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CI BUILDING UIPERONNOPERMIT
CONTRACTOR INFORMATION:
Buli.8ltFff'5'E ANZA BLVD
DONLON DE ANZA PARTNERSP
ft IT NO. 02040099
; :EV&DE ANZA PARTNERSHIP
ATMFT8"jnT62
FHONL
SANITARY NO. CONTROL NO,
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
IJ —LI
LICENSED CO.NTRAC OR'S DECLARATION
I hereby affrmma l am licensed under provisiosof Chapter 9(comm
�sCrlcncing TENANT IMPROVErsfE pIIOn
who Section 7W).f Division 3ofine Business and Pmfcasions Code, and my license
Lin full rce and effect.
foic,nse
(TUTORING CLUB)
Class Lica
Date Contractor
ARCHITECT'S DECLARATION
1 u W<rsrand my plans mall w used as public recordsFI
N ��
Licensed Pmf<ssi°nal
e.I ..exemptOWNER-BUILDER DECLARATION
1 hereby ,(lien ma, 1 am exempt from the Conions Co License Law for the
following remon. (Section 703 L5, Business Professions Coag Any
2002
MAY 2 1
and city sometmy
which requires n gems, construct. alter, improve, demolish or repair any ,Wmurt
$7000
11!0110re the
slicenad e. Informanttotes,hovisiosocant for le uch Connorniuofile aicense ned awoCaom<m
mean licing ensed So anis kmep ,sn3ofthe mantis amid
se LawlhisCod9
ab bo(a) rD ss
Area -
hq Ft: Floor Area,.,
_iF:BV L
isexemtdic
or that he ,i exempt mcncfrom and the bans for me alleged ex<mq on Any violin on
siso the alleged violation
=35'91804.3*.`'0�0'�.tt,l, v -
' '
- of section any dll for a pe,mit sobjccts the applicsm to a civil wnalt
of not more than five hundred dollars tssntn. y
-
APN Number Occupancy Type
01. as owner ofine property. or my employees with wages as heir sole compensation,
101 - FOUNDATION
will do the work. and the structure is not brooded or bBemd for sale (Sec. 70.1,1._
Rasiness and Prdmslens Cade: The Contmcm" License Law does no, apply ,o an
r of property Who build, or impmves,hereon, and who does such work himself
or tit
Required Inspections
103 - UFER
that such improvements are no, intended
or throughhisown employees. Building car or
n sola within one gear of
offered fon sale: If, however, be building or imen
'<mprovefn.meowner-wiener
- - -
10 4 - 'REBAR
of proving
will have me wince or proxing ma, he dict tint beim or
impose for pu,pau art dale.).
105 — ANCHOR BOLTS
❑Lauctthe of tecp pens I.,s ly mars, 6 1M1lde.d ,net sin
__.106 --SEWER.-&..WATER .......
construct n(sp ],H,1 B JProf atom coae)Th Contractor's
202 — UNDERFLOOR PLUMBING
Law nes ,hereon,
Law does no, apply l ,n owner m a opertycontractors)
who) Ids or sed pursuant
ad who
. dna woo contracts.' such proj«ts wima comracmr(s) licensed pursuam m m<
'
_____2 03 — UNDERFLOOR
ice L
Commerce' License Sec
Rlam exnrpt u.a s« .B&Poor m„reason
_MECHANICAL _
204 - UNDERFLOOR FRAME
ZATIONICi Z,
205 — UNDERFLOOR INSULATION
W R's coMP�ATIoh'DECLAR
- enalty of pt) ) one of me follow ng declarations.
1 hereby afT m under penalty
301 — ROUGH PLUMBING
3 0 2 — TUB & OR SHOWER
❑ 1 neue and will normal- a Ceeireato of consent m .,elf -Insure for Wmkerf
3 03 — ROUGH MECHANICAL
Compensation, as provided for by Section 3700 of he Labor code. for be
304 - ROUGH ELECTRICAL
perrman
mce of me work for which this permit is issued.
5
5 -
3 0 FRAME
FRAME
131 have and will'malmm. Worker's Compencanion Iommne, as required! by sec,ion
3]00 of the Labor Code. for he performance of me work for which his permit is
3 0 — NS
<aM
isCaaMy Compcn......Im.morce carrier. and Policy n6mher are:
3.07. -. INSULATION
f st3018 i' 1 tbSHE'E'TRO"sCK",h
'am CERTIFICATION OF EXEMPTION FROMNORKERs-a'
CO_MPENSATIONINSURANnCE,-. -
_309 -._.EXTERIOR-LATH-_.._,__,_.-..
(This cecton n'ecd not biicompleted if he Permit is for one hundred dollars
310 ' =' 'INTERIOR LATH -�-
Ig100)orles,)
SCRATCH COAT
. h kf h hWs� ti
I scuff, thatf which
dull - ,he p
.,311_
.• .
313 ROOF NAIL:.
not employ Yyaol blthes W.a., kOrs,I
Com p Y to
,j -
501 - FINAL ELECTRICAL ENERGY
502 -FINAL PLUMBING ENERGY
g NOTIC AP
`Irf a Cfot mpcnksat hp. C n,'aI hca o, nnf Eercaw° ..y.oushouldt
enppl
n`tothenwM comity with sucnpovisions othis perim,hall the, thermal revoked.
503 FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
504— — FINAL BUILDPNG-ENERGY. ,.,;
Inhereby affirmthatconstruction lendingagency r ,wprr°rear«
Leel ole! hien ,h pe.it'Y'sucd (Ser.309] Civ. C)'
505 — FINAL ELECTRICAL"
Ione xNm<' --—.-_-.
506 -- GAS TEST-._.._ ...
larders Address '. - .. -
”
- ...-....... - .--. ._ ...
507 - FINAL PLUMBING.
I.,ire,wtihavy rt,m mid npphpati�� and. lone that he above i�fimma,i°n is
,neer. Iree,° comply with all. city and county ordinances and sinte laws relining
508 — FINAL MECHANICAL
to building conauunion, and hereby aathodu representatives of Nis city in enter upon
509 — FINAL GRADE
,he above-r«mion<d property for inspection purposes.rm
-,.
(We)agree t000s. indemnify and keep haless the City of Cupenin6 against
510 — FINAL PLANNING
liabilities, judgm<ms, costs and expenses whim may in any way seems against said
City incANTUcnceofthe greeningofthispermit.
APPLICAhT {,N�/:RSTANDS AND WILL
514 - NA P WORKS `
COMPLY WITH ALL NON -POINT
. TIONS..
Issued by: Date
\so11WWIL
5�21�o
autoarc f AWppII in,02m nt art'{„ �' " Doc,'
' - HAZARDOUS MATERIALS DISCLOSURC - .'
Re-rOOPS
..:.. will me zpplicartot future wilding aes W.,tore or hvMt' haracksm material
.Type Of Roof
as defined by the Cuwn o Municipal CM Chapter9 12 and the Health d Safety
Code. Ston 25532(.?'-
❑Yes f3 N.. ti t b,. I
-
. � , ' I :' � 1 i 1: t 1 , ..
a�
W.11
aircontaminants
All roofs shall be inspected prior to any roofing material being. installed.
h t future wmbg ire Bay maAtliquile , device rentnch
i, h tl nntam,n,nted' by
If a roof is installed without first obtaining an inspection, I agree to remove
g p
is,nn
u Yes NO_-
all new materials for inspection. Applicant understands and wi11 in with
'is
all non -point source regulations .,,_
I h recta me'hawd mdionsl qu«men sena Chap, 6.95 of the
,.;
"
Safety Cod s«Tons 25505. SS33mm2553,1 Ilily1.nmm that
.uparCaliforniaHgdoeealth s
nave vcwe r itprim m
ric ,leingaoes not c�rms
w
oceupam n( me require cots which must be met priono issuanc<of a Cenificam of
me, swuncaibila Cenificue of
i
24f(2 2/a L
i
Sgnature of Applicant Dale
All roof coverings to be Class "B" or better "
°a, rada age., Dae
.... .. � ... �. ... , .... .. .OFFICE
CITY I)F CUPERTINO
fit ILDING DIVIMON PERI.11jilk
CONTRACTOR INFORMATI
i.f`""" 02040099
ANZA BLVD
DONLON DE
ANZA PARTI, RS
"DJNL*t i DE ANZA PARTNERSHIP
A 4r1)SSy"2Ti'02
PI1r1NL
SAN'ITARYNO. CONTROL NO
AkC fill I.CTENGLNEER
BUILDI'v+I PERn11T INFO
&LDG ELECT PLUMB MECH
DECLARE
I-lh:SED CO.YTRACnd,,
Ihere, ofirm that lam p Chap— a+ng
sof Chw 9ndinyI
TENANT IMPROVEh V?escription
of 1h, iln.1
a. uh S__ 7 / Dniswn 3 of me Busies, end Pmfessian, CrMe. arM my hcense
\
(TUTORING CLUE)
rwlfnr.eand:aelt
enu Cl _L.1.0_
Dine —C '"U"
ARCHITECT'S DECLARATION
I understand my pians shall Ix uwd a public records
FI-1ed Profeas+owi
OWNER a UILDFR DECLARATION
1 hcm'oy aif,— Na[ I'm .-P1 from the eonoaclor's License Lew fa in,
follox+ng reason. (Sauon 7031.5, aunnen and Pmfenia s Cade. Any city or coon"
x h+, n reyuves , plum[ ro eon . din lmpmve, demnhO, or mpav any .Quem,,
$7000
poor tons ;uuau,, law «qw«s dx pp:- far wch pttrt&t n file a ngn,d sutemttn
wl he:, I—nscd pungent 1. d provllion, of d+, Cine—al Littnw LJ (Chap,a9
SFt.
FlooC'Area
Valuation
Icomaaamg with S-- 7000) or ON.—3 of it. 8.i.. and Prof,u;om Code)
or that he ;, _or,n Ihenfmm an4 the basis for me alleged exemption. Any vio6Qon
35%18043.00
of Sttoon 7031.3 by any apph-on fm a perwt wbj_ the applicant to a civ& penalry
or nal mine m.n fi:e nane«a m0,,, aswl.
APN Number
Occupancye
�p
101 —
FOUNDATION
❑ I. a, owner or he p apeny, a, mr emp oyee, wen w.ge,, melt w1,
will o e oh. and! N ,- e A not inwr+dad or .Rend fa sale (Sec. 7=:
dm
aa.ane„and PmrN i� pT w Can—,.'. � w�
103 -
UFER Required Inspections
o<d�:«n x«ilnim lir
f{{n n xo n,mpl yell. r+ vion°did owl .a h improvemann .« �a intend,, a
10 4 —
REBAR
off «d h, wl,. If. ho ,—, , me budding a i.;a v en, u sold within an, year of
im,`eio;pueofwet,wmn.ve the be,+deo of p+osingtwbar aid nal Wild or
105 —
ANCHOR BOLTS
106 -
SEWER & WATER
of dx Prap,.7 an, Ilii- v,la d Pf—g win hd,:) r wnhwta, m
70.41, ausinus P Code:) The Canvutar's
202 -
UNDERFLOOR PLUMBING
mal .Se project lsec. and
ry ho Wild,
203 -
UNDERFLOOR MECHANICAL
and hl.axdoesnot farl.wanownrahprain—ohawTimor;mpmveauw„an.
and xho comrun (or such proj+Y[s win a xvnvac[a(s) Ikensed punuaN to the
Canh,wn uceme Law.
204 -
UNDERFLOQR FRAME
f1 am exem ""PC” Nisneon
` f(i ticsZ
205 -
UNDERFLOCR INSULATION
W R'S COMP AEONDECWIATION
301 -
ROUGH PLUMBING
I n'«ey a neer pan.lry ar perjary ax of dx fa1lawmg &eclan0om.
302 —
TUB & OR SHOWER
303 -
ROUGH MECHANICAL
❑ 1 ha.e and -11 maintain a CttQficn, or cane. m wlr-in,u« far Wafer'
CampenaQan. a p,ovid,d fa, by Sm;on 3700 ar IN, Labor Cada for ,h,
304 —
ROUGH ELECTRICAL
p-1.- of dx —k In, whi,h IN. perms i. irwea.
305 —
FRAME
❑ 1 h,ve and -It mamwn W nku s Comp roaQon mw'nano,. aanalby Sacaan
3700 of me Law, Cade. far the perfomurce or dal work for which mia parva u
306 —
HOLDOWNS
„sed. My Warkoe, Compe ,n I.—,carrier WPahynQmbtt,a:
307 —
INSULATION
Caaa;ca.PolmyNo.:
308 —
SHEETROCK
CE—TION PEISA ION INEMrnSURAN� oRICERs'.
.309 -_
EXTERIOR LATH
in,, we.ion wed not be -nopl,ted If lba p,ron— fa oa hiih ed dams
310 —
INTERIOR LATH
1511N» nrku.,
311 -
SCRATCH COAT
I ,=Wiry the ;n me perfarmanu of Ina waf ra, wni,h minmiwed. 1
313 —
ROOF NAIL
eshaamll employ anpw;m;-Y mmWorkn'
ahfn a
501 -
FINAL ELECTRICAL ENERGY
pseonl.alion
APpb,a
502 -
FINAL PLUMBING ENERGY
Nfrrlc APPLI" ILof¢rmafingmnCenihcareofEumpuon.ywshould
he,ana aable,t la &w a,f'r, compen„hw pmvi,ionaanne l.aba eo&e, you ma,[
503 —
FINAL MECHANICAL ENERGY
forthxlm comply xnh o<h prosivnns or m+s pumas sh::)b'd«med resoked.
504 -
FINAL BUILDING ENERGY
CONSTRUCTION LENDING AGENCY
I he«by aMrmmal m,« is a c ... waion lending q-, for in, pnformance
505 -
FINAL ELECTRICAL
,4 be r,kfa,wh+,hin,,permR+,+.wed(S .3W7.Ci,.C.)
Iind'r's Nam,
506 —
GAS TEST
Lender,,a
507 -
FINAL PLUMBING
ra
I <,nify mat I base d thn, apphoban and -.1.a mthe awve id—a.-is
508 —
FINAL MECHANICAL
,I. I agree m comply wllh all vy'+M cwnry ordinams and ante law, rtlanng
+o buddn,,o tin lar. a+M hemby amhoeae np,gen o -i ofmn-yto emtt upon
509 -
FINAL GRADE
me ann,ememioncnl pmpeny rut Impaliw pmpous.
IWkl ag«. ..... nMammfy and Lap harm.., tM C+ry of Cupenhlo'gainn
510 -
FINAL PLANNING
IiaQdnas. )udg+txnu. cows sof eapenws whilh mey in any way ucry again,[ land
C yin ,ansey of meg g fm;, P'tmt
514 r,—
NA P WORKS n
f PL ICAN f RST.{NTS AND HILL COMPLY WTTH ALL NON.POINT
y no.S
Issued by:
✓(�
Date
S.L -
Comuaml
D'x
Ignomm u/ApP HoA1ARDOUS MATERIALS DISCLOSURE
Will Ne a?phrm[ orfuwe bia"'g _r_ nal or hard. h,aardcus mawtial
Re -roofs
Type of Roof
as &efin,d by me C.Pen+na municipal Cade. Chap— 9.12. anal me Health and Safery
Cai<. Section 1-55.3'(.)'
°Y”°' 9No
All roofs shall be inspected prior to any roofing material being installed.
W"I", applirar+t«Lama wining awpant use equipment or d<vias xnich
If a roof is installed
without first obtaining an inspection, I agree to remove
mit huudam air comammann u defined by the Ray Awa All Quality Management
o ,troll,.,�
all new materials
for inspection. Applicant understands and will comply with
[IY„ foo
all non -point source
regulations.
I haw «'d ftha:ardw nutu;.ls requiwmenn un&er Chapter 695 of me
Cal.rorH<ahh d Safe,) Code. S—a.,15505.25533 and 25534. 1 uokro.M ma[
n+a
f me wilding dws not wrtendy have a Imnl. Incl ,.a my rnponl.bihry n notify doe
curym..l me rtqunemenn winch muu h mel Mar in timate, of • fe Ficwe of
_
Signature of Applicant
Date
— �__[_Z2�6L
ed agrnt one
All root coverings to be Class "B" or better
w— n:
OFFICE