' GERALD: J' AND. KATH R'I_IVE'' '"6Er1w SINCLRIR' FRONT GE RD06/26/2000. '
n OWNEIR'SNAME: �• r }„ APPLICATION SUB DATE- • - '
a (408)934-8844
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PHONE: - in - SANITARY NO CONTROL NO.
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nO aO Z0 ARCIII'IECDENGINEER 4 • BUILDING PERMIT INFO
Uy.0 NLDC' LI.EC F. +.PLUMB 'M11-CH
m 6 y ' DECLARATION AC LIN I T
°N Job'Descrlpiion h' ^,
Z S m Z LICLNShO CON] FOR'S
O4 t: Ih b B' shot 1 d 1 of Ie 9(mnmeneng. -
F,�F..{�i w'ehS t 71HIOl fD 9nf the Bu' Il rofess Ce nenyl ecnse « I
¢c Ia s' f llfrd,and oRca �.
a s ¢ License Class L N - '«f +
�3wm Data c t' Ir , j..
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ARCHITECT 5 DECLARATION as_
Cg o I naemmrd nY plansnhall bed std p bl c dcnNs t•.
gor�ad
alao0 LicensedP I .:' I -
S OWNFk BUILDER DFCLARATION
ir1 I he ny ff
hot I pr t , he Cmumn,on'silLiamed Law,Could
-
L ' following .(S a 71YSISB anlP fie' Cd Ay ly ry
F� which reclairesi a PermittoIcl after,implore,chandish,or repairany f I p. a h '•
. pro t t Lo 91 to ppfc tl hrc a II asigned statement - r ' " $3261f
that to tt a p : n rm c t t L Ln (cit pt 9 S Ft. Floor Arel
(co ,enangwdiSecfo,7000)Li Davis nlofine Besot nd Professions Code) _ Q•' V31DaUOn
or that he Is exempt therefor and me basis far the alleged exemption An3693,9C
P ,6 P Ys'LlcYo- :«
of
Seenumte03nfive ydred f R t: Ijmarnc vppRvm n,u c,Ips why • `
ar net more man five)hundred aLlwrn(ssoo) :5• APN Number t' :'S Occupancy Type
„ ,.
❑I ftnp pdy Y ply drag ad I ° I noon; HQN ,
CA
still d m dm trot _ not intended r offeredforarray no 304' `r, R01 1i4�
Bn allP f, C Ih Contractor',L 1 d - t 1 to an tLhc YR�L ;4
°w fproperty Wh h Id P d ad h d h klnisell �T-�"f.
rm soh ply .p ton t. 1 ' p e: t e Ice or 505 - FI�IRL. ELECTRICAL ' . .
rfCe d for sale,If,h el b IJ'ng P t Id d year of Y
o. PI. to Ila wnhavethboost ea oftheir,d ehedid6Lthaldor 508 — FINAL. MECHANICAL .
improvef purposo Li:I )
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❑I av(avran(if the pvpiaaty am exclusively contracting withlicensed mrti�Ulu,to "
oImushom,the pralece(Sao 71,14.Business and Profess ons Cuda The Contra mr's
'License Law does not apply m an owner of ph upeny who builds or improves thereon, -
and who contracts lot h project,with _ tmctor(s)licensed pun ent to the
Characters Llama,Can, I
'❑to on exempt unde,S - - B C in,mis reason
Owner Data
:- WORKER SCOMPENSATION UI CLARAfION
' Ih by Bt e I pe IeY.fp 15 I fm III gd I i ���� uv
if^01 h J 111 Ban, C e l me fGarlands 'par W o k a'
Camp :t p idrd r by t 9 3S 700 L f the Labor Gxle forthe
peH a nn LI whichm, Perot, e 111 have a will hou k C p t I :u c t aby5 ci
3700 of the Labor Code.Fin the performance of the work for witch this per nil's
_issued.My Workers Com,himativan Insurance tamer and Policy number are
Carrmr a 1 PopcyNo. - it
-CERTIFICATION OF EXEMPTION FROM WORKERS {
COMPENSATION INSURANCE d o r
(fl t eeJ nal he c,mpleeul'1 0 1 nil n h r one hu,dred dr Ilan a.� Y�
" (S I 0g)or tear).
I comfy that In the performareo or the work for Wimall th Enema is's.0 cd;1
shall not employ any perm in any manner.,n asto became subject to the Workers' - '
G,mpumadian Laws of Cellfondo.Dam
Applicant - V
NOTICE TO APPI ICANI If h 'saki ngeh is Certificate ofExemption,y oilshould _ j . '• ,
Z benne 'ti bj theta k C .pet p ,at th Lb Cd Y_ to _ r
fortivim comply wlM1 Ipmolilinallnrm Prne shall residue it revoked.
is
F y CONSTRUCTION 1 FNDING AGENCY I -
a,, 1 he shy wTnm tl t there is a conalmation kaa'ng agent,for the perfor nonce -
.w
or the workf I'ch this pane is assiall(Sec.3897,Civ.C)z -
.G Lcnd N
t7 z Lend Address . 0 - _ •
V 1 verify that h" dth'.appp'-f and state that the above f d s
LL Ey torr at I agree to ply with all city and county modirmusis and state I - tai g
- C V .to buildingcnstruc(on,and hereby author 1 enlnlives,l the city to eperi pan • «
�; ry the shave-mendonee properly forieipenion purposes.
(W)agree esave,indemnify andkeep tr rh[cx:the City ofCopenint,against
r V] Cityi j dg Ince:' e d gp s h h my nary y accone against id l - , • e•"
V 71
City i ro,mc consequence of thegradin en es wpermit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT �/;
SOURCE REGULATIONS ISSUed by: pate _ '�---VV�-�((VIIV
Sign I m of ApplicnnbConmacmr -
Data , Re-roofs -'
s' HAZARDOUS MATERIALS DISCLOSURE x . - W
VIII d applicantfurore building or furobu ld podstoreLr h dl I b :m t `I Type of Roof,"' '1 - «•
ar defined by the Cupertino Nuntp,I Code,Ch pt J.12 and the Health afety laid Sol I -
Cod Section 255320
❑Y ON r '
All roofg shall'be inspected prior to.any roofing material being installed:'
Will to ppf t rmm n w s porn h,r egatp e d n h If a roof is installed without first obtaining an inspection, I agree to remove "
cn,itlar tin,am vionantinsirs a,defined by do,Bay A.Air Quolty Man"croun_
'Dior, all new materials"for inspection. Applicant understands and will coin I with
Cl Yr, °N allnon,poin[rsour'ce'reglations pp py'
is
I have d the hazardous materials requirements a Ch pt r 695 f the
�'hu a Dealt&Safe,,en de a t 255115 t it
d 25534 ],understand that ' - •"- - `
r
occupant o' gl a currentlyhavetenant,mtT yep of
tC Yfyme
occupant of the requirements which munM1 rpilot to usuasa afo Ceri banns . .a
' Occupancy. y - - •
- _ Signature of Applicant - Date
Owner infludiwal ogwt _ -ri Date ' i All roof coverings to be Class "B"or better.;
., OFFICE .f-