01050133 CITY OF CUPERTINO
BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION:
HUII,DING ADDRESS: PERMIT NO.
(1)F.
OWNER'S NAME: APPLICATION SUB DATE
ry.Pinywhinr POO 1
TI
(INE: n SANITARY NO. CONTROL NO.
n z Z ARCHITECDENGINEER: BUILDING PERMIT INFO
z O O BL ELECT PLUMB MECH
Nd
<o
Nj LICENSED C licensed Ill
DECLARATION ]Ob Descrl Ion
oy_o I hereby affirnn than am IiecnscA under prnvl.inns of Cbupter9(commencing
F-@�'i with Section 70g)of Division 3 of the Businc.,and Pmfcs,iun,Cale.and my license
in full fora and effect.
�eewa is in
Lic.N ' REROOF.
3a N Dae LL �e• _
AItCHI'IISC
' I'S DECLARATION
EDECLAARATION
f:'y—`i O 4 � I unJcntunJ my plans shall M awJ as public recoN. -
w y pO Lie enveJ l'rorenaional !� /
G ad o T Oat I or comp, R DECLARATION -+ O
w=,�, naso .(firm that I am exempt from the Contractor License Law for the A1
following reason.(Section]1131.5.Businessland tePru&..ions Code:Any city or county DIw1 G
ac�D which requires n hermit m consvnat,alter.innprove,dnnnlish,or rapmr any,werum UIL 1v
•�3_ prior its conduct.also inception the applicant for such pmmino file a signed internal
math,I,Edcn.en......almthe pmvi,int,.,,rdeCnnowho,leen.eLawtChnpmr9 Sq. FL Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Professions Cale)
lir(hut he is enempt mit nnn and the haste panic allegcA exemption.Any ululation
of Section 7031.5 by uny applicant far a pe.it s.hjcr,,the applicant m u.,it penalty _
ofnot mo„than five hundred dollars(S500). APN Number Occupancy ype
01,as owner of the popery,or my emphiya.with wages a.lhcinolc compcnsaion, e
will do me work,and he Irr,m,i,ran intended ,,offered bor sale(Sec.Hua. Required Inspections
Buord,and Prom%sions Code End Cnntracmr's License Law docs not apply an an q .
„Wn`r or PmpenY Who build,or impnrvcs mcrcmn,and vino duan a.c11 work bmnalf
mugh his own employee.,provided that such improvements are not intended or - 305 — FRAME
offered for sale.If,however,the building or improvement is sold within one year of
aml,letan,mcowner-nuildcrwiu have the burden of,sroving that he did nmbadar, 307 — INSULATIONmiprr,.c for pntprne of,di,.l.
„nbeproperty.amexclusively contracting with rcensedcontracmr 601 — ROOF TEAR OFF
ndrxnne project(sae 70,14,Businc.,and Pmfc,ran,Cale)Tbc Cantmeldr's 60c — ROOF F'I_YWOOD NAIL
pierse Law does no, loan owner of pmpenr won Huila%or improves meteor.
and who contracts far such project,with a tontmaon,)licensed pursumn m me 603 — ROOF BATTENS -
Cammcmr's Licunw L: ,
01 an.ea ,t der ed .R - rthnmoon 60!t — ROOF IN—PROGRESS - -
one, I Do
l —:'SAT ION DECLARATION
ereby affirm under penalty of perjury one Lir the fnllox log Acdam;ism: -
7 use and will maintain a Ccnifictim of Consent u,s f-insum for W'orker's
pcnwtlor. as provided for by Section 3700 of the Labor Code, for the
pe conduct,of the work for%I ich this permit is issued
0I blue and will maintain Workets Com,samnion Imumnce,u,required by Section
37M of the Labor Calc,for the performance of the work for which this peorit i,
owed.My Worker's Contpersat oo Insurance canter and Policy number are:
Canlcr. Pill i,,Nn.:
CERTIFICATION Of:EXEMPTION FROM WORKERS -
COMPENSATION INSURANCE
(Tmis section need not lie completed it the quina i,for one hundred dollars -
Sigo m Iccl
I cenify thin in In,perf.rm:ecce Lir the work fur which Thi,permit i,i„aed.1 i
shall not employ uny Person in any manner so an or hcome subject to the Worker'
Comlxnsninn Laws or Califontiu.[)are +
Applicant
NOTICE TO APPLICANT:If,after making this CoNficme of Esmnplio I,you should
Q Qwnbe subject the Workers Cmnlcnsn,on pros•nsion,of the lalaa Code,you moa
mm fnnhwith comply with such pownions or this Permit shall be deemed rooked.
z —
F N CONSTRUCT ION LENDING AGENCY
�. I hereby orlon that there is a conetmmum lending agency Iia the perfonimnm
of he work Iia which this permit is issued(See.3197.Civ,C.)
I"naer'n Namez LealAdd....
I certify that l lnvu read 1111,applidatlon and.cnc that theabove infiltration is
+• F.. correct.1 agate or comply with all city and county ordinances and dam laws reining
C.) mbuildingeo.sswnion,and hereby oumarim repre,cnaaivde Id his city m enmrupon
} W the apse-mentioned properly for inspection purpmaea.
C. (We)ugrecrosimc.indemnify and keep hanlne the City of Cupcnino uguina
In Iinbil'uie,,judgment„co,� �and enpenws�wh§gh limy in any way accord agar said
C„j z City ina,ns I UNDe YrtK Bmt)A of DmnsatbCOl
Sol, -AN'I'UND'!p'/OIAD SS AND ffLCLCOMPLYWII'IIALLNON-POINT Issued S
SOH. _ ;GUL. C Y� Date
st but.reor the )Comamn ame-
HALARDOU Re-roofs
E
ill 0 applicant or lam,,huildimg'Kcupant fort or handle hareardom material Type of Roof
teed the Cupertino Municipal Qde,Chapter 9.12,and be Hcai n and Sure,
Coda,Sc ran 25532(a)7
r'es 0 N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
color Ilii...,air roannirem,susdefined by the Bay Arca Air Qrifi,Mater,ner, p
I'i,tdct” all new materials for inspection. Applicant understands and will comply with
"" all non-point source regulations.
PP p y
1 have read the l maton,2 requi mem,under Chapter h95 of the
of the Irnin Health clye, s'vta tenant.
55s ary ow5534.Imdcnoli fits
over
uilJi lieu ea,be at itismyrdupon.i,ga m rill the
n m 4 r, min mnt.t be ct plasm n,nnnod ora ccnificare ar -
da pa cy Signature of Applicant Date
ow raamm t agent Drum All roof coverings to be Class "B"or better
OFFICE
FROM Lee, FAX NO. 406-446-1091 Apr. 24 2002 03:03PM P1
I •
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is
CISY OP'CVY1Ff'N'.- " - - O - --
nI!n.ul"aUnLSfOPERMIT
CONTR?iCTOR INFUKh12lTIClN
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1 TNrIH;IT(:17EN(,Il,uf.PR', !'Mi1\'l:: ii1;11.UINC�I RMfI'INPO
1';.11116
5 x . GL INSPECTI N _-.__.......,.—._..-.___
i w r INSPECDONS DATF, iNSPEC. TO^R ' ,106 DESCRIPTION
z± t nl,l.�-322$Ni ND.vY.PRIDA 24 HOURS Rac1nENTIAI.:
n BGPORF .....i1RFIi.NSPFC'.TION. OBADDRESS
r V.Z FOURUAI'i0\(PIEriSf.H.U.S, U SFDWL U KITCHEN REMODI
0 - AND PFRAT a.ARE NEED)Vi'H ;N PHNNG. � ADDITION ❑PLUMBING 2F,P[PI
El tlrrR rRQUND
f_ Li NfULfi-LNII' f_1 STRUCTVR.AL
s 3 PgDISFT BACK-CER I' I RESIDENTIAL _ C'UNIMERC al. OTHER. _ MODIFICATION
°. RAGE SL,\RS/PRF(IU\ITF
HA%,\RI)OUS FII .'\ LJ 1N'I'ERIOR L SWIMMING
REPAIR
LLC - ._..,. .
!y n_, 6 NO GONCP.ETE UIJT(C.4801 r IIA\PiFES SIGN'Ep INIPRob'EA9GNr n S\Yf:W9{INc POOL;
a^ rl RXYH RF.NIODFUREEUR J DENIOLITIO:N
idUNDERGROUNDrSLAH ;: YE:i !i)�, Iw,d.:w:•d tl:rr,Clu:... ,...:mNy I.ryllh-.l.
S°z�-- -- I � � III OTHER
4" PLUM BINC,
NO Initial
F`<<, ELCCTRICiL
a n D .Ej ITKIFLOORUNTIL`.A13QVEHASBEQa
NSIGNED ICICTIVGF )9( F'CO{IEFILG
J NEW BLDG/ADDITION �I DEMOLITION
i� 1'L'NANT LI 1'OVUS6KvICP.
PLUMBING Nwn6cr of e:istine cun:rim:>_,. IMPROV LNIENT
MLLCH.ANIC'AI. I,-I UCIfcR
FR.A171G GENTS
lN5UL.4TIGN TYPE OF ROOF COVERING
%AC 'O; lffi;00R I IN'TibAB@%'L dal BF.iiN SIG?FD PROP'1CFD
I<UUF CiI( iuic-
iI HIDfgPHiL ANI Lt�TI� �/�—
M.UMBING = llL'?rirnf G 6n,11'iip Rn:^
�TCB�.S.Q SHOWER PAN T
I „7EC;linNICAL _ \bad Sk;kc. ] N'u.:,l SLaktc
LLLCTRICAUPOOL EONLt 7 tVon[I Sl:im_Ic: ❑ l4noA SL;mtica
FRAMING/ST.aIAS/II.EGRESS I _ UIh<r(ipaciry)_. ._. U Ou;er(SpztiifY)
INSUL.ArumNLNTILnnoN Prouidrl.0B.O.Report No.
__
-(AYV,F.R N,(>W('I,RK..UNTIt1.>Bi1V,li�11.1 BEEN.SIGNED Prrrvide Nltr.Ine¢,Ir.Iion Sp,,-� E 5HIL�WHOLU DOW\ .
IN"!'IRIOR�SHF.AR/HOLD DOWN -
>,HHhrRf)CK:SHEETROCKS_HFAR INSPFCTION SPLCI.'1L1NSPLC'I'ION REQUIRED FJ DArF ni
�XTF.RIOR LATHAV-SCREED _ -
IOWFR LATH S /^
i-APF.1OR%fT-aS•rEK�u,:�TR, OOC'L IIAS BEEN SIGNED
SC'RATC'I-I CO.P(FTFMPORARY
APPROV-'d.iP{NCY
I
1-Cfn1e�C
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HANDICAP
U ^ ELECTRICAL
PLUMBINU
L-j NfF(HANICAL
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ENERGY
CCUPANCY OF EVILDIN,Ll Sv
OT PERaIITTFL)
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PRF-INSPLCTION:
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SHA AP -------------- FIn' Ulv 1),VPL,
PF?OVED ACCESS To R FS ----------
A., HALL BE PROVIDE
---- APPLIC.4n
POS7'1,yccopy
OF? /IVSPS
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