00090064 . - -- - -- -- `-- - --"
BUILDING DIVISION PERMIT '
CITY OF COPERTINO CONTR_ACTOR.INFORMATIONc
BUILDING ADDRESS: PERM[F,NO. ,
00090064 '
OWNER'S NAME: APPLICATION SUB DA'I'H14ARPT.19901 RnSERT 1- AND "
09/13/2000 .x .
PHONE: - SANITARY NO. CONTROL NO. -
qo CHHF.CDENGINEEW `' BUILDING PERMIT INFO
ce w BLDG- ELECT PLUMB MECII '
u
III. 6 Z� O J ITI• LUJ
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Zlz v 3 LICPNSEU CONI'RACI'Gaia DECLARATION Job Description
z y= 1 hereby ntiirm ivi 1 n 3 offs B nines p anti
Piuns of drag¢..)ndmmenense
i, F,Ii:_'�J with section 7011(p of Division Sof my Business vin Pmles.ians Gde,and my license
in full tome and eft �. ��./(t' � /�
�o1a LinnseClaa-' Lie # �y�/x/�8!6 ADDITION' TO MASTER BEDROOM!ELECT .
3 a N Dae 0 • (k.-P_W Contmcart-/Ij_gpyy({tyKf� .
w C ARCHITIEd IlEC1.ARAlION'//\ 1"
F Lai 1 understand my plans shall M used as public metals
pK} �►A E
Licenxd Pmfcxinnal � TD
k o z OWNER-BUILDER DECLARATION -
w_m I brach,v1Brm Baa 1 em excnfpB from Bhe Cmdracv's Licence Law for Bhe ���
F Z G following rwawm.(Section 9031.5,Business and Professions Ctdu:Any city or county
Otcs which requires a permit to construct.alter,improve,demolish or repair any amemre J O
ada. prior Bo itsissuance,also requires the applicant for such proud in file a signed uatcownt
mar he nslicemed I....al to the pnwmons of me Contractors License low(Chapter 9. 'Sq.'Ft. Floor Area Va U tion -
(commencing with Section 7q)0)of Division)of the Businessand Professions Cole) -
or that he is exempt therefrom and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for v prmtit subjects IneaPPllcanl to v civil Penalty
of not more man Five hundred dollars($500). -- APN Number ncy Type
01.a,mciri of me property.or my employees with wag-as lhe{r wle compensation, '
will do be work,and the structure is not formed ur offered for sale(Sec.7044. •-
40. VIL
Business cad Prore;,htns Code:The,cmar mm:c Liere"pass di oro apply at an Required Inspections
or of progeny Who build,nr impnnxs mm,and who ds such work himself
or therathough his pwa employee.:prospect that such imp.mxment ere nut intended •1 01 — FOUNDATION '
offered for,ale.IL however,the building or improvement ix sold within one year of '
ompl,fon,Bhe ox mer huilder will have the huNen of proving that he did not build or �` — .BIERS
improve for purpose of sale.).
0a ruoxther ofineproperty,am exsiness acontractingwithacfawdeontmact to
:103 — UFER
icenseet Brie project(Sec.
appl 7000,Business pm rrofcainm GdoO The.c,tmae'„' '104 — RF_BAP.
Licence Law docs not apply man projects
w of progeny who Halide se purse s thio the
and who Lic,d for men p.memv with a enntracro a)Eran.re pursuant m BM1e 105 — ANCHOR BOLTS .
Cnmmcmrc Licence Lew.. -
Olan,exemptunderSec. .B&PCfntthis fervor, 106 — SEWER' RWATER . .
owner Dar 202 — UNDERFLOOR PLUMBING
• WORKER'S COMPENSATION DECLARKI'ION `
Inercn
hereby arrn under Penner nr Perin..Ona of the following declarations: . 203 — UNDERFLOOR MECHANI CAI_
— UNDERFLOIIR FRAME .
❑ I hove and will marina u Cmitictne of Consent m cdf-ireurc for Worker's 204•. '
.ompansah,n, a. pnoided sur br seetinn 3710 ..1 the Labor e..ae, ha he . 205 - I-INDERFI_OOR ' INSULATION -
rformvnceof me work far which this permit x koned!
301 — ROUGH PLUMBING
I) if the will maintain worker eCa....vc inn a w...k e.for
thieh his
by S is .
3700..r me Lala,r e..ae,sur the perrurmamce..r me work sur whim mm pe.nm h 302 '- 1"I,JB �' OR SFIOIdEft .
issued.Mywsakerccdmprnaanonm>nmance canicr:mdpolicy another
are:
303' — ROUGH MECHANICAL.
Carrier. CERfIFICAI'ION 01: ix]IMPHONFFROM WORKERS' 304', ROUGH ELECTRICAL
-COMPENSATION INSURANC17 - r
305-' — FRAME
(Thissmti..n Head dm be conIord,d it ran lmmdl ie ane a bumhed d..h”` p„IF ' MI OI�nONhIS
- ($1001...less.) • - ` - - t
1 certify mal in me p.� :Hianni e on m wore Le whteh rot,permh is molten,I " 307 `— INSULATION
coup I'trp fr 1I` ` tux. tt E w kers' OCt ts- � h
APpI t ✓ -
NOTICE TO APIIICA�R h k bd' c tl t fl IB y O ma 309 EXTERIOR LATH ,
z bec bi v melt"+ k e p , B 1 l the 1 Cide.y t oust 31,0 ^ INTERIOR LATH
y Q Q tonhw th re nilly with such pit "At ns oe s.genii shall be dereard revok,d -
~ CONSIRUCTION LENDING AGENCY 311. — SCRATCH COAT - '
11 h di tth tthe n tm t d to, •fnr,nnw
a leading 313 — ROOF, NRII_
Len k( hhBl parol a'nsuW(Sw'aOq.C'v.Cl
Name
501 — FINAL ELECTRICAL ENERGY :
Lend rsAdJrcss
U 0 lem-fify that I have'readhisapplicatioa and state that the above information is 502 - FINAL PLUMBING ENERGY
w EstearrerB.1 agree to comply with all city and county minamera and state laws to aging 503 — FINAL MECHANICAL ENERGY
0U Bo building camtmeWm,aa,)nemhy amnoric representatives of this city to enter upon
w 'he above-mentioned Property inspectionpnrposec504 — FINAL BUILDING ENERGY
F.t 6t (We)agree to save,indemnify and keep nnnmless BM1e City o(Cuprodo agaies, - a _
Uto liabilities,judgments,costs and expensrs which may in any way recces againd avid 505 — FINAL ELECTRICAL
7�. chane..nargaeca..nne gra 'ng omni,prrmh.
APPLICA UN .RSTA' AND WILL COMPLY WITH ALL NON-POINT
SOURCE , u no' Issued by: 50F ��s'T7 Date
sign nBraeBnr . f Date Re-roots'
it ROOMS MATER1AUS DISCLOSURE 508 — FINAL MECHANICAL
Will the applicant urfuture.building oecnpern., icorhanalehaa.mou.materiul Type of Roof -
as defined1 iheCupertinoMunicipalCode.Chapter9.12,andtheHealthandSafety 509 — FINAL' GRADE'
Cade:Section 25532(0)!
.avec' 0 N " - All roofs shall WMspe—ct�d ,Wto�' %Yflf�L�,@aterial being installed. _
• Wiillthe applicant orfnmrebuilding occupant use equipmemnrdevices which Ifaroof isinstall'ed'withcEtlAOQlobt�f4 Vin, n`�Iagree toremove
emit Imeardous air eom5minams a detailed by'be Ray Arca Air Quality Mamgrment
District, all new materials for inspection. Applicant understands and willcomply'with
°i" °"" all non-point source r illations.
1 have read the hazeNom macdds requirements under Chapter fi 95 of the
alifomia Henlm ffi Sa&ty Gds,sections 25505,25513 anJ 255JJ.1 undersanJ ma
i �me buildingfires nm rurtendy heveaBcnent.ma iB is my req onaibilitymome a d 2
��uupam of me require nc which must h met prior m i.ceuunee of v-----------of '
ni
Signature of Ap ' •ant Date
to vumoi or agent r-r�Dar All roof coverings to be Class "B"or better
OFFICE .
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