00100142 CITY.OF CUPERTINO,'
BUILDING nivtsto v: PERMIT' CONTRACTOR INFORMATION. ;
'BUILDINGADDRESS _ '^ i _ +1 F_(Z
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OWNER'S NAME: ,• "APPLICATIOR S UBIInfE
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❑CZ ARCHrrECTIENGINEER: '.BUILDING PERMIT INFO +
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t 2, O 'BLDG r, ELECT PLUMB. MECIi,
n' LICENSED CONTRACT ORS DECLARATION r
z 5 y= Job Description'
Iherebypoliceltl I and provisions fChapter 9( n m g '
' 01., 1- i1hS t 9gJUI fD " 3 ftn Bt alk l :.'o.0 d Wnry l' n. , ,n
inf llf d Rel.
�K < 1e els pp a= DAT,II REPAIR a
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u G "111117
C ITFCT S Dh AR 1'10 ,� ,(•
p1 hall eod M re+rtdn
c0 ' Lir d Perho'sional. -
AJ UWNLR BUIL ARATION
id I h by [f th 11 m <m Ih C I el I e e I r ,h
Z G f II g (Section 911315 Brodell bePref......is Code n y of,, t, _ p'"%"T'r„ r, '
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which y a p n tt , t h p demolish, p y St ,
Ir t . - e L y theapplicant l c1 pe tt I II a signed statement
d 3 that h a p I, 11 p l a C ,a, r L Law(cn i Sq: FG Floor Area - Valuation,' '
(commencing w
nencing with Srfn 9a00h of O via me sulfide Box,ass and Prefess'm,s Cc ls)
hi-that he is exempt memGom and be baso.11orthe alleged exemption.Any violation ,
of Section 7131.5 by any applies.,for a permit subjects the applicant m a civil penalty -
of not mem man five hundred dallara(s50tn., APN Number . . ''11 Occup h e
01 fthe ppdry r m,loyea,with we,pacsmc le namparsal a,will do.the k and tire structure :not intended or refleamd for.ale(See 9044.
Business and Professions c do She connector's License Law does not"pply to at eVcq�aired Inspections -
owner of property Who h ild, ,,inprne ,I rca;and who does such work himself
-
,,through his two arciple,ce, privadel that such int,io,crohnsare not'intended or - '
offeredf sale. a rid bridinge improvement is old u" neyear er. 101; — FOUNDATION' •
completion,the -h ld l " v
l he the burden of proving find h n rid builder - -
. . r,provero"mpoxeoramel. I.02 =' PIERS . .
IJ 1, f tire property, 1 . ly contracting w ith licensed othourricarktet - 103,,-- UFER '
construct the p l rsplyto ry roodProfessionsce )Tet . a 104 — RF$AR �l
a;m., Iswl.ed ,apply iIp 1 ,y n hard, Imp cmc the ' R';- ,
d 1 , t: f h p leets wlh eon,rm¢rt(al en. d pursuant,o the
c,.l , License L , 105 -' ANCHOR BOLTS -
❑1 pr nears, . ,B&reFill...reason
1.0E — SEWER`-ii,:WATER
Cook, Du1C _,202' — .UNDERFLOOR' PLUMBING
e
WORKER'S COMPENSATION DECLARAI ION ^ „ a
1 nmehy'amren nnehr penalty of Perls ,,.err the reunwine aectrommnx: 20.3 UblDtRFLOOR 'MECHANICAL
I 1 nand and will accrued a Certificate of career,to,all inxme Tor waken, ' I 204 : UNDERFLOOR'.FRAME_ ,"
'ompe.aatiun, as provided for by section 3900 nr the Labor,Code, for the - -205 -..IJNDERFLOOR-''.NSI I
err...to,eotmeworkrorwnimmieperinnixi.sued. J AT•IOhI
❑Inaae,r,e ww md,t w Rix°wrrlp "r I .eu Tey,red by srvr,n 301.- - ROUGH- PLUMBING'
3300 f the[.he,Col r d 1 I nee ill the w(,Pk� which has ft rl a 302 r TUB C(' OR ShIOWER
iaamd,nrrWorker's c Pe "f 1,. r.,r,e ran,,a,d Pfl y bury , - 303 r- ROUGH. MECHANICAL ..
carne " Policy y� 0!1 t .04 ROUGH ELECTRICAL
GERTIF III 10N F EXEMPTION 1 ROM WORKERS
COMPENSAFION INSURANCE,- Y x
I
This`sectionr,ad m enmple,a Imepnrm, xrorunanaaam ar,uar. 305 FRAME
(x1 W,or 1e5a.J - .. - . . 306" — HOLDQWNS
- I_ ntfy that nn pt to rd work far hchthis pe t faced,l 307. - INSULATI01�1'` '
'shell not c rtloy E,ty Perstari at tiny mo,I as,o become effect,o the Wnrkam, ^
Cglnpenxyaon -Loweor Calif re,Date 308 , SHERTROCNc
NOIICm - r. o _ r, t .L �• i -
:becameETeedtomeW act,Cond,rusali hieCi,,rr,morHxemptiodesyoumbuild '309 Ek'1ERIOR. LATH
bed comply with
k C nsor p ms tithe Enter emedGvowd. moat'
OC Ferment, aplr wi,n. provisions orhas p 'Lenall be deemed revokra 31. i0 — INTERfI�OR1+L/A1T14 - a'
CONSTRUCT ION LENDING AGENCY '31 L"— SC'RATCH` COAT
- 1 therapy a0 nd 11,1,1 theri,,,hconstruction lending agency Radio perform mea
oG m w r nu,n p ,t
it(Sri.3099Ci,c) 31ROOF NAIL
ame
As ° hen nlnce 501 FINAL' ELECTRICAL ENERGY ;
U O' alc nytd,ln dmi ppl n d sit [hill n n - fir fa.+. 502 — FJNAL PLUMBING ENERGY
w F tobuilding discreet.
l g t comply e u ,v d aro r e „ r . dilating 50 i FINAL -MECHANICAL ENERGY
O [) mba ld yr , , do by representatives f,h ,yt ,rup _
yL w throb we, 1p cid,to l a 504 — FINAL •BIJILDINr
pe (We) g , . d t,ryddk pet 1'.:m city tap , g t ' .. �.. EI IERGY
m Imo , idn e outcry this
hi which m.y .any way accrue 'aa 505 — -FINAL' ELECTRICAL
U 7� ,city qumeLti gam.g olio ape t .. 506 GAS TEST
APPLICANT U CRS A ND WILT OMPLY WITH ALL IS N pO T
sautes r nTl� � D olssued by:' Date '
sign tApplcnVC ,- a+r , Re-roofs 4 - `_ ws - .-i' -
HA]ARDOU nT- ALS DISCLOSURE 508 FINAL ,PIECHANPORI_
will he applicant Etre grypa,mina&h, dlnarer,.5nemam 'Type of Roof` - '
as defined n,md Cameron.Municipal Code.Chapterv.12,and the WOO,add Safety 50�-+'� %FINRL�-GRADE •
t Ccdo;Section 25532(a)?
❑v: Cl No All roofs shalfr3_gd4ns'pe�eT11�Aibr,t(Pinr9t NdiiftY.Tnateria being installed.
wet,I ppl ant ne building occupant" use eyuip -l -d ,which If.a roof is inbtJ16d wiffilthl[ LORIIIS11910 i jj(q,'I ag[ee to remove
emii ha: Ifusarefm meas ralnea by the Ray ArwArQuality Mamba tent •- ,• ,.
Dletria'! - aWnew materials for inspection. Applicant understands and will comply with,
°vie °"° all non-point source regulations. . .
1 have d,he hinsioddy,chatenal,re'rimadmo fail,,Chapter 695 tithe, t _
Califormalienitli&Salcry CodSections 25505 25533 and 25534 1 undersand dent r
'fthe h Ie ,does , Ilyha to , ti ,',' y aq bl,y, rorty the '( •^ "` -
spat I,h m IF It rot x,b . ho t.suance of a CmB"t6 of
Occup I -
_ ag/�//� Slgnature'of'Apphcant Date
uthorecd agent +All.roof coverings to be Class "B''. better.
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OFFICE