00050142CITY OF CUPERTINO
BUILEING DIVISION°PERMIT
CONTRACTOR INFORMATION:
9111LDINGAM12975 N' DE,'.ANZAa CL'
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PERMIT N000050142
OWNER'S N POWLKS THEODORE W, AND MY
IAM
APPLICATHeap)(11AB/2000'
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IIONE'.. ^
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SANITARY NO, _ CONTROLNO. -
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ZZ ARCHITEC'1'IENGINEERf, -
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BUILDING PkiRMI'r INFO
BLDG 'I` ELECT PLUMB- "±MUCH
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IJ' '7111 L-1 I�
Z LICENSED CONTRACTOR S DLCI ARATION
11 by ff IM1tI licensed I V fCh Pt J( id,
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)OIJ,DCSCrI t100 ,^
.wilnfSectionend)reer, of Ba PrarxmneJ awlnyl
REMODEL1INTERXOR'OF HALL BATHROOM, MASTS
U L'inf 11 fi,¢v undefi«c .
ien. •Class L' #
Dal C"Uncon
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ARCHITECTS DECLARATION'•
g- 1 tuadcournaloy,are, led b J J:
-
a,p„bill
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Licensed Profession,,]
OWNER -BUILDER CECI ARM ION
I localityff that I arn exelillo term the Contractor's License Law for the
arcountyhere
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D whih y' p mel 7 I eller p d I h p' y.lhnare
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Q Prni t an I. q' .Ih PPIc It hp 'n fl E e.Itmem
marl dp u J V” fIM1 C l' t i. L L [Chd,9
(coin E 'TI S u' ]0011) fD '- R fel B JP f! Code)
.S -Ft Floor Area
,, Ip4p1q(trfyvp
_ nr mut he v exempt Ihvrefrnm and IM10 bac c liar the alleged ex PI tit. Any ni or
it ,9 l•
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ofSttYan]Oi15M1y:nY PVI Attire Ve 't: hl is the appl n civilt penally
'nrnamere
- AIbe9 00
- `Occupancy Type,
loan r��n I da a rx lssoo)
❑Las owner Orme prop ty 'y ply wlh k a. m I pc
' ..,z
;. - '
.man
will d Ih k e p e I t t nlcnded or olicreJ f (Sc. 7044,
"'p:' 101 —� FOU rITq�SpectionS '
'
BHC d P (e o C d Th C IraUo's License LI 1 1 pfly n
na
ox fp pay Wh h'Id. p :Ih J h I- 1 kn Ir
ro En n'. 'ply :.v 'e dml: u e r I t doer
W��R11H9„CYJ7V .
”' 1171?.--_ PIERS t. -
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otry Jf Ifh - lh b'IdnE P t: ld th' me ycarof
`on oll (he- M1'Id-will h,cha odnnfprorigr lhedInothuildor
103
mc t
,LIFER
❑I. flhl Vtty I:'IY tik �lhl I: d�II t
104 — . REBAR
, •,' '"" -
construct o force, (Sce, vo•ta B :i'd P r: c e ) Th C It -
Lice L d alley I merof V p ty In(, nada ' pr , Inereon
1:05," —ANCHOR ANCHOR BOLTS' '+'•.
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and Incl r h p l with nl sclen,)hers,,d p : an1 In he
_
] 06,= 'SEWER„ R WATER,
Contractor s L'unse Eaw. -
❑I,at c.reaunder See ';R&Pefor fnislewilli
202—,'ONDERFLOOR•PLUMBING.'
Owner a Dale
WORKER'S
203' - UNDERFLOOR 'MECHANICAL.
COMPENS AI ION DECLARATION
Ineenyarr;mue pIly rplrvrynlennnemu,xp r
.'
•r 204 ",UNDERFLOOR FRAME
,. 205 — UNDERFLOOR `'INSULATION
:11 ha e and will carintraid a Certificate f Cole,,cat to s If rtf W rkcf sA"
Comp ental, n, urm.led for by Scatter Bnlo.nf,me Labor Cede, for me
301 —, ROUGH PLUMBING
perr�amaneennee wnrkfor which lhis per t is issacd
- 302•— TUB 1A• OR SHOWER
'7eJwill k cue:l eby S
00ofthe Lamm Code,f the pr na a the work Ia which Derantis
303_ ROUGH'MECHANICAL l .
issued. MYWorkers Compensation Insurance earrierawP.Ryremnare .
_
30/4.— "ROUGH ELECTRICAL"'
carver �
305. 777 7
O CJFMPTC
• CERTIFICATI NOF � (F,MP'1'10 FR M O K'RS'
—;,'FRAME -
' COMPENSA'I ION INSURANCE`
'*. 30E •—" HOLDOWNS •2' s•'
n
m r m c� mumled rm u mil Iw mr nnaar a gennm
_
307'— — INSULATION e
A 1 ttfylhm' lM1 fine kf hicllln i'%o
308 — SHEETROCK '
I>ef pe I I I
,bull an( "empl,any lem - )mental- .t h r mice'totheWork
e
'Comp 'fol
,
..u09..— EXTERIOR LATH"
Laws ofC if n Rte -
App'
:310 INTERIOR' LATH.,
NOT ICE TO APPLICANT If, after k'g h Cell of Exemption you shark
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bcca tai I theWorker'sC p t u .ofthe LannrCode, you mal
forthwith comply piths Harr,tel, ntm,pern'I snnu tae ace fed rennknd
311 SCRATCH''CORT
- _ .31i —_ RL)OF 'NAIL',-
CONS rRUCT10N LLNDINC AGENCY
'byafrmthat tn i t leading Encyfar the perrer„u a
'eiscrEf
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501. FI}NAL':” ELECTRICALL'ENERGY '
nrinII
ach fle,71.1lit is amzcro.c)•
lend N e --
+Had::
,1 •... .' 502 -, FINAL PLUMP'ING'.ENER6V
Le,a
I 11Ylaid uh Jp- mem n t r r I,
- 503,— FINAL.MECHANICAL:ENERGY
" '504
e
1, d od
a' d state 1 1 fon
ire e l s I ply Iereb
.
— FINAL' BUILDING ENERGY.
an re
tcalsobailds r dh hereby l ep tre. Inn. city to n1 upon
the ab en l Pe tYr .p i l p
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5055. FINAL=: ELECTRICAL
tdoe
'Heel
(W) E t infernally keepIn ole theCity fC .ccarbon
' e dgn waYa cle a8li lsi'id
T p S ¢;
f 5-11<r Fj — GAO TEST
Citya.
a. arred,se of e g,aln.nly
DSA cf DWILis I'
.APPLICANT UNDERSTANDSANDWILL COMPLY WITH ALL NON -MINT
SOURCANTUN UNDERSTANDS
�.: Ib •' •. n '
`sued by: 507 — FI LUMP ANG -Date ��L
TION&
�•/U
Signature er ApPllcvmfConvacmr _ Date
HAZARDOUS MATERIALS DISCLOSURE - j
Re -roofs•` ..'509'.--' FINAL. GRADE '
wn me apprcanl f I b -Id s ccupant,tere or handl I . M ; tectal
as der fed by the Carlo ", Mnn lipid Code, ChapterH 12 and theHvnllh and SI@ty
Type•of Roof 510 .— : FINAL PI > `
y -ANN I NG
-
Code, S i 255j2n' -
. ore n.❑ n "
-' 514 — FihlAl_"PUBLI. WORKS °
All roofs be inspected
shall poor to any rooting nmtena7 being Installed."
wn aa airc'ap�lI fate n'fin seoccupant :ecu ir'Q l I nen
emith J onwt' l sdel ud by mi Boy Atha Al Q IIy M'nagv nem
If a'roof is installed without, first obtainin an ins ection; I'a ree to remove •
- - g P g
Don t -"
❑v, El No
t
- all°new materials for inspection. Applicant understands, and Will Com] l wit
P PP. pY
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at, non point source regulations. p' .
1 have read the hd,ard.h,s herdowd, mqultemems Onde Ch p1 'fig5 of the.
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Cnllforn'IIIenIIh&Safety Cwt, Sections 25505,25533 and 2553411nde ... and the n
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a., earn, I held brain,uih l'i: nYresponsibilityl notify the
'°' r. t
o uP f the rey ire t 1 h 'h sl he t p to Tina Cen' wee f
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, Pan
,
Signature of Applicant Date��
'Owneroramhonzod dmm -
k Date
,a
.. - ` All roof coverings to be Class `B" or better
r s 'OFFICE