001001281 1
CITY OF CUPERTINO 1
':
CONTRACTOR INFORMATION:
-
ItmLDING DIVISION " PERMIT :
4cQ
BUILDING "•
_ -'
PFRMII'NO'• J
/ADrDRE55'i _
2^#
•
•OWNF AME
-
APPLICA9'ION SUB DATE. '
^ '. �)"
DN, 'r." Y
°7
SANITARY NO. CONTROONO. "*
9 ?3. 9
�O
AZO
ACHITECT/ENGINEER:- -
y,- - BUILDING PERMIT PIT
.0
m ❑
.. BLDG ELECT PLUMP MECH ,-
JU
zy=
.I ICBNSEUCONI RAC FORS DECLARATION.'
., f•.' P
.Job Description v '
cz a
11 by darn inti 1 J-p rCnitd9(comm. g
,
F'3C�
"IIS t ]ODU)ID"' lithe n'. JI f:. I'CI ulmyl
lun
V -'F
o
D ucf eIC/ Cto I 'or
EJ 3 w f"
C O
ARCHI'fLC9 5 DECf.AR TION
•" 1' dI d be I sae 'c rctt,ras
W
o
y plan,shill put,]
p
c�o�
Lia d P fesi Doul
OWNER BUILDFRDFCI Aonarra
Ih M1y fl II 11' p f II C I �f �'oppose L fi Inc
-
fall 6 S f 7031.5, Bovine, d polo, f : Code. ' A Y City count,
- - _ ' •.
rc
�3—
p-il I'. I. rc4 theapplicantf hp 1111 'E dII m-
spoord tamer
S t.'Floor,Area
•'
Valu'ttlon
'
Innlh : ep u L p fN C I IFI L (Chpl 9
'.
(in y with Section 7000) t D i f the'B . d 1 f ', . Cade)
or[bar h arpnh f dthe 1 1 the alleged e pI AY'ltn
e �7
,
ofS I 901 by aly.tpplcanl foray t orithe appl anwle'v'I penny
molar elnefventlgrmnou...r$500) ••.
f. - "APN'Nurriber
- Occupancy Type:. ,
❑I ,caner of the propeoy;or my call w'dl writes as (fair itnpen:afon
e
- '
will 1 th k e th
be I I intended « d far Ic Ise bk
BI v andP Ie d apply to
I.'ll Contractor'sde n. Ire does Is&,7 n
i es an
Required' Inspections
own r i p P Wh b
a-
or Through h'x own
o ,p
y deal that i ' p I are nitintendedone
-
- -
offered fors tic If. ho then
however, p t sold within i year d
yr
- 1'
ave t n i
completiol, thiiwnir bullJer will have the burden ofproving that liedid nm bu'Ilor
- -
imp f P 1 f I ).
.. '
w.
fin P petty,1. ly t NI e I I r•
-.
- -
conruuIh project is 90]4 B JP f.: Case )IA.Contractor s
JIre c i
F-
' -
Lrn 1 d not apply t won nl I ml rrvex the n,
1 [ - `
_
a cc)nil}
Co h Lila: fn. such projects with o root-¢tnr(v) wised pursuer m Inc-
❑ 1 um exem I undo' Sec. B & P C for thin rexsnn
p
e'
_
1 . -
Owner �. Dates
.
WORKER S COMPENSATION DI CLARATION
In-byu d p'hr rpei> nn mw bd"r r°O
,
l
1 h d ''lloriental-'C rnNat f Consent to If f Water's
-
omp err, as provided f r. by Section 3900, of the Labor Code, for Inc
,.� - ,
perrLmaLe nr the work tin wmm� ILS pem,il .x iarn,e.
v .
J will no I" Weak,,', C p I E q 'red by Section
'-
3 fIh Lbo Cie 1rNe pert fd k'l rah ch N': pe- t
ixsu d M) W r Z t o Instant errler anI Pull/y I hepamp- I
+` �•. )'.
Carer of yNn,.-•T��%-L n
,I
CERTIFICATION OF EXEMPTION FROM OR KERS.,
.
• COMPENSATION INSURANCE'
'
(ro, section necd"rL be complatea dare purpoil is b e hundred don ry
- •, 't
'
S 100 orle"'
f
_
1 ,unify Thal In the ped ir cares, of the work now wh'ah It : p 'I is N " d 1'
- - "
shall no a npley any panes n any fanner so a, m become subject to the Workers'
Coop .fon Laws ofClf na. Dalen
)"-
'.
Appl t-
,r`I
NICE ICL TO APPLICANT If, fl on,lh Car, 'f t f Escou,nm, ye should
Z
hec subject it) theta k C p .at 1 11 x,ftne Labor Code you lost
forth 'Ih comply with or Ih'v bed
Q,
p..cents purL'I shall ,nrd rcenked,
CONSTRUCTION LENDING AGENCY
1 hereby aR rL that there .I t m level tit a'ge y f thepercrma
of the wink Int which thisprnlis issued (Sol. 3099 Cil.C)
Leldms None•
o z
Lend_ Ale xs
V•C
G+'
1 n'fypar Ih emdthis pplicl and state hadtti'h f tonic
corrcr lagree menmplY, with Il I)' darr,p, 1
,k. -
"'
F
(,'
uflylnl titleIesrelvilg
liblleltgci lunaeonand hereby umbo' p . hive. fib: fyI cmcrupin
✓ -
(W) & t J 'fy dk ph' I,:Ih Cly rCupertino y' t
liabilities I i't
4 '
j h, I I p. s 1' h an � any Y agr led
- r
.V
-City n ewp weeofth "o Itilitof lI, po I
APPLICANT UND 5 AND WILT IMPLY WITH ALL N , r'
1
15SUed by Date;
SOURCE REGU IONS �� / V
,
-'
slsnatlrinrndprrenlrcno mor ; - m —
- Re-roofs, _ s
-
•. HAZA.DOUSMATERIALSDISCIOSURE
- •'
,Will the applipan or future stable, a pant I a handle err'tearful'
'I, Type of Roof-
as dil'ned by the Ceperl'ni Monaural Code, CnrPtur 912, n Id the Health and Sandy
'
Cod SE.Cion 25532(n)^
°Y �,
'•Al
`
l roofs sQ1,be inspected prior to any roofing material being installed. '
Will the apibeast„rrw�re buldingoc,npant;�,aenaureL8rdavi�ixwmen
final
ifaroofisinstalledwithoutfirstob[ailiinganinspection;lagreetoremoye
emit sit eontamional to defined by (he Bay Area Au, Qualify Man,, paent
nxld,tgYe
- -
all new materials for inspection., Applicant understands and will comply with
all lion-poin[ source regulations.
Ihae real'Ih hmeu: apareli.11 orlaivirearesd Chapter 695 if the
California Health IS, SflyCoca, S111ion, 2550525533 and 255141 undararedIhl
if th builifirro,Illusion( currently anI a I hill it is pay re"Irdlellyt tf the
f •
I f Ib 4 t h'e I r a n t p to'neu c f Can' ,care f
_ VVV
Ouul
_p in.
` Slgnatu'reofA licant. ”' -'Date" _ ^
r
- - All roof coSCrmgs•to, be'Cla"ss `B", or better
owner it aamnfeed tr u . ate
OFFICE