00120128 CITY.OF-CUPERTINO ' .. :,•„ , '1 .
nun.plNc mvI8
1ON PERMIT CONTRACTOR,INF,ORMATION:'
BUILDING ADDRESS <t PERMIT NO ,
:;s7rsc ' cl:1u_INoSWORI1-1 "ST �Imi uri :rs;
OWNERS NAME ' t APPLICATION SUB DATE
L'ROLI_. ,JOHN D AND ANA( R.
HONE: ( _SANITARY NO. CONTROL NO,
O O AR ER - - - BUILDING PERMIT INFO'I
w� . j
BLDG ' ,'ELECT PLUMB MECH
1 Jw ��Elo 1 ._ �� _ i_ :.
�?Z I.ICENSEDCONTRAC'101CS DECLARATION
Job Description A
�Z Ih 1, rf vhtl I' a J P : rChapmrv(connu neing _ ,p
F, t � ilhSei 17000) fih m3 ,f,ncBu a mJlnfe.ons Cnde and myl cense -
aLocnwlclass ane Lic.x BATH P.EMODEL_
U, Date Contractor
0ARCHI'I'FCT'S UFC(ARA9'ION
a I J n J Ypl ..h llh IscJ PM' Goran -° ., "
LicerawdPedelleenal OWNER-BUILDER DECLARATION
a - I hereby iffinal that I ren werrol for.the C , t Uccr,c I mime
C <
following reason.(Section 701.5,li d Profic,simes Code Any city rciane, -
$2 p
which I.Imne,.prot to consforct,afte, p demolish, repair- y structure ��•'.
a
3w pia t t I. q .aapplicantf 1permit t flsignedam
t• en, I -
mill he is licensed ponnumn tofficativemas of the Contractors L c n L (Chapter 9 +
(commencingm- " Section 7000) fD ': 1 fm :B aP :Code) Sq, Ft. Floor Area /'J .Valuation
- <,-thin hen r,,,not be,cefiroon and the basis to,the Ilgd ishipindAy Neon •• - I/ -$650 L0"
of Section 70315 b,arya6dicarfforap ,it subjects the,ppl' uut to a tail penalty -
ofoptm,romanr,"en a a I llrF(sv)0. - APN'Number• - - Occupancy Type '
01 a rm property, Ye PI Y m g as their I I I i n ..:.•.r'S FJ�. J@4E 01'11
will do the k I In, a I r mmowd I,offored for a (5 c 7044 - - - C - - -
Bus d Profession,' Code:Th C 96s t r l e e : t apply t a, _ Required Inspections r ,,
I p p ny Whobuilds p thereon, nil h doe u h work himself
'
o"through his doyees provided that. n f enh are aid,encoded or 1.01 — F OLIN Dig I ON -
one d for Halt If,howeve,mo bt ilm g at impovenumn is sola w ah n one rear of1 _
ompledon,rot ner-hmwflueHo
er,will have e rden ofpuMag mal he aid not heild or 117.12 PIERS, _
iow
mprov for purpose tl evlcJ.', , 1031UFER • , •, ,
Of, ,uhePropoay,con e.mt,h Iy mr f gwhnr e1 I Idrnm' - 1.04" _— ' REAR
on t t theproject(Sec 7(Wa Buslnnv m
and Prortcs' u erac,) the Cal urarr's '
'
License Lawdoes for pply In d property who build r'rp c t rent t: Y
and who coal nets forsuch projects w'0 a commmor(s) I' msed pursuant to.the. 1 t7J„1 ANCHOR ]BOLTS
CourtmmS License Law. '].17.16 — SGb1F_R 8 '.WRl-ER
°I an encrapt uldcr See -,N&PC I` tM"'r sen .. `
owner Date '40 'UNDERFLOOR PL•UMBI"NG '
WORKER'S COMPENSATION DECLARITION • ((// - I,,,Il ._• UNDFRFl..00R IYIECFIA1\pICA1_ x •,
nembymf...nmIn,,pcnphy or perinry-,,nc onhe[1,nowin,itcaluraeons: 204UNDER FICO OF:`FRR ME,
I h,womed will maimain a Ct:aecam or consent 1.,elfin,"ere for worker's ?0'=) — UNDF_RFI.:OOR 1.NSULA-C I.ON
Compen.emiou, an P...aEd for by Section 37011 A the Labor Codc,-for the
Purrorm:mecof the work for which it...pmmhis iomod. .. • _ 301 — ROUGH PLUMBING" '
olbase i will main in Worker',Cmapsanmfoa Iacquiredhys t " 30.2 — TUB 'R' OR. SHOWER
"a ill I we,Chua lariscrocce,
mom pnsran,atrmewarkl r,h atic. ti. 303 — ROUGH MECHANICAL
"a d.nfrw kcr,"e p= 'r insurance carrier and Policy mnn r re.. .
11
c;ie ' Polley No ROUGH EL_EC-,rRICAI_
CERTIFICATION
COMPENSATION IIN URANCL[ON FROM WORKERS' '.30 a — 'FRAME
(Fr, (olInecdlotReCompleted ifthe twoulit I.far o,1hundred dollars ' ;20C'• HOLDlaLpNG ..
3Vi7 INSULATION
I cm9fy that In me p Itcounite Irma wmk for which d,1,permit is i'oh,L I - :171& SI-IEET ROCK - -
,hall n t enpl v' ry n r "t be M1I t t Ib Workers
compc -f ,I rLlr UI
APP( a t ER•1-OpR LATH .
.NOTICE TO APPLICANT If. B k gth L et t IL npu n y ht II .. 101 - • JN'I EW6'0R. 1._Ad I'I
Z betsubjectt theWorker C I t P v ' rd I b C,d y .t r ,
tont ,mannplYwm hp n. rIl permit hIlh downed n.voked, w11 - SCRATCH COAT .
E+ 4 CONSTRUC9IONLENDINGAGINCY 313 •-' P,GL7F AIRIL. ,
11 by ❑ d t m a I lending upency for the pc,farr word
of Leader
.,it for liebth planar lss,u,d(So,,30T/ Cv.C)
_
z LeadersNane Q�l — F'[NRL_ ELECTRICRL 'EMERGY '
Londe :Add2' — FINAL f-''1UMBING' ENERO
r.. 'ilXY
U O 1 count,(Bar Ihis' m:mumation and she(In,,Ib r mi for s 50? - FINAL MECHANICAL ENERGY'
GN j- con' t I cement plY h all it, a county d - d saw,'I totaling -
O U to buildingen.tmclion dthereby antim momaWeve" rmsety(I,enty,pen 504 — F1.NAl' RLIILDINCU 'ENERGY
the clene-ri,ationcal IT Perry r .. lienponcow,
m iianit(`Ye)I6 et,,s II ry dl
lkeph ns,tbecI,Dm,.which may in CtyunCP,,Ii way w .gaud 505 FINAL EL.,E`OTRICAL
U id
Citi in Io .cy(anceolthe Standing of fluk PermitX06 G If, fist'
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
so REcuLATlorvs - Issued by '9(h'7 -.: F-T�.IgI —t IMATK 'Date s• U V Va
SignemreofA F11caniCum on., ,Date Re-roofs `JQ8.. — FIINAL, hIE:CHANIG:AL
HAZARDOUS MATERIALS DISChOSURL
Withe."trent or later,building occupant stoicor mall hvaodua,mNIA Type of Roof. 509 — FINAL GRADE,
asJfnd by the Cotentin Manic'pal Cad Chad,,9.12,and theHahmand Safety
��.Cm Su, n_ss12aF1lJtd_ PLANNING,
All roofs shall I�Snnspected pftiOtto dny f.00fitlg riahoJFiWLbeing installed.
Will the applita t I,,main,n ildingo,,apant use eon p -t I swhich If a roof is installed without first obtaining-an inspection,I agree to remove
mit h -d nmanmers a,defied by the Bay Area AT Quality Management
all new materialsfor inspection. Applicant understands'and will comply with '
°Y �'" all - omt source regulations. -
' L
l Il hazardous mol 1 c nlc under Chapter G.95 al the
nI t dmatt mlyh tthtt':nY P 'bllyt ilytne,mol Is wh eh must he eI p'rr a sso e ofa Cerbfe t f ..Signature A licant '- Dat
.ed listI heer datings to be Class better
!,OFFICE',