00060054 CITY OF CUPERTINO4
r
BUILDING DIVISION . pERMIT CONTRACTOR`INFORMAT'ION
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BUILDING ADDRESS: - 'n'^ PERMIT NO. -
OWNER'S CREEKLINE DR
A9'4 - - _ APPLICATI S 'B Y
.1909
7- Li
ONE:- G. }, -'J` SANITAR AO NO❑ CIIIIECT/ENGINEER: + BUILDING PERMfr INFOBLDG+ ELECT PLUMB MECH
IJCI NSEDCONI RACI Ok S DECI ARAIIONo1 hereby arum thin 1 r d I p r c1 pt 9( pangJob Description
p� ith Seefon 7000)nr Dna 3of the By :,a J Rresrttno Ctdn ltd mylceme ;,;
e I or IICI us anJ slices1
C ttmaor SF'DWI I . FINALEDi
w
w 3 w y !ARCHITECT'S DECLARATION - '
��� I .wad mY pl ::nail nc asst :pll' recoras - r - .I - "
oLicensed Probe...nasi OCT'1,8 2001
ONNER-BUILDER DECLARATION
ed— I hereby affirm mind are exempt from the Cnmrua n'.LieIr se`Luw Endo, -
�$Q toll g (Section 703L58 : dP f.. :CJ Any 'ty amnty BUILDI re -
Ix❑ xh h 4 P u t t alt 'ternJ lkh sp ,t
ar nylcm mNGS,.
�3m p,io,Ip,t,oauaacc '1 -I ' .tl 'PPI tl r. M1p milt BI gnG1.l'lemen
that In, I - :cl Wreirson,t thepewrown,ofJ c nt.. its Licerge Law(Chapter 9 1 Sq. Ft. Floor Area Valuation '
fmmese ng with Section 7000)of Omicron 3.1 he BudinesI Ind Professions Code),
or then he is exempt therefrom and the basis fo`r the alleged'exemption.Any violation
at Seem 9031.5 by any applicant for a permit sunces,the oppllcar In ucivil pe entry
ofnot ainum man fill mnwmd dollar.Sybil): AP-N Number .. O c 3n pe .
°I Ith 1 p % v employee, II b. sthevear,mrpan t - .
will d ah k d tl fracture t intended or offered f (See 9041g(t -
Bu .. I P fad Code TI C t l trs I,cense I 1 t ply t an' ; wC' .. e. quired Inspections .
ower(if property Who builds or impowe,thereon. ad,III dee,such - k himself , _
throughh ply p Jdthn h pme t tintendedor h
fr d 1 note,If, thehold tg improvement sold within one ye r of j,0.]. "— ,FOUNDATION- '
oPlt theb'mrwill havens burden ofpovngthIt he differ saki or - t
° m, [ p rpaxeor'me). 102 — PIERS
nn property,am excwx elf n t g d renxed conono ser' 103' — UFE'R—
ic t t 11 o project(S ]to a eu.' r- 1 P-f GOJ )Th Contra t :
ue 1 a t apply to rp q rmpets n builds imp :an .1.04 •' - REBAR r .
nd 1 contracts lot , h Pnjua.with ommemgs)licensed-p Ltd, th - '
con t L � 1 r �' 105' — ANGHOR' BOLTS
°1 nal, e ptunderse. B&P C for this' -
.Gw xIul�,rr ��J ] 0E — SEhIER 8,.. WATER
W ER'SC PF.NSAI'IONDECLARATI)N 207_� - LINDERFLOpR =GLLIMBII\IGr,
ins gra nnawerpenany fperj rynneormernndwingdrlarnann.:'. x, 202, = , UNDERFLOOR .MECHANICAL
I 1 lawn sad will hour ain a Ccniraaw o1 Conant a„elr-imam err Worker's 204 — UNDERFLOOR. FRAME"
'ompensation, Is provided for by Section 3700 of the Labor.Code, for ther
pcath.m:mceoI hewnrk(orwhi,h,l,i,permit axissued 205 — UNDERFLOOR- INSULATION'
°I novo and w,d mmntmn worker's Coi,tpen'satlofrmxumnce,a;re,uned by Section' y 301. , - ROUGH PLUMBING
3700 of he La or c le,for IN german anee of roe work for whim this permit Ix 302" -'TLIB R OR SHOWER
R
Ixs d My W rzker,Compensation Insurance carecoer
carrier and Pol ey mbaw t }
ca ' Pride,No. 303 — ROUGH' MECHANICAL
•
CERTIFICATION
COMPENSA'IIONINSURANCEN-FROM GI2KF.k5' 304' _ ROUGH ELECTRICAL
fro'. section n a not completedirmepennitixmronenandreddoli r< '„ 305 _FRAME;
($100)(ole".) 306 — HOLDOWNS .
1,ruify that peHon»anee of min work for which this Perm in ix issued,1 ' - 30,7 — ,INSULATION' t.
shall not anploy any person in any manner se us et become subject to the WoAwO' }
Compensation Laws of California.Date - ,�
' Applmnt 308 SHEETROCI
NOTICL'rO APPLICANT II art ;k'nb ah c rr 't rL ,n t v n old 309"- ,EXTERI'OR LATH
bcemnc sublecuo mnW k c cop t p fthcL n Core,y tst
s'
O
Ambition eo...1,with rip this penal, [ u1 dared invoked,' , _ '310 — INTERIOR LATH ..
Z� CONSI RUCTION LENDING AGENCY - : 3.11 "- SCRATCH' COAT
'
1 by ff but[heret tion lending agency for the performs mo - -
tiCa mods f n hto pent xiwaee-see 3097.Or.c) - 3l.3' —, ROOF NAIL-
z ,Lead AddlName I es, 501° - FINALELECTRICAL ENERGY
v;0 ,fifty erllfact, this applicationand...imasse FN,,d intermitis ',9132 FINAL PLUMBING ENERGY
gT+ r(r urn t I g t ply ttl II tyfail c my 1' ' d:mmla ehfng
Inb ,d tgc armedi di by th representatives of this city toenter upon 50,E FINAL, MECHAN.I'CAILENERGY :
ay r� the h li d'go"en,l inspection P rr `
y (w )ag d iffy !kph le,,the City ofCped g,nst 504 — FINAL BUILDING ENERGY
Z liabluses,programs, t:srid expenses wlt cot ons,at any 'r aceme..,a oat sod 505 AL ELECTR I CAL � 1
G-Z ,City- c q 'core g' t gcl t 'a pertit - r -r D -ate
APPA NTUNDER NDSAN ILLCOMPLY WITH ILNO d'OINT - 'n �� Z
S(yyat I,REGULATIOf S. �p`����� Issued by: .ri4�1 TEST
- Dater
AA
" tAl,]lea to—t�r� Dat Re-roofs .507. —' FINAL PLUMBING-
fiAZARDOU MATERIALS DISCLOSURE -
Will the applicant flmb:ld'ag upantxloreorhdleo-zrdous,talerna Type of Roof 508- - FINAL MECHANICAL'
as defined by the Cupertino Municipal Code,Chap re 9.12.and the Health and Safety -
'Code.Section25532w)(' ,509 - -IFINAI_...GRADE'
All roofs shall`Ui)nspecQectpti _tolapyldpfM(Ml teria] being installed.
wpm 'fpr n r t r'a 'm' b p t :_ ymn r e ''.wmen If a roofers insEq}!all,withpujjALob}'syl�gg�;ingBtjr I agree[o remove
omen J ,n r-:arneln>tn ByA Air Q araM Management
:Oases t - all new materi�l0f`or in F(Lqp, 0epj,fkgtH d t els and will comply with'
°Y' °" all non-point".sourc regu]a'L��ntt��
Im dm Id,. v t 1. v ire t e Clppt at9s nn G!aY, "' 'HUUF` BATTENS.
Cmr Health&Safety Cd S i .2550525533 d2553d1 d t dtht ROOF IN-PROGRESS
'f1l building l _ t currently love tenant,that l Yep bllyt fry she P
occupant rah q ' nv to hch musts npriorm'sx afu Cen foots of - - - i
oge� p , Signature of Applicant + ', Date ,
u All"roof coverings to be Class `rB"or better,
O authorveJ agent Dm' '
k OFFICE