00080053 'CITY OF'CUPERTINO 4 '
nmLmNc DIVISION PERMIT ' CONTRACTOR INFORMATION: '
BUILDING ADDRESS. PERMIT NO. ,•
' 4
as
OWNER'S ADPLIOAT 19
10NE: RID -NG/D " "T - 5; - r1 o,,. SANITAR NO
n00 ARCHITECTIENCINEER�, La' i+ BUILDING PERMIT INFO -
W
�' BLDG ELLC'r PLUMB MECH
Z Z hICI NSEI)CONTRACTORS DECLARATION. Job Description -
OZ-C I hereby affirm that la,Forwarmadiorp 'Clo,or 9 arm;averain,
^dry with Seuinn 700)of De. n3.1 he Bu' ,d Prfe,' n,C We and my,f - - -
in
0 License fiCl eandeB t # „ Fliiu : FI'N
rue ALED,
-ARCHITECT'S DECLARATION T
`vaso I Acer fiat ypl , Ill bc,sdspbl oras - t r '
moo Le dP t nI I OCT 1 7 2001 '
OWNER-BUILDER DECLARATION ..
w=.� I M1 by m tl t I pt 1 theC m tram L : L f th
F Z so w n6 rea: (S ci 703LS B d P f:r' s Cod Any city orescrinty, F '
$� ❑ whch lv:ap a r t h p e I h c ran,'c tr . ` B�
�3
pro,
n t t,s tr nce als requires theroof ca t f h p tt 11diatomstatement l/
math ]- Ip tI top fthe C t t r ee L (Cil m r9 -1- • d` Sq.,Ft. FloorArea Valuation- -
!comnencngwith Section 70W) ,fD'v" 3 ff,Runnc. dProfession,Code)
x a but h Pt therefrom end the basis r trip'llegW nacrapti r Any vimat on F2 )I'
ofSection 70315 byan)applicant for apermit- bj ts the applicantl 'sierd penally
•nfim,mart man ave ha,dree do0a;,($500; APN Number,•
❑1......cen,f the ,opluty,amy employee,will,wase,a,thebsoe,ompmeudoa,
will do the work,and the structure is not 1mended or offered for sale(Sec.7044, - n -a
Bailor, d .Probe Code:TI Contractor',L,cen,c L d t apply t - 3621700_.�7�ry quired Inspections
owner,f properly Who builds or Improves thereon,and whodes such work himself '
firBurial hicold c. p ddtbut.O,lr'pi,econadr,a ,at amended or
offered par ale.If,howeive,thbmhfg improvement la al yea,Of 101 — .FOUNDAT'ION,
co nplettn,the xue hider Il have he harden m
den ofpv'ng thin hedid,nt build or
/f p is r:l ) 102 PIERS
af,y nw,er,nnep pdy.in.c.1mi,ely' t- rg icith Binomial e 6cl :t, , a 1.03° '= LIFERsl
. Liconstruct the projou(Sec 7044 B,s fie Professions C 1 )Th Commawrs
cense Law does not apply loan owns tiProperty Who h, la p c,merua, -b 1.04' �— REBA R .
ands, h t-es-for such projects with if contractor(,) firemied plabs d,the
•Cr r , :Fire„o Lee. , � 10 15 — ANCHOR �BIJ'L'TS
❑I.,if usePt der So00If for this '
Owner td •' o yo 00 70E — SEWER , ,WATER
•t. woRKERs COn cnsnTloN.DEc1.nRA5'ION 202 r— UNDERFLOOR 3PI_UMBI.NG .
Ihernley art,nutderpenaltyofpegjryoneoftliefollowmgeeclarahons: - 203 — UNDF_RFLOOR' hIECHARIICAL ,
ZI 1 have aid will tannerif a certificate fir cometh to.,m L„nro for wor 204 — UNDERFLOOR FRAME
Compcnseion; as provided for by"Section 3700 of.tne Labor Coda for the v
performance of the for shicnmis permit is issued. :,, 205 - QNDERFLOOR INSULATION '
'El I haved na ill random-w ak s Compensation res,timad bys ti - 31b1 ROUGH',.PLUMBI NG,
3700 of Labor Code,for[he performarace of the work for n this permit , '302 — TLIB;:R' OR SHOWER
Issued My Worker,C 1 .ndo,Insurance carrier and Poly fiber n'e
Carrier PoEcyNo 303: ROUGH MECHANICAL_
CERTIFICATION OF EXEMPTION FROM WORKERS'; `104 — ROUGH E4ECTRICAL
COMPENSATION INSURANCE
on ,ec tnneennotneedmpmtd nhepdmn ,Rrenennnareaadna 305°;,— FRAME"
(surd) a".) 306 —.,HOI_DO,WNS
Iterrfy thator I
he performance a,o t(he workf li h this permit isissued,I 307 — I'NSULATI'ON a• a • '
,]fall not employ any penswo in an,pound, s a,to bwnne ,p,d ,,the W rkers
-L,
'
Compensation Laws of California.Dale X308 -SHEETROCK
NOTICE TO APPLICAN r It rt - k ghu,c tr t rE pt roan Id ' •309 — EXTERIOR LATH : ,
z 0 bee t e. b uothe W k Compensation p fth Lh code;yona '
.rethwthcamplywith fihproviosorthis q.rn,shelf b decided _oke, 31.0 � 'tI+-lN+TERLORf+LATI•f;
V] , CONSTRUCTION LENDING AGENCY' - 3'1'1�' —' SCRATCH!COAT
a, 1 hereby 6n r, that th compact I d,g O,aey BittheDedormanoe 313 — ROOF- NAIL - ... -
of,h work for th pe t�issued(S 9097,Cie.C) r
z 11
�e n sAddre., 50).' FINAL EEECTRLCAL •ENERGY. .
rose,
' e5002 — FINAL PLUMBING ENERGY,NE•RGlY
mtln m ppb tin .th r nal on .
I get plr thuty a countycadmium, t 1
ton l construct"',toldh byam Pe Wtve rthcit,l terr,oa 503FINAL MECHANICAL ENER
GY
'504FINALBUILDING ENEPGme bvemenf saproperty f t'P t rpm
I , (w)sued t t o nrr hmme,,ne fO p himo".i ,a
I 1, t ab r,c.tad xpc,wespdah a , a)Wria-Lal.,.,a,, INAL ELECTRICAL
'
- ,
V CitY,, fixggquence illm Brom ng ol,h t
APPLICpt/r UNDERSTAN SAND W OMPLY WITH LN N POINT • ISS LAG b SLAG �l r�TEST patC.0 � ��j
'SOU Gt t ONS I0 `LO�O'0 y' -. NAL PLUMBING
Signa efApphn nUsm
onem, Dale Re roofs ' . . . '
HAZARDOUS MAE.RIALS DISCLOSUREry Ql�} — FINAL MECHAhIICAL .
Will me apps e t fur bulding occupant store or t dl h d naler.il Type of Roof` rT -
as del A
nee by the pert no Municipal Code Chapter 9.12,and the Health and Safety 50.9 FINAL GRADE,
•Col Seton 25532(x)? _ "
❑Y: 6 ❑N- Al4roofs-shaflAnnspeJfe1iyQbrtFr'I#4b1iWfi2telial-being installed.
fall m 'I pl , f 1 e building p t„e equipment 1 ,a,which If a roof is in5,Mdd'witAnidTtTTlft ob1hifllit ihJ1P(,k21%,.I,agree to'remove
en t haraN .1 at,cr mad nahts a,defilard'by the Bay Area Air Quality Managoment -
Di t , all newsmatei6stl 6vo insW00.,FPjp[fdffttl611nddfAtithds�and will comply with,
❑Y °No all non
< - . pomt' egWdW_'BATTENS
I have r d,hbar d materialsy L1d rCl Clamor 6.95f the r.. —CaWrmHalth&srr,Cl Sections 2550525531an25534 Ina t dtht 604' R00FIN—PROG
RESxS
`
ifth net
-
-
h Id' gd tdyh athtt! y.r responsibility tfy th , `•F- - f e' . ..,
ee P t f t ,quirt est,whch mu,t 1 prior to e of a Certificate1 ' \,
°e p° Signature'of Applicant .' - -Date
Ow raamorveaa ate.
All roof coverings tolbe Class B"'or better -
. OFFICE,