00060033 CITY,OF CUPERTINO
BUILDING DIVISION, pERMIT : CONTRACTOR INFORMATION:
BUILDING ADDRESS oil PERMIT NO
OWNER'S ^' APPLICAI' 33.
PHONE: -APPLE- , SANITAR No
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1.
G z X -ARCHITLC I/ENGINEER <408)3Z9 0400 BUILDING PERMIT INFO
w BCUG ELECT; tPLI1MP. MECH
Y ..
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h y" LICENSED CONTRACTOR'S DECLARATION "' if -
Job Bescrl tion
�.Qy,O Ile w ff vhtl 1 sed d p feo-ne9r ncns• P if .. ,
aLn F•J ,`th5 t 9W0)of Urvson3.fflw Bu dP fi.esi,m'Code and mYl cense _
in ra Cl force and effect
'Lie - ,L b
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LLODECLiRATIONh 231 SG!'. FT. o FINALM3 -. t
a555N1 , rsr p nI -ccoNs
WO O
Lateral,ed tf i nal .,
OCT 1 6 _2001
X o y OWNER DER DECLA
LL RATION - y
WI he,by offlon that I pl train h Chronic,-',License' Law E '
the. Y
C'�on following Secom,7031. B and P 1 'Cd ty Any rany 'd
SO whh 4 peormtoo conwinal,aftr p demolid. ,,",artY.tcum _
c,a. pro t t e ab 4 tl pphe tt : hp 't fie E Ia l oem t• f� r• r
that he 1,1 recoiled Palomino al the,anvoica,of the Contractors License Lo (Chapter9S Ft PIOOf Area' r valnitlOD -
(enmmenangJ mSeel an 70011)at D'viA 9 rf the Ruaim d&olosxlone Code) q' ,p.
or that he is cerem,pa themfmm and the Lois far the lie 1 concon,dimi Any whado.
'l 70315 by any appl dam for a permit obleug the appl'c nt t clodpenalty
Ur - -n ttm man five hancrea dahms(asab). yAP.N'Number' QC QI�j'pC
d'�" ,
❑1 fthp eery Y Ily * r ..
Bill m k i ill t ct tintended RLas f 'I (S ]lMq
! a. P r : ai a.The contractor',L p 1 31,62201.7.' 00equired Inspections
'ownerfProperty e l Id: -np th a 1 de 1 If
rer 6hh- plyc e vlltor h' p m t t ,
offered 1Jfh m building' 'npn ' t' W within eee555 /
cnmpli rtn h IJ - 'lin ❑ hid ft ytntl did tb Id t -i.01 FOUNDRTION '
hp rrprp: r 1 '.x.02 - PIERS". r _
°1 a: f rh t ate l i v l t f I ^^
P P Y Y gxlh l' n, d t d,rs¢ 'r 103* — ,UFER
Lim.t nh p ) t(S 70'44 H and Pm"I ..i loo )'fh C t etor's
ce : L d n t apply t 1 property wh r na l I p d ..o,. 104 — REBAR m
'hnd h,cera F for:ac,pmleca wall a amwemrt,) I' sed pms ant m the 7 '
Contractor,License ad,,
"105 -"ANCHOR BOLTS"
r
. 0 lex npt undo Seo.+ � -' ,B&PC fivahis rearvt .+ ..
owner nate 106 'f;SEWER R WATER
WORKERS COMPENSATION DECLARATION' - 202 UNDERFLOOR PLUMBING
1booby affirm maderpmaltyof.permyore ofine fonowingdo,hmtimw 203 — UNDERFLOOR MECHANICRL.
° 1 l a ill Certificate of Contend to:if r W k '� ,, 204- —' UNDERFLOOR FRAME,
Co w f as avoided r by Section 3700 ,f the Labor Code, fo th
perfroarnowenfifficmictmovollintn.pe r a;, :, T205, = UNDERFLOOR ,INSULATI ON
so
°Ihave sadwill naa,t wk C p . f 1 . Ice q dbySed, 301`' — ROUGH ,PLUMBING'.
3700 of the Labor Cnde f .th p fornance of the or k which this.pm nl c ,.
slued.My Worker,Compensation insonate carrier and Pro fyound,rate: t :302 — TUB K. OR SHOWER:
caRim: .
Policy No - 303 `— ROUGH *MECHANICAL" ' ^
CERTIFICATION OF EXEMPTION FROM WORKERS' .304 ROUGH XELECTRICAh� "
COMPENSATION INSURANCE p'
(Tl ...donNcdhotheconceled if 1h f is
h aeaaena. 305 -'FRAME
'(shoo) ), x306, HOLDOWNSI
IGeri fY hat nth performance of the work for which Ot. .....t sod [ ' 'Yt r
INSULATION
shop
.hall tploy ally par an,marine,so os to become sub3ect to the War6en
'
comp . Low,ofcrr ia.Data °• ' 309 - SHEETROCK • -
Applicant.
NOTICE TO APPLICANT If,'after A t g the C rl f L dhd n y h Id �+•
bison bj lI mew k .Chalfant y 1 of be Lan cdeY .t +. 309. — E-XTERIOR`'LATH
,O C forthwith comply with hp ,+aont,rtn prntshotIhad mwrc,oked.' 310 ,INTERIOR, LATH
.tea CONSTRUE I ION LEND]NO AGENCY A
4 1hereby affirmmatthere kaconevudo/lending agencal thperfor ace 1 31'f. —'SCRATCH COAT
H of the work for which this permit is issaod(Sec.309],Civ.C.)s; rNAIL ^•!
ow. ❑ Lander',Name ; ''313 ROOF
u C ndd ,501 — FINAL ELECTRICAL ENERGY
effify that u,ava roadtintapprearon awaata matin nwenfoarmrint: 502 — FINAL PLUMBING ENERGY
QVw E. oormt.lay et my m Ecpand i Ire a a tater relating 5$� '— FINAL NECHRNICAL ENERGY
tobald ngr .daf dh by that p tf ofn /tel ter pn ?
'y r� the nb t' d pml ny fe ' epee l p p s, 11 id ` r J
p
(Wo).,re,m,tindemnifyaNawhih iinmygan fLpLm against504 —' F,LNAlf BUILDING ENERGY
,may V1 liahill' I ns,c t In e res which n ry in any. aY a,'g ins..aWf ' -
U z co-yme wee he gr rJhispennit - , .505 —� -,INAL ELECTRICAL'
'�I SPP BF, PST ) ILLCOMPLYWITH ALLNO i Issued b r ^ ,+
y:` -wil — GA9 TEST Date
signator= ppr mr De Re-roofs 507 'FINAL PLUMBING
HAznRD
MATERIALS DISC OsuRE Type of Roo156B F I NAL..MECHAN I CAL
'II rM1 PPI Dant f bt ld ng p td tr handle hazvNout'noteri.l ,
us def l by th C p n "l al Gd Ctr pt 9 12 d rn He Ith I S fety
Code,Section 2553 c) � 509 —`.FINAL' GRADE r^' "" • '
°Y f ' All roots sha IiOiuspeftj4gI Lc' r tPB.!AAI1 ftjSmaterial being installed.
' wllth I t ';LJ? t - t
PI g e I n C y devices [f a roof is ill 1, d-1vit _rt��Li& igd*an', /'agree to remove
ntith d nn tadf ea by the ByArco AQI1M t
tall new materials for'inspection. Applicant understands and will comply with
°Y all Woa
ons.
I have d me �t aal w' t. d Chapt f.95 el the ^
Calif nP H h Seft Crl S t v 5505 255(3 d25534 d .land thn - ��
'f theb Idi . en r that it ay y thillyl tify e
sec po l B re en nun be et p' o, sir e La C tifev of -
oea Ig - ; ,Date
ow m 7adage,t • D O e ocoverings to be Class "B�'.or'better
^ •
OFFICE