00060055 CITY OF CUPFRTINO-
BUILDINGurvist�N' "` PERMIT INFORMATION
'..ti BUILDING ADDRESS PHRMIT 90. -
` OWNER'S NAME.:' - - 'f„ APPLICATION SUB DATE
All IRE)
2
{ONE.. .. .) a, �. ?':. r .. SANITARY NO.. ' '; CDNI'ROI.NO.
M z Z ARCHITECT/UNGINCER J-. BUILDING PERMIT INE05 -
n POO ` •'Pi e. , t RNhDO 'F.LF,CT PLUMB ' '- NUR H
'¢c ,. - 5 -
y" 1 ICENSED CONTRACTORS DECLARATION
5�,'' ' 1 bunch, ff n th u , l ea d f Charter g ' ' Job,Description
O n_.j P 1 rc,mme -
�, Cw w'thS t 90flll) f6 ' 35 flhc Pu a and lmrervions Cndc,and my liceme
Xo Date `l c mctr ,4478 LIVI'NO =,SPACE;' 733 ,GARAGE -
O u. s AItCHIT'FGI S DFCI ARATION ' '•I
�— 1 J t d r pl shall he'uae I puhl c rein rd: �� -
ao
Line dP fnxma,d FWALED
OWNER-BUILDER R 13UII.Dro nDECLARATION OCT 1 8 2001 +
n I h eny «- that N DEpt Contractor's I' L for iM1c r " • •.
full to,cano..6,1ion70315 Bicine d Prz fe,:nn.x Cafe.AnyctynrewnlY. + .
m
which reStairs,a parinitun ornartarG. Its,urpoi,c.dciwli,h,ar,,,ac,anyin are
3F
entitled, reavuel"non".111'"gred dareaccut ^'
flun he is licensed t, dl p ,on,offle,Conaboon s Locure Law(Chapter 9- Sq. Ft Floor Area•' BUILDING Valuation
(ca ,withSect 7000)of Dbi, t 3of his dm
Bas e
nd Pod ,,,anCde)
or that he is astanerl f nd the har,k bar the alleged ina Any vichadecen. " '
' afS i 70315by� 1pl'c tf ' 't. bI t the appl tl acv'lpenalty
or tc mag I ee h ndred dollars(s5Ln) ., . APN Number --^'-Occupancy �pe;:;.
❑I c f,M1 1 tmnY Y Ilyc th -g. Ih . p t. _ ._. ,,. ...
ill d d - 'k d tlsoon,t n t an de 1offered f : s 90o .- - +4. i_.
Business and Prefexx„a Code The Connector's Liters Law does not apply t an eg0lred Inspections
ownerf propwrtyWh lrupoweektherson,and who d such workh If
rthrough I ply P ridnbw I p t tit II �•�
offered f I n m building nalold within crioi f 101 FOUNDATION
completion,theb ld In the bM fp " gthali Idnot buld
'tap rp n -nr ) 102 .PIERS*'
❑l a owner of the prop nYexclusively contracting with I' on ed arnarachar,t _ -`i0� -LIFER•
cot t an projectrs )0aa B . d P fel C d )Th C thereon,
I
1-e 1 heoco ' t pply ec.7 rp pro p h la p m 1.414 �P.EBAR
,d n contracts r n p reeks with- wan,gs) d P t t n ' --1]05 - ANCHOR BOLTS , a -
21 anMnl License me�s .,' a&PCI, th a 1 .' ' 10P1 'SEWER :R WATER
Ow Ie �o z° °a 202 LINDERFI_OOR -PLUMB '
WOR 'R 5 COM NbALON UECLARAI'IUN '
d
u.
203 UNDERFLOOR MEG1-IAN'ICAI_.
I herehy affm under peidly nfp )vy one of the followingdclaratinn.�. -
/ ' 204, URIDERFLOOR FRAME,. '.
7 I hl,veund will muimain n Ceni&'arc aF Cunxem to self-Inaurc for Worker's
p t' , as provided for by set a)oo I n Labor Code for me .. 205 - UNDERFLOOR+ INIS. LATION ..., -
perf.manu,rthe work for which this p tisissued. -
` ' 301. ROUGH PLUMH'ING
01 have and will maintain Worker's'ConTanswion Insurance,as calcined by Section n - . -
3900 of he Lbbor Cade,for be pc«nnnance'nf the ,,,it for which this permit Is - 302 — TUB & OR SN014E R -issued My Workers C p :at n Insurance and Policy nt Whet,no - - -
3o2, .— ROUGH—MECHAN.I,CAL
Carrier: • - Policy No!: .
CERTIFICATION OF EXEMPTION FROM WORKERS 304, — ROUGH ELECTRICAL '
- COMPENSATION INSURANCE "- 3415. '- 'FRAME '
('Th section n ed cot ba eo rplet d if P per nit is f hundred dollars t -
($100 1...) - - 306 H.01-DOWNS.
' I cord, ha,inbe,P=fdnnce l the workf n ithe,ninint . . ,dI f 307 — INSULATION,''
Quad not cral any person in any manas in honoree abiecq In the Wa rkers ,.308 SHEETROCV
Cnmpen..ran Laws ofLit veto -
Applicant e I
NOTICE TO APPLICANT if,after nk g this CanificateafC n you.Imuld 309 EXTERIOR LATH, _
Z beconeslyootmdteW k C are "t p .ons Lab Coo y noxa - 310t-- INTERI'OR+ LATH
O O
forthwith co edy wan such pr i ms or th a perm t shall he d Wed invoked L+ f+
�^ ti CONSTRUCTION LENDING AGENCY, 311' — SCRATCH- .�
itan-hY effirni thrathconstruction lending agencforthe rfotma ct, ..p
if the war kfor whichth pends sued(so,'3097,Cie.c); 1" 31.?, — 'ROOF �NATL. -
y p LendeC,Addo 501P - FINAL- ' ELECTRICAL ENERGY'. ,f
Lend Albs
an ry that in readeeth s,ppra,t on a,dstate ant In n 502 '— FINAL PLUMBING. ENERGY
w F
correct.l g IncomplywtM1nuegyand 1, dna,cc drf I g `503•'— FINAL, MECHANICAL .EhIERGY-
"O.V,.fobuilding .t r'o do by tl repr mit a Ith' tyt t r p 'dT
areproperty n.pect npq 504 —aFThIAL BUILDING ENERGY
dF a i (W)agret 1 fY keepdM1 I .. tireCty fC[mf against
m wanlr i ig t a pees ntnnay any try eaginsr d i s.505 FINAL ,ELECT,RICAL
. ,` �o- Zr�p p,
C.) -City a u e cc nl the gmming aF tM1l pvr - e ..
APPL NTuesce T SAND WILT PLY WITH ALL NONPOINT '•50F — GAS TEST ..
sol no O Issued by. . Date '
sig t ,rApprem c
unrest., n Re roofs 508 . FINAL 'MECfIAhIICAL'
HAZARDOUS MA IALS DISCLOSURE' u - '
Will the appl ca t fu are h lding P t t r handle I W s boalial T e'Of Roof.
usernd by meCupeino Mu,t'palcodc,Clunde,t)12,and his Bertrand Safer YP 509 —. FINAL GRADE'
Code,
ud See II n 25532(a)? 1�' x
°V s 0" -
All roofs shin d inspecFnA%r tFi'lar�r fi aerial being installed.
Will In ppl t' r t 'h wi s tc Ipa,t useega"pm d- nirn If a roof is mssiJIA&Witffc1iN �t'ob}h� �rg1 n 1 �{1tiFh�1 agree to remove 'i
em t h d s r com n ,.as def m l by the Hai Aoc A Q dirty Mana,raceo ,
D`Wacll res a ❑No '- all new matefidlid'=fmr insf Eiffli :Ff{pj3lk&�YR2AlIt thhds and will comply with
all non-pgin goNe:regobj3 ts'BATTENSa", ^..
CaldomuHewtn&soflycde,Sedans 255092553 an`.ad,,
2554 l under e,tand hot 6041— ROOF I11-PROGRESS
if he her[d' ,does-net Correctly hale a laniont,thtit try ho notify the occupant of the requ'mmems Which must M: prior m ss e of a Comfit to of '
oeCa o_� ,Ott "-Signature of Applicant ' - +Date
oWn orantnnnudogent, Dale " All-roof coverings to be Class "B" or�better
- OFFICE