00060165 CITY OF cUPERTINO CONTRACTOR INFORMATION:
DIVISION PERMIT.
BUILDING ADDRESS:. . - PERMIT NO.
(IWNER'g NA r_ _ - .• ',S INTERNATIONAL A'PL I
65
E -EAB RD
PHONE:Y , ( SANITARY N r (1,
v , .
t
Opp ARCHIERCI'EllsGINHER: - — - BUILDING PERMIT INFO' r
w- •IILDG ELECT PLUMB• MECU
LICENSED CONTRAC'IOWS OECLAI [ON lob Description '
_ 1 items,affirm tha 1 ana licensed utitle,provlxlnnx alChapter 9(comnmoving
F_t-w with Sutinn](KK))of Divixion7ol the Business and Prore,,ions CoJeandmyliceme -
a Y g j is in full force and effect.
License CI... Lie.. KITCHEN. REMODE
Hie a� D::m ••ctr�rae�ar.
3 F ARCHITECT'S DECLARAT]ON ~
C u 1 understanding plans shall hatted
e uiM us public iceord, /
H
_Qp0 Is 11 f.. _ I� -
L o Py OWNER 1exemptLr DI CLARAl10N - ` - - .`/ ,
a•1 I hereby rfrm that I am exempt s m the Contractor's ; ansa t4. for the u/-
h Z<
following (S ion]on ru Business J Prot Cwt Any l4. county
O ,
I i O wti h ,u rvs d per l i re comm et ppl p t such
Jan:Fish, r repo r any sat nice
a. 'h t t: aL 4 ep t.pr of Ip It IIsigned Le te9 ( . • _ -
mann licensed p . m o : nI Contractors 1 I (Clostern) Sy. Ft. Floor Area ' 'Valuation
Indian
in6 with Rennin 701 of tDivi.on finds,
e,ed l tion,Any Cale)
or that he is exempt la,and ani the basis ror the ellegN exemption.Any riolnalty
e of S t ramc 71.5 by la,and, for a permit mihjetx oho npplicom m a civil sanctity
algal marc recta five hundred dol (ssnn). - - - � APN Number'' - Occu a e -
01.as awner of the property,or my employees with wages as their side compensation.
will do Ilio woak,and the notion,is not intended Cir offered on sale(Sec 70414, s _
[in ineak and Pro ....tiu Code:'Tha Comrnnnrk Lietrco Lew dnex nota (o,an `�- 41red I4NpeCtIOHS
owner nl'propeny Wilt)builds or improves thereon,and who docs such work himself
or through his own employees.provided that ouch improvements arc not intended or
offered forsale.If,however,the building or improvemcto is sold within one year of 101 — FOUNDATION • -
orrpleninn,the owwrhailder will l ova tha hiraan of proving thin he did not land or ,
Improve fmpurpou of sale.). 102 — PIERS' -0 1,as ow,tier of fire pro,vartyrom exclusively contracting with licensed contractors to 103 — UFER' ,
,omni t rhe gni si 7044.Business aW Professions Codef The Contractor's
Lieeme Low does not apply to an awner orpmpeny who lurid,or imprava mect, 1.04 —.'REBAR =
and who contracts for such projets with a emanations)licensed pursaant m the .
' ContractorsuanseLaw. 105 — ANCHOR BOLTS
El l am ctempt under Sce. ,H&PC fanhis reason 106, — SEWER & '.WATER '
Owner Dole
WORKER'S COMPENSATION DECLARATION 202^— UNDERFLOOR PLUMBING
Lhcmhy aflion antler pmrdly or,>cl_iury one of file rnnawhig:melarmiam: 203 — UNDERFLOOR MECHANICAL r.
. El 1 have and will maintain a certificate of Consent to self-insure for Workers 204 — UNDERFLOOR FRAME--
Compensation. i, provided for by Sricion 37M of the Labor cope. for the r 205 — UNDERFLOOR INSULATION
rarfarmanee of the work for which this permit is i,aial. r
301 — ROUGH PLUMBING
El 1 have and will maimain Worker's Grmpensatinnamurunca m rcquirtl by Section - •
37M of he Labor Cale,for the pcommmnce,of the work for whmn this permit i. 30?_ — TUB & 0 R SHOWER
i,.Ceti.MyWorker xeampemahanlr.Cmnaaamtytarolmy�ryntthrare: 303 - ROUGH MECHANICAL_
carries(' UFDXRMh1hI`Io. 1�}ZDy-39
CERTIFICATION OF EXEMPTION FROM WORKERS' 304 — ROUGH EI_ECTP.ICAL
COMPENSATION INSURANCE n -
TIhissethnacedamin,camplmeeIfinept.ril�, termaI adreddoiwa' - - ,305 — FRAME. -
(Elwlgrle.,.) - 306 — HOLDOWNS .
1 certify that in me pemormance or the work for whim this permit is issued, '307 — INSULATION -
,hall not card a....in
person in any manner so as to become sub,iocl m the Workers - -
cnmpenmliLow,olCalimrnia.Date 308 — SHEETROCK
Applicant
NOTICE TO APPLICANT If,after ak g this crtdcan,ofL Exemption y should 309 — EXTERIOR' LATH
O 0 h¢ -hl ret th6W kr,Cnp ;w tprol.l r:of rheI"b CJ y must '
mon mcanplyw'Ih uhp v'donaor'h Lerma lallthea calre,.k,d. . 310 — INTERIOR .LATH
F4 CONSTRUCfIONLENDING AGENCY 311 — SCRATCH COAT
ai 1 hereby aRmr that there Is a construction lending agency for the performance _
of the work for which this pennll i,Issutl(Sce.3997,Cie CJ 31.3 ROOF NAIL '
yp IanaersName
Z Landers Andras, 501 —r FINAL ELECTRICAL` ENERGY
U 4 1certify thatIlmvamad this application and xmtenwttire above mmrmationis 502 FINAL PLUMBING ENERGY
Qw F caret.I agree In cai will all city and canny ordinances and n,1c m,,ml.dns S¢13 — FINAL MECHANICAL ENERGY
I,) ro building construction,and hereby aummi.e representatives of this citya enter upon
W flan. (We) greeho,cm.ta !"r if,andn"purp°se`. 504 — FINAL BUILDING ENERGY
F„ a above
memaem property
I irypactim see,lie 'lie Caponinn ugnimn
., Z liabBhle,,;adgmmrl,,cn,1,and ,wave,whluh may day way l...me again,,said frhi, 505 — FINAL ELECTRICAL'
V ti City in co"segaence ar the rm
gniag apermit.
APPLICANT UNDER DS D WILL COMPLY WITH ALL[JON-POINT Issued . 506 — GAS TEST 23
E U TI S. /__�' /.�� YI — DBIC / ^
ICJ C..l-LAJ
It axrea App reariCon i' lir [).,aRe-roofs 507-7
..
IIAZAI. OUSMA'1'F:RIALSDISChOSURC 508 — FINAL_ MECHANICAL -
wn f ppream Mali b Code,Chapter 912.and
the
n exalt . Safety' .Type of Roof .
Code, anymec ant endu 9,hz ananteHe Health and Safety 509 — FINAL GRADE
Code,S.don25fl2U1
0 Yes No
- All roofs shall llh$pecteff�tMlr�ko't -I36�1hM42tterial being installed.
Will the applicant r, t hammgaccapanlmeewpm m J x,sahich If a roof is insta$dtkiwithoff T)NAbbt;IE tjRU1Qts0QRM9 agree to remove
• trot hatanlmn nl.cn.an at 1,as Jefire, by the I,Arco An Q""liry Mimuge nern
Dimrmrl "Irk.,
all new materials for inspection. Applicant understands and 'will comply with
Elvf, _ � ", all non-point source re ulations.
I hatic mal tic lavaii all climate, car,underCh1pur(„)5 i t the
Chipman n' II dalth&ofSnarly Code,Sit nant,met
itis d 25514 1 p .I A nM1ut
if the Wildingd n currently have alcnam telt :my r
capsonsithilityt Fry the
occupant of of the myu re Ilia It he mel pr r roto issuance of a Cenificme of
Signature of Appli ant Date
Dwmar nr.al o�:ca agent Date I All roof coverings to be Class "B”or better ,