00060056 CITY OF CUPERTINO'
BUILDINGBUILDINGAFS
DkurvvsfoN PERMIT CONTRACTOR INFORMATION:
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OWNERS NAME:, - t,:S` f APPLICA9'ION SUB DATE
'HONE.:.. r_ -_d. .y, r "r „ Y - ... SANITARYNO,' 'CON'FROLNO.'
G se z ARCHITF.CTXNGINEER,- - r - - ,BUILDING PERMITINFO
head F " "BLDG 'i LLf:Cr PLUMB" MUCH
LICENSED CONI RACTOR S DECLARATION
z8-_�' - 1I fyfl,ladtl f d. a p of Chapter 9(' ng Job Description.
KzCad wihS t 9,101➢ fD - on3 of thL Bi lad Profess' C d .,id ehyl -
qww< on,will f 'e end cRtct; " SF,DWL.
E. Dat ••.� ne Clr: C k" .. 1.
3 m ARCHITECTS DECLARATION
��a, 1 I r 1 plan,,hill he teed public nenrn. + �'.�i A ��. I
Hapo Lic dP f iI ' ,V/� I I '
dS I ILL
OWNER-BUILDERexecrofrom
the RATION NOV, O S,ZOOI
u� - ng to R d 703 x pes to L , , l: ,,ca ty
Z 6 fullowing Laso,.(Section]1131 5,Bus to J Profdssoa.Calc Any Lot,or L ante E.
D wmm�rcqulrcs a parml,m mtu¢ucq alma mtprave,Jeinole alar manor any structure
pm , , . q ,n 'pPl ,f 11 '„ fl n 6 d „encu .` y
a ,cin l dp c tn-p nh Contract. 1 L (usCar9 Sq. Ft:Floor Area .` BV� ���� : Valuation
at 6 ,I Su, ]000) f D' 3 fin B d P f:.' Codc)
ur the
,he'is excurd houchoin and the basis for the lleged ascription Any v aWudn ' -
ofSection 7031.5 lay ar1 applicanafinor a drout subjects,he applican t to it covin penalty
oro , o,etheir fiveheaded mown.(s5a). t - APN'Number LEI. - :r ;'Occupancy', ype
❑1.us ownar of No property,or niy cmplayeos with wages vs,heir,arle wmpen.minn.
will it.tire work,and I,,:, , ,hoarded or uttered f rel-'(S 9844 L, „
Business,land Probes.ot.Cnae:lho.Contractor s LEEE Law doe,oot...1, Required Inspections
owne,oflu.,dEryWn h lit,or necroses flue7vo,load he d ,,all workhm if
or through his ply provided,n,
' - h-'- p L' o ton la:ded. r _ 10 = FOUNDATION,offeredf IfI dmbnlding p tId Fneyour or
mp t d tndd Evill t h d fr rymNhe id tb'ld r 10.2 PIERS: ) ]'03 LFERne arl "(,Party, It g licensed , , ,
the pi (s 9o44Bsinss Lal t. Contractor',
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Cacoo, .
l . REBAR
Le L d , p,I, fp lay h b
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old who contractsr i'.,iamn with a onmcla(s)oversell parsieurt.. the A05_ —, ANCHOR BOLTS;
License co ,actorsr, Lill.
I dors B&P cr mo
' its 1.06 — SEWER R' WATER.
oatoe . . ta�mp..
U,no I<ERNco, eNsnnougccl.an�loH "— 202 '- ' I.INDERFL•'OOR•_,PLUMBI.NGWOR ,''
«eby,rmnundepe,pl,yarp a anemmaron ,�deelara,nn. 50�r '.; .'UNDERFLOOR �MECHANTCAL '
+ 2204"' ,z; UNDERFLOOR. FRAME
1 have and "II C rrf m i Consent to. If'. far Worker.,
p l 'd o f n s t Bunn r me Lee... Cute, for one �� 05 `—1 IN
DERFLDOR INSLN_ATI,ON''.''
perfarearce ofthe work for Much.litsP ht is issued.
301-41 ROUGH., PLUMBING
❑I h d 'll t W k Capirocation lartericau,a,octal by Section — -
39(N1 roe labor Code for the-aomo„n,rne rune work r,wn drill,permits �" 302 — TUB 'R" OR SHOWER . ..
i....ed My Workar'.C top 1i....loseTalice carrier suit Policy nunbcr o . , -- '
303 — TROUGH--MECHANLGAL
Corner:- CERTIFICATIONOFMEMPPolicy ]ON FROM WORKERS' 364' — -ROUGH ELECTRICAL
COMPENSATION INSURANCE 1 305. . FRAME
'
a (l
(Th':sectionn a con becorrelated nh pemdlhm h,ndir ll .306 ".H LAOWNS ' .
l$In0) bless)
Q" w
loy that nareperae b
,mlo, ane work for nc
wn of pe,ro,f.....r 'I '• 3107 -" ' .INSULRT I;DN.'
l cer
sinal , pl y' S En lady o ,so o,to bacon subject to me Worker.; 308_ .SHEETROCI'S
Applicant .. -
-Co P usuiou Laws tf Cal'forna Dole me '
,.30� .— •EXTERIOR- :LATH
NOTICE TOAPPLICANT II after ok g'his Ccnuflcaac tAccon"ItOr You:huld r '
.ZVI 31 TNTERIOR LATH forthwith P
Z ) 311SCRATCH COAT,CONSTRUCTIONLPNDINGAGhNCV
a;� ! hmeny,fr' a'tmrc wit)r,lendogagene)mrtheprrrarnonce 31.3 - ROOF' NAIL,
of the rk 1 which this P o issued(Sec.3099 civ.C.)
w q Lend N e :50] . — FINAL ELECTRICRI ENERGY
Z
Leader',Addia - - 1
, U � to ,rym In edln ..ppuer d „ m,n labrr ,
502 — 'F7NAI_ PLUMBING' ENERGY
ford" Iagree "oplvw,hnucity anf ,yard",lanes td aces lacksreDang S03 — FINAL MECHRNIG,AL ENERGY
0 C) tohald g n.h 9ue Ih by II p t I, rant city in a rupan ,
W the ab edproperty r p t purposes, 504 'k, FINAL BUILDING ENERGY .
Q. (W)agree l cce.indernuff,canalkeep n in,City fCntr ogalxl'
. m wmdifs judg aL costs L d vs,ara,Eshich 'y to veagainst laid :505 —. FINAL- ELECTRICAL "
U'Z City n u Lgpnnce of @ gran,ng of th " r
APPA ANTUNDF STa 'UsDW OMPLYWITHAL NON DINT SCh6• •GE(8 TEST
s(M �ULATI N . (o . Issued by:
Su alio ofAppl' HAZARDOUS TERIALS DISCLOSURE, D m Re-roofs ,. 508 — ,FINAL' MECHANICAL'' ,
Will the applicant a,fill...building occupant store oro dl n .Nus mmenaf .'Type of Roof - - _
as conned by the Cnpen' MEL Code,Chopla,9fz and ne H�lm,nd surely . 509--171 FINAL. GRADE ' at
Cod S , 25532D ,
❑v.' CI No - - , Al] roofs sha��5 tQ1,inti inspect Art Aho 1 r`' - gri•I beinginstalled.
Will d ppI n t future n 'Ids "p Ia p I h which If a roof is in5ta'l l0'd wttlfo R,o � �'�n ftb ;I agree to remove
c limb :sora' Lo I: : Ihuedbyth Bay Area A Quality Managmnent g
Dish all new ma[etFitl�b 'or igs? UikFin. FA0,114 {fin etas and will comply with `
ores
Cl No" all non-point {yl e,'reg ®(mss. BATTENS"
• In lit n N . t '�I q' ,. ' I cup, 6,95 fore 604 `-ROGFF IN-PROGRESS. "
Cnl'f Health @Safety C d S , 25505 25533' d25534 Iunderstandth't
ro
With,bila role not� tlyn I[f I fbar l' y p '6Tty, fly,h A " ,. , v '�• ,
' Oa up Pt aRha rLqu rL Cv wh ch m rt i p'lar m ., f v Cottilla t [ -
mcy
�.�J. Signature of A�ppLcant` ,I r Date)
G orb ,n,horeedagea, , l nate ' • All roof coverings to be Class•"B" or;be'tter,,, -
. , '" ,