00060059 CITY OF CUPERTINO . CONTRACTOR INFORMATION +
BUn.owc DIVISION PERMIT
BUILDING ADDRESS: t - PERMIT NO. ,tuufftr
a f VE LOT APPLICATI(tA�I1�iRr�{{rA,59 ,
OWNfik°SNA . . - _
I— ONE: /. ' � ,.. SANITARY Q'.wlvJ J
[�m Z ARCHITECT/ENGINEER:' - "- a BUILDING PERMIT INFO
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I ICPNSED CONTRACTOR S DECLARATION
z$ 3 In nynrrrudr,l ,bpLnswrnaap ..rcmP,rne „men�mg - Job Description
OZ ,hSe, 70flah fD' 3,ftheBu adP fe..' C I andrylicense "0 ��
41 MW3 sin full f 1 Bc f
fie p��< 'Lic Cl vs L 9 ,
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W o Dal c mmmor SFDWL. .
ARCHITECTS DECLARATION -
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Lmo,od P bestirred - - " 1, Iry �� a
ec� OWNER BUILDER DECLARATION ,. L ,
d I hereby adfirm that 1 am exempt human the C , " License L a the ,
fall g (Section 7031.5,13 : d P 1.:' :Code MY ail,.r ly T Al '
whthrequire,' permit' 1 , , II v hierraticallyabandon,
' - OV 05.
i3= prnt t 1 'm �I I' nnl forsuch permu fl a 'g ,I.,,mem' - .y.
mall 1 Ip ," m Prevision,of the Contractors License L (Chapter 9 Sq. F[ Floor Area . Valuation. ?
or. y- nseLLo 7eom,f D'tvis 3 n1 Busne and Form is Code)
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that he is rinallatb f d the basis for-,h Il oed corruption.Any violation
of Section 71131.5 by any epplmam❑a 11 pa-,it em aid,the applicant to a Cil I Plly
- _afaa,a,arethan five handled auat
asasw). enaAPN Number
°I.as uwne,of the property,ar my employ'ks with tvap�„s meir salecnmpensaimi, _
will do the k d the standing ,intended..,offered on,sale(S ,7044 -
B,w dProlosaimas Code The Contractors License Law does
t man r 26
21 7-002M. quired Inspections
owcrof Wh, Id. 'mprove Ih m who ssoak work
mrugh hisown tnptoye9.Flrvidedmmsuch Inpnivanensare naineadedor,
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alfemd for sale.IL however the miming or impenvomen,k sold within ane year pr , -
completion,theawner-hudderwillhavempnurdenarprovingmmhadidao,buildo,. 101. 1 FOUNDATION
pr/oveforpnmoaeoffean't 102 .` PIERS
8T a f"he p P "y ly apart withh l a , c, In• - - ,
Uconstruct me project(sce 7044,Business na Prare..rr,Cada,) the,Canm Mora. ?! '103r - �UFER
c Law does I apply to rpropwaywho ndll p harem, ' 1r04 REBAR
and who contracts for uch projects with a coranclm(s) f sed port un m the ,
Centmcm xLeenseLw - °. ' i 05 a ANCHOR BOLTS' .
❑tun enc nndcrS B&PCT th a -
ounel". of Za o0 „ 106 SEWER A WATER
WOk SCO fNSATIONDECIARA ION s 202 UNDERFLOOR PLUMBING.,..
cony arrr 'naer reon,y of peeryoe ofthe mu g'aeamias. 50� . UNDERFLOOR MEGHAN7C;AI_ ' .
1 l have and will maintain Certificate f Contend to self asure InT wdrkrw 204-'-- 'LINDE�RFLOOR•-FRAME
'ompemahon ,s pian Sed Tor by_Section3700 or the Libor Code for "rte s - M1- "
prfarmaneearmewpr rnwpiendn. etmiti,ieaned. 205` - UNDERFLCIOR' INSULATION
❑Ihave and will maintain w k %ColopensidionBe,ra;erequired bysgmn 301 — ROUGH.-PLUMBING
3701 m use Labor Code.fir the performance of the work f which t.perms is
Suet 1,My Work,,sa p :t In,denee eurrerand P,ry 1 • - .302 '_ TUB .x 'OR SHOWE•R'. .. -
Carder: ' PaheyNo: '' 303 — ;ROUGH MECHANICAL '
CERTIFICATION OP EXEMPTION FROM WORKERS' - - ,
COMPENSATION INSURANCE r.. .304 "' TROUGH •ELECTRICAL
(This t ea to pltd,f me perms fir 1 a ddhars :305 :— FRAME:. .
1sd,(o ) ,. .30Er HOLDOWNS .
1 employ odybe,it go,(m rte or the towhichm P' rsrk.l +t307' — IRISULAT30N'. -
Cor t ompl y am f n t r n. , become sobject m dIe workers _
Applicant anLwsarelrrna.D01e' • �7 — SHEF_TROCK.
Appy t .�!.B ., Tl I ,. ..
NOTICE TO APPLICANT If.aft k' y th C tl hwt f Ee Apt on yaa should 309 — ';EXTERIOR LATH
1
become- n,, nvheW k Compensation p . + f the Labor Code,you most '
O G Tann 'd ply w.h suchp :ons or recruit bar rte deeper!revoked. 310 — INTERIOR _LATH
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E'er CONS I'RUCTION LENDING AG ENCY , '311 . �• SCF ATCH,'COAT, _
WI here by offrm,huh onewe"ian lending agency hiring porfonunnc,�, of work for which h p issue(](Se 3097 Civ,C) 313 — 'ROOF NAIL .
a,Q Lenders Name _ (1. . S
Leal Ada :. 501, — FINAL ELECTRICAL 'ENERGY -
0fearpit ' 602 — FINAL PLUMBING ENERGY
if mtlh Jm'. t n ndTt Ik t,l b [ uone T x
court 1 gree to comply th all eat'and It' d ata Imo Its -mining
O v ,ab ld g ., 1 do by ,n , t tinn ilyt e to e n " 503 - FINAL. MECHANICAL ENERGY- '
w men dproperty r Iyand P firrialc4s the City p SQ14 NAL BUILDING ENERGY
s
QA liabilities j dB ,em. c is d ow,w ,I keep which may in any act,a Convention
age ,f said -
�-t "S05 FL'-ELECT,RICALa
C..) APPLI NTUNDERST kDSAND Ws OMPLY WITH LLN -POINT C '��r Z� •�� ' '
soux'� E,uLATIOrvs - 10 "0� ' Issued by 505 . ,ht TEST- Date p
S, r .1Appucoal mrae"ur . Data. , -Re-roofs '507'-= ..FINAI_ ,PLUMBING
. HAZARDOUSS TEk1ALS DISCLOSURE.'
Will no appuwnt or future building oceupam stare or handle Iia,ord as material .'Type of Roof`-f 013 — FINAL. 'MECHANICAL _ -
,s defined by the Caroming,Municipal Code,Come,9.12,and the Health mW Safety,
Cod s t 255321) 509: — FINAL. GRADE ,, � - x -
°Ye,"v IONo. All roofs sh kllUg idspgctfojoior ppLaM4I94$.iM material being Installed.
Wdr,hatili,fician or hman,b 'la' g P t' e pmp e , dei s wInch If a roof is iUp4,edy✓ifhji A[stq�j t�+ me an I on, 1 agree to remove
emuM1 d , ,. .dl dbY the bay A Q IIY''+Ian'gemean r F.'` g
f D„ all new mateed����lS for intI��g$����((��__on�t� t curt' e��t�nds•and will comply'with
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°Y: °N all non-poinCsYftrce,re$tf}'Jt15ns, llll
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I n n 1 d , 1t d ch n, 595 nhn 603 — OOF -BATTENS
CaliforniaH nn&srlyem ser :25505tit14 d25534 sponsi1 i , vhm —'604 ROOF 'Ill PROGRESS .r
'fthe building' d l Safety Code.
tenant, M1255 y 25 'b I'ry, ad the A— .I
'�ap fin e4i,emens whch mast h pner 1. ssunce ,ra Cordiiia 1 .'.+to Za Qts .Signature of Applicant r t, Date -
owneraraamorieedagen, -
/Date " - All roof coveringsto be'Class `B" or better
OFFICE',..