00070049 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR.INFORMATIOO N `
' .BUILDING ADDRESS: - PER MIT Ntl '
22146' DEAN CT ��A ��mK. 'rlP�Sr7Ac . , ." 0070049
OWNER•S�AME.
IC � APPLICATIO SU3 DfT�
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ONh NOaAK Vm
SANITARY NO. - CONTROL NO
tAE, `G 9 ris C� ISV50
CZ ARCH111C'ULNGINLER_ - /'y/ �5•'' - BUILDING PERMIT INFO
w <, t. .BLDG. I.F.CT PLUAn ME:?,
Z O I h ny [CICFNSLD CONTRAdCTOR S DECI AltA)10N S Job Description
OZ (� fail f a de 3dlhe Nu p eP l ': :CD ne nyl 1. e
is ce Le any, ° „ 02 KITCHEN REMODEL AND' ADD f T ION
.any,O ad V .Dui - C atlor •y i
ARCHI'fEGT S DFCI ARAT
OQ 1 'd , J ypla.-,hull he nseJ p bl' nrds - '
�w}F00,
Liveme,c]Professional
k o OWNER-BUILDER DECLARATION
-m (Si 703l 5 B - ad P I uneasy y 'Ir that 1 n[ tie C 1 1 s 1'cense Lax 1 me
Y,Z Q fall . f :Cade Any cit county -
�',tp wh I reg P 'il 't t ult Trp J I:h.or repo ra city
n3C3 om Dr: lod,
mal n d p : I t O p nn c l t r I D mI t o S Ft: Floor Area' .-
-(con t 8 lie S 7DUlp 1 D''. 3 rlh R J P f: C J) q• $YLU0138 '
mon he is corept flasonefroun and lieu basis for the alleged ex mpl on'Any violation
n[S t 70315 byany applent fare yI' ll ls the applicana1 Ipealty -
ornt thanf hundred dollarsf350p _ - _ APNNumber - Occupancy Type•
of the popea>.ornrempmy . Ila m ip .area. 3,9709021-1. 40 � I
will J (lu,woA,add the fracture t idonedidal at offined for sale(See 7044 -
Ba'saus,and Pedflaquar,Code The Connector's Lle 1 aw dene,arit apply ad an + Required Inspections
owner I p p ty Whohill. r apr v fl d 'h d e. such k n' If
oro ugh Ili,own anploynen,pm ,n
vde)thtahlapmven rlare an intended or ' 101-,.— FOUNDAi'LON`- ^'
ofrerewm
dforsaleLf,haua .debuild,g p is sold within ane)car of -" . . i,02 — PIERS • ,
ininpleran the owner balmor will have Ih burden of proving Inas he did not build or - .
mprove rorpurpo,enr,me), - - °1.02,. — UFER - -
Cl 1,as owner of the propertr,arn exclusively training van1iona'ad Inualball,Is .],0�f� 'REBAR
Lon t t m p ct(S 7044 ❑ . d Professions Card.)TI C a t • -
ic L d t apply to f property h bila: Plateau, _ �' •• ,
d o t r' r projects with a entraetm(s) Perused pursuant l t, 105 ANCHOR BOLTS
Cent el r L r. - I& -' SF_I•IEP, WATER .
0 ant elicaux unld,SsC ,B&PCI this r ,o I
Owner Dale 21212 - UNbEERLFLOOR, PLUMBING
t - WORKER'S COMPENSATION DECLARATION Gi7i,'J =- L.INDERh'LOOR MECHANICAL.>,• ,
I heren frnnl under 'lt r e '. g 2104 — L.INDERFLOOR FRAME,'-
'' I
y a Pena y a p j )one onhe Ion J laradon,.
I nage anew n a lautin a Cern i,n .ef can,of to,,If-n,a,a far Warken, 205 I_II IDERI'h Of]R I'.NSLII„faT ION
Can p I . p' ded for by Section 3700 r the Labor Cul I the -
per 0 36i ROUGH PLUMBING
In a �ut,nl 'w kc p rnl . requiredays Sect 3110 TUI! R OR ShI0L+1EP.. -
a7oo I de[,he,Code,for the polorialance ofn k for I h(hi:parnit is '"0"' ROUGH MECHANICAL `
is.a d My�{gkersC .ndon lour carrierdPol y number are ✓ 3+, '
c:Ir >111�2- =ParnyN„ a 1{ 481 W01-M � 304 — ROUGH ELECTRICAL.
'> CERI'IFICA'IION OFEXEMPTION FROM WORKERS'
- -'OJS — FRAME -
`. COMPENSATION INSURANCE _e 3
adnoam Ie¢d f„ 308 — FIOLDOWNS
(5100)(This section need thep • pcnnil is fern ne hundred dollars
317 INSULATION
I cemrr(but In the pattern....r ohne e uk for which alis purlai,I,issued.I „30i(o SHEET ROCK',
shall not employ eny person In any manner no as to become subject to the Warkeas'. `
ApplicantCperadion Luw,ofealifurlJa.Date '.309 --;EYTERIOR ,LATH-
NOTICnt , -
-
OTICHTOAPPLICANTIr R k gm Crft m fL pt Y on
ld 3171.1 INTERIOR' LATH
rz 'travme,uh rally thew k ev nn r t , . f e decided
e M Cul y nasi :
O O rormwmtan,plywm Dnp vi.ana'orm ,w,itsnmineJ- rmtevbkee: 311, —.,SC,RATCH. COAT
CONSTRUCT ION LENUINO AGLNC )
: P ;,].e ROI7F h•IA.iI; a
11 cr ny fl r n lie t II a n.trucTon lending n y f the performance
of tie workf hehd p tn,issuul(Scc-LIN , C) r
wq Iift :N e 501' —' FINAL ELECTRICAL ENERGY.' -
•� C Lead Add : 5N2 — FINAL. ,PLUMBING EIsIERC Y
T tfrth tint read
l e.It mlln b f f , 503 - •FINAL�MECFIAN.ICAL. ENEP.GY” .
FL [y nrr 1 1 b t ply -lie 1 IY d ly d' c a 1.t t l Iaf g -
O U lohold e I ,' dl ya lie n tr fill, city locals, .'. ' .'.50.14 ' - FINAL. BUIL,DING,t ENERGY ' .
meal I ti .ed, - r 'espuf p m • „
F a" w ) 6 also
In le ry ak pl. all. nocty`re peal aha ,I `505 FINAL ELECTR.
I' d p I y o day y g�n,t r E, GAS TF_ST
f..I -City' nnsegt- nrtie gan'ngDWILL nit, ��
SOURCE NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT ���y.,,��
SOURCE REGULATIONS I$Slledby�� altll� - AVKKIA.Yy ate
Signature ofApLitt t/Carbor.bor Dale i Re-roofs 508 — FJNAI_ - '
HAZARDOUS MATERIALS DISCLOSURE
Will the ppr t fuldne n vin p t t h mo--. L term 'Type of Roof 509 .FINAL ,GRADE -
asd.f day tie Cpan M npn CI pt oreorandl 11 III and SafNy -
Code Section 25532d _ 510 - FINAL. PLANFIING . ,El ye" All roofs shallL_b¢tps ec -
p t�d[(DdfAtfoFah�Bbdfpilg6tfdl@i being installed.
Will he apprennt f t eb ��� p t ey lin t e h tb if-a roof is installed- ' it first•obtainin an inspection, I agree to remove. -
earn w dt u- .at a my tie B y A 2'A Q I ly M nagencnl - g p g
Diatr l all new material r ' ecuon A hcant understands and well cola 1 with
❑r Na all non Loin', ur reglahons PP p y
1 h ad th_h : t t e l: d Chapter fi 95 of the a
,find H olth& t 1 S t s 5505 25531 d 5534 J 't dthm
ifhel building
llyh nen the t': y p hl lye olfy the
dont o e rc lieh eraw b t pr:r t r ss c I a C airtm of
Oewp Y
re l� n b O� gnatur t` pplicant Date ,
net .Heed a I Dale - All roof coverings to be Class "B"o-r better -
t, ..OFFICE ; .