01020061 CITY OF CUPERTINO -
nmLnwc mvlsfory '`' CONTRACTOR INFORMATION ={ = -
PERMIT '- x,
` BUILDINGADDRESS. - PERMIT NO.
'10510 CYPRESS DR LEE RAYMOND K AND JUDY . 0 01020061.
OWNER'S NAME. " I APPLICATION SUB DATE
LEE- RAYMOND K AND:;IUDY C :. 'J.: . : 1 102/1 4./2 1 001
GONE:., •, _+ _ "SANITARY NO. , CONTROL NO.
OQZO ARCHITECT/ENGINEER: ., - - B UILDING PERMIT INFO
BLDG F.CUT PLUMB,i MECH
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F'¢o
LCONTRACTORS DECLARATIONN
: ,hereby'Rnebut i licensed d provisions of Chapter9 I r e 'nx �. Job Description,
bn
r<4twith Section-7000)ofEuvision 3oftne B ince,andP Ew, Code ad my le tie -
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Is I.fulldPub , -
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Lecomie Class Lea.to ADD ITION•',286 SO FT •
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XOyU Date I I . -
w 3 w e - _ARCHITECT'S DECLARATION „ •e' "
�� I andeveram,dum, liall b a,rd a, addi,re6ord,
w�ao
LicensedP f meol.: FIIlIALED'
°i X n OWNER BUILDER DFCI ARA1'ION nJUL O n rsoo�
w I I by affirm than l m exempt from theContractor's L l 1 the 4 L
'b 6 toll y
(S,,fion 70315,R:' d P f: Code A Y ca,or coma, f .
O wh I
'umsa vinnit I tonsured, II prove,olemaxish,or repaiiy sirimare
pilot to itoa also exprim,theappleendfor such pe t to file a signed statp •''+ !. - -
he,If,I,Ic wd ratifiedI het :of the Compact...License La (Chapter 9 S Ft Floor Area ation
(eo nmy a h Section 7000)of D s,me 3 of Bus tie and Pmfwv ens Cade) q'
'A or that he,x axetil I f m •fro • -
p 1 rc m d the sn I the olleged exemption Any Iona on ... '. •;r
of rnSecmn7115 byay PPC la 'pe' t:hJens the pPlicam mac vii peulty P , y ,.,
not nm man nee I I mrw donate fsso). APN Number n � Occu ono Type
e •
❑i,"—,vrc,oI de p,,pcdy,or my naplaycer wnh'wuxd-s ns men stele compun.afian. ' .
will Jo the work,and the struemrc lx not intended or offered fur sale(Sec.7044, r
Required Inspections
Bu: a Pnresnio Code:Tneconl t License I, a of apply to til ,
wn fp p ty wn n 'IJ. 'tip a th - I n 1 n
k himself ,
though hiply provided that sn improvements are 1101 inuendealor 10x1-. FOUNDATION f.
pl
offeredf I vh n n 'av'y improvement n r ,.. + 102• — PIERS "
c theh Id willh heIborder fpin,door he did Ih ' I IJ -
IS
J p m r ) 1.03 — UFER
i id'f ,wimr oft property. exclusivelycontracting hi l d t cf +consumer -
d prof t(Set,7044 B .' e P 1. ' :Coal TheC t., 1 d-- 104, REBAR 1 -
License Law does rel apply to an owner of property who builds ormpmvice there,o,. '
and woo..c.on�tr,a�c�ts for such projentr wim a cdntractorc,).bcemed pureacnt to he 105 ANCHORf..BOLTS -'.
oil / pt �azrs .B n.PChallI,re: 106 SEWER $ WATER s
war?
o.��e t `. 202y:,.- .,UNDERFLOOR,,.PLUMBI,N6
\ ORKLk ti COMPENSA'CION DECLARAl10N y
203 — UNDERFLOOR MECHANTCAL
nlrtn under rnnmty m;pe�m,orroddre fonowmxda=iararon.: l X04 - UNDERFLOOR, FRAME .
EJI has. 1 II - t C t f e c I f C n to If' . ref- W rker's ,2�5 — _
Cone nI alar ny s t a 3700 f me un Code ror the UNDERFLOOR INSULRTIOM
.perfixerance ofn k lor whichtb' peraut is issued. "' 301 ,:.— ROUGH: PLUMB'ING:
❑In e 11' W off',Compensation lrealhys tion 302`— 'TUB & _OR SHOWER ,
3700 f heLob Code f theped f thek f 11 INpn nlil is
s,aedMy)smkv,sCom,xn,atonmsuriuniRer ,dPolaynnmef,pro 303 ROUGH MECHANICAL �l
earner: ' PalmyNo,, y 304 — ',ROLIGH, ELECTRICAL
Cf RTIFICAI ION OF EXEMPI ION FROM WORKERS
COMPENSATION INSURANCE 4 ' 305 ,,-. FRAME_ - P ,
(Thikwatiornicedrollop,tfl,Pleled'rmerenTaformehunlmldollln 306 — HOLDOWNS''' t
(s mo) Iva,) - - :TNSULATI'ON .
shah employ,
pl y hanIy'np,sonvin
nany manner So a
al,rte -.kIsubject
f whirl u n1 p t t niiniti's worurkneer,.I .. SHEE'TROCN
Compensation Laws of California.Date 308 ,
Appl - -
NOICICOCANT al 'k i 003 — .EXTERIOR,,LA.T'
H-. .t
Z bend IhJ subject to the Workers Co pc t previsions
f theLab Code you rumor 310 \:- INTERIOR LATH .,
'
- ,-
°
7 ,
fonM1 th comply x lh v h p snonr or Ih p i n t xhnl l sed mcd n.rnknd. - -\
- 011 SCRATCH—,COAT,.f
r^� y CONSTRUCTION 1 ENDING AGENCY
C ,heebyoffrmt Id r .If lending raeneyfor hepem —rma e, 313 ROOF ,NAIL T.,
'he workf whehll lentil x ssued(Sec.3197.C'v C) y. +
E, LendName 501 — FINAL ELECTRICAL ENERGY"
o z `Cres Adv 502 — 'FINAL I PLUMBING• ENERGY
u p
tI' bryhat omId . Pyl' I andstate
'I thatthe
n n 'ty'tr o
formal.l I comply tB I d I ordinancese v e it p s
503;'— FI'NAL' MECHAN,ICALG:ENERG.'
Y,.
tlbuilding s ebs h
he h I d ly I :P tP P -
504, FINAL BUTCDING ENERGY
(Wr).gare indpartail'yandk plrtI :h cty ofComforlievoR,rind ''`..� l9 -505, -1".FI.NRLs ELECTRICRL,prE'`- .
rn liablt Jdoo I lend pe ': I h aymany y' ame agonssand -j
-U Z Clly :y ,, fm s lix fth'xp 0't. '506 GAS TEST '} 2. Z-n (n
�( ��'SU RC LG A� }' NDS AND WILL COMPLV WITH ALC NON P 11T, ' Issued by: _ Date, `
3�az a907
pllcHAZ tR—� DI "Re-roofs' 508.`— FINAL MECHANICAL
HAZARDOUS MATERIALS DISCLOSURE � x,
Wnthenpplcanl It nnwlnx p ..t orb m1 n 1 ler al. Type of Roof'
d ,509, .r FINAL GRADE
u, l d by d Cupertino M p I Conte,Crude,9.12 I t h Health d Safety
Code Section 25532(a) - '
❑Y. El No * ° All roofs shall b �gls0ectedFl}�Ny,AtgLa�F�''LA HN�,I.[�N�C.ti�[,� in installed.
1 w'11 a ppl I" r t b mi Ix c , t se nycpt .I d e which If a roof is installed without fi4Sf ol3[aifirfi 1 iSLHI�aee to remove
smith donsair ennannna,,a,JefnneJhytheBayA.Air QlltyMatingsnen P g
Diarist+ . all new.materials.for inspection. Applicant understands and,will comply with
oYe.� ;o No • -all non-point.source regulations.
I have read the hamNous materials m plircomer,under Chapter 695 of me -
Calil Hodh Re Sarnar, S T ?550525533 anJ255}4I d .f tJ tint _
.. Hthehu'11. xd snm,amentlY nrvcamo I flat it a y , nab lltyl ffy th ') �C
the requirements which must he et prior issuance of s Certificate of
O.aramy -'.• - - .
3 i-t D1 Signature'ofApplicant, _ Date
ihnrlxc a I at
to
-a :All roof coverings to be Class `B".or better - x
OFFICE '