02040073 CITY OF,CUPERTINO
BUILDING DIVISION , GONhCTOR^INI'ORI4IATION:::
PERNYIT'
_ 1. -
v. BUILDRIOADDRESS:: - - PERMIT NO,
A• 02040073
OWNER'S NAME
It APPLICATION SUB DATE
AhkWEST COAST':TAE ' KWON DO. 04/16/2002
.ONE
ip+ 1170 �t:F t r/t 3. _ SANITARY NO, CONTROL NO.
0
Z.
_ BUILDING PERMIT INTO
U BLDG. ,ELECT, PLUMB MECB
z z ' LICENSED I a CONTRACTOR S DEof TION'' ' Job Description
Z it 1 tlIrIb,.70 0)of wi,h am licensed under Provisions of Chapter 9(commencing p
I,IF nn Sen 7000)ofDl nianJ orthe Sus sand Profcssiom Code.and my license y na< ,s In nuan, rB<n TI (HANDICAP BATHROOM)
tanaOL< Lic,Dm<nu Chs :'s '.L ♦ F� LE®
'Lu : C°nl nor
ARCHITECTS DECLARATION -
utWcrnana d my plans shall be used az public rtcaNs
n<I -
io o Laenxd ProfcxsLonol.,�., '.:-•. .11 11 2 3 2002
�E �' •N "'' •:...^I OWNER-BUILDER DECLARATION ` ' '
:.License
:
I nr as•,(Tan that 1'am,Beth t fzzml the lleass sor's Lianu law for the
C?a fallowing reason,lSection 70713:Bpsircsi and Professions Code:Any city or county '
�C which'icquiics'apermino;mnswa.aper.imprme:demolish.or repair any structure
34,., ..m(pcn5ootmrhmtc eg1 aIangtuawaMnicdapl,v$arsgliuotaonrenuq7v 0il0i0a)tpohrmfDssppwlIinScIsaonontl3flahorfsCluhoceAn8upxuersmtonticnsssoLaBttnldenaPxrsOilgfannwNslolss , BUIL
IN 6
OOO
...at --" - -(ch.""9
code)
Valuation-
or That he rs eicmpt thexfrom eM Ih baz s for Uw.11<ged eiempswv.My
viwhution
"o4Sccuon]Ol IS by any aPDllcam Ire a perm 1 vbNcu the appl cam w a civil,malry- q
pf hmm rcma 'r\m nnawa n�a rssool 101-pN1rDATION Occupancy Type
❑las n of she propenY YeinDloy thwag<sm tharsole compcnvaon, ,
will 3o.tfigwbd.'knd me swadle is nal Intended or bBirfe fdi sale(sec._T�,_
'Busineis.ind Prdfevions Cade:The Conuanor's Linnse law dins nm apPly to on 103 - UFER Required Inspections',);'
owner of progeny Who builds or impmvcs thereon,and who goes such work himself o
or through his awn cmployees..pmvide_.or mu- v...t I ems art n.imrnd<d... 10-4 -"_RE BAR-_. .
orf,ed fol Ie If however ilw WMlain Ire '- "'--- - ��----
8 Pro enl c sola within one Y<ar of
comply th<owar-ba me 'nn.rcuxbame of proingmalneaianatbnuaor 105 .- ANCHOR BOLTS
ilnpro frW!pasebfvlrJ `• I:It�(Ca/ *. 's di;nr,•l_...
t _ 106 SEWER & WATER
Ol euct the aLtheproce. am `cihoisel - vxs ti Im`hce:u<dronnenotorto
's
construct the ro eel S¢.]to Business am Pro who th Code)The Contractor's
202 UNDERFLOOR PLUMBING �.'i -'" ` " `---'
m 203 _ UNDERFLOOR
LItt'x Law d......pplY so owner of progeny who bmlds or pursuwt w� _ MECHANICAL'
.sad n ,Liems rm sum °)ecu ire a cormxtor(a)licemd provra mercy¢,
Constructor, x a 2-0'4---UNDERFLOOR'FRAM$-' -
' ❑I eempt Sac
Ba ctmthisrcazon 205 - UNDERFLOOR' I'NSUL'ATION
`r Io 6 D 301 - ROUGH PLUMBING
i - ORKER 5 COMPFNSA'�SN
ON
I`: „Ihmeby ffsm under pe Iry of perrvry ane afdc/Rows gEeclarno-au' 302 - TUB &r OR SHOWER
❑'I n:a pe w, ounat.m.'eenlrr,lr or tonK l m'x -lass 303 - ROUGH MECHANICAL
rc for W°rkeri
Conlpcnsnionpaz pioviaW'for-by-Section-3]00-of-the'Labor-Cade,^fm-the 304 - ROUGH ELECTRICAL '
T, peiforinarice
of the work^rar whim mMa pemal u isslrt;l,.:s t 3 0 5 - FRAME
37M of a R l C dga worker iCompr Ion m'sumnx requ sed by,Seen.. 306 - HOEDOWNS ..
.: 7]00 0(Ih Labo Code,for IM1e perfomuntt of me'vork'for h ch this gamin is
s issued.MyW rkehmx
1' , oonl sura acamcr,ae Pmiry -mise arc:' " - 307 - INSULATION
Icy No r 3Q.S.j' i$9E,E'I`ROCK •�- -,.
a cEarFJc co NPensAr
."n to°R— s — 3 0'9` +t EXTERIOR LATH
310 " ;IN;TERIOR .liPTH
fTM1n imt need thio ylelcd if pemul is for hundred dollars l
(S[W) l°") 311 - SCRATCH COAT a 1.
:' l«n ry that n inggggggperfo of the orTk hill I rmn's Iseuc3 1 •313 `ROOE^'�NA I li-" - --- -'
ihvll nol<mPl y Pnyon Pal,morn
b on - - " _—- -_'�--
AFF pe ntlo !a sof el m q _ ) mm�y should 503 FINAL MECHANI CAli��ENERGY l
P 501 FINAL ELLECTRICAL''ENERGY
r - -' 502 FI'NA'L-PLUMBING ENERGY
Z on Ye a.I Id
AP Nf after mo l��gm sCertificateofEe pt
Z becomes o me Vor ompen htlon o Gni f the Lebo Calc ou must O fo romp1Y with ssfcn Prov¢oro w th
Z O n DINGAaEbedttmm <okm _504-. RI'NAL-.BULLDING ENERGY
(.y ,CONSTRUCTION�. , ,1D G AGENCY _—
'" 1hdebyaifnnThatmereIseI,aswcaon�eMmggecyforthepaformince' SOS - FINAL ELE�"TRIGAL 1
t� � of she work for Mhmspermlu lssud(Sec 709]Ci C) ' FI' FI I.
i.
p' l'.enaeraN.me-_•.• --"._.,__ .-........._ L, ...�.+: .---__ .. _ 5.06 TEST
�" Leodars Addni - --'-" -
_.
507 - FINAL PLUMBING " ' " '
p"L1cnrYm tlhave read Wsappl cal on rW sum zhn Ne It.is 508 - FINAL MECHANICAL^
OW:[..' correct 1 agre<.t iore dy N all ny enp county rd nanpee.ndsute Taws rotating
.,V in
to -1sena-difiling conslmduon;anahercbyauthL3aercprcsenutiveiofthis'citytoemrupon 509 - FINAL GRADE '
L4 me.boy<. xglpnge ° f°`in' rd°" 510 - FINAL PLANNING
�' P!lxnY . P Noxa.
`,l IW)ogre Id[ave rMemd ryane kc pAarsnl<ss the City ofC pen oegunzt
v3 Ishii te�7 ag vts.cm rq ex s wh qhm yl yw yxcruea nal Ia 514 - 1AAP IG WORKS
V Z. C'ry' n con eq ence of Jz rant of this y<rm 1 *•:
APPLSC'A\T CYDER f D\\IL4 C0\IPCY P ITH L 7;e �` / /
s LRCEREci-L��] s x �Y'. 1t �'� Issued by:
rtl1�J P FIA7lsRDOVS MATERIAL$DISCLOSURE � } Re-roofs
i
.z,Will the aDW eam m furan bead g omPmt norc oe M1iMle harardmu aural .-Type Of Roof _-.
as defiled bythe C Peron MIm CoOe Ch Ater 9 13 na the Heaph end Saf ry -
Code Seaton 15531(.)?y �\y,
-
o ? )a 3 -All.roofs shall be inspected pnor.to any roofing.matenal being installed.,_..,.
WII Ne appl cent Orf bu ldmg occua flay <q preen,of ee ic<a jet If a roof is installed without first obtaining an'inspectlon TagrtSe to^remove _
+)IsmcOYes I , rr: rtLmenss'uMe Qualuy Mangemens
�" + rtaa new._materials.for inspection Applicant understands.and,will comply with
„ 1 ha a read the hanrdou ma&pals
RYI ameous arr comm nems e,dein d bl Ne Bay Are A
all non-point source regulations
ti k V a F 1 I. J ._
c Chapmr ers at
C.pforrua 11 aim&Safer Cade coons 15505:Zit is and 1553. I Ity to a lid met
bode n8 dose not an are uenant.matitismy responsibRiry'lo osiyme- - - "_" -""""-" " '" ""-- -
eof
Octu enc 9 ...
0 1 rc 1 nu h m mon h et p o re ssuance of C J
,r
d n z Signature,ofApplicant,
.._ __ Date.
"on ed 8`^' Dn<: All roof coverings to be Class "B"or better
h '
l '.bj >slr rf;f.ft i.