S 4538OFFICE
CITY OF CUPERTINOor
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>CQNTRliwe INFORM;TIONi
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rotvtstoN PERMIT''
,BuaDINCA0964 DEMPST,ER AV
' MRM DESIGN CENTER IN;ERMrr
No. S- _ A C?O : .
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50
OWNER's N
NIGH
1676 MONTEREY HIGHWA
APPLICATION SUR . t59
PHONE:
SANITARY NO.
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ARCHITECtrENGINEER:
BUILDING PERMIT INFO
(408)298-8668 BLDG ,ELECT: PLUMB MI:CH
LICENSED CONTRACTOR'S DECLARATION
lob Description
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I hereby affirm that 1 am licensed under provisinns of Chapter 9 (commencing
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with Scdinn ]IHMB nI an 7of Ncltualnass and 'ml'cssi xCmI
in full (Cent and el
ae .
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Licenw Clens Lien
Dare Cnmmctn
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I and n ,Y used as pn
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REMODEL, ELECT PLBG MECH
LiccnscJ ProfITCHEN
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OWNER -BUILDER DECLARATION .i
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1 ,(lien then 1 exempt from the Cmrtmemr'x License Law for the
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folloh rx,masom. (Section 707,lh em.11Css and Pm Cwlr Any city orcounty
brio I
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derrols
wh M1 q a peen,( n c t ,, elt p J mtol fill. or p -any structure
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p t t: snce.1'hprrm, is k dshaanem
,list th .dpu: u tire p ns : ren arusine I' Los(ChapterCcr9
Sq. Ft. Floor Area
_
Valuation
fro ecmg with t ]01107 fDi t CWcl
i fthelegede:and Pml nyviolation
_ $•=Qmal�r
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bas i
or that 7 exempt firsonapple and air baser Tonne alleges exemption. Any vat
malty
of Sre,ion]071.5t, hundred"',, for aprnnhsuhla'ts,hr uppl,eum toscivil penalty
io any
air not n,mre men rwo hundred dnlla,a (ash') �
APN Number .'
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Occu ane e
p y'JP
32648030.00
-
prove y ye acesen g penes
°Las owner of me n, orm In th wa es as ihcirsolc nmm tion,
,
Required Inspections '
is
will do the work, unit the hale I he is nm "„'tied or offered for rule (Sec. 7044,nor
Brod... and enantroro License law Jnee ern apply m mm
r of progeny ills or
re(if y W hn b,sese nr improves thereon, and who encs such work ndedor
or through his o provided that such improvements ere not intended or
his emplehowever,
is slid within one year or
eredfr . If, [l is
offered for sole. If, er-hol r, the l have
wiu n., nate henna, orpriving Dena, nr did not b,dm n`
me ower'_ ti e i burdenproving
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'mprovetfor saemr
p pm
101 — FOUNDATION
°1 nn p pry, , exclusively contracting mhrenelientmetr:tm
_ 1.02 — PIERS
c t I e p jest Is ]too ❑. P' I' n C I) Cont I 's
Jcesnt I
103 — UFER
applytofp venywnoh p csm'eons
Licensehe
and h e ntmas 1 such projecn ,n nmannrts7 licensed p .uam , the
- 104 — REBAR O
cmn,me,ora Lieensr Lew.
01 an, e.emptunds,See . RerPCfar ihixrnaxm,
105 — ANCHOR BOLTS
Owner Date
WORKER'S COMPENSATION DECLARA9JON -
106 — SEWER 8. WATER
. Ithereby ,(frmorder peowtynfpe,jur,on�ol herollovI.gdeela,amex:
202 — UNDERFLOOR PLUMBING ..
.
0 I have and will maintain a Cemi'cam of consent ,n self insure for Worker's
203 —. UNDERFLOOR MECHANICAL
Compensation, as provided for by Seedon 3700 mf the Labor Code, for the
204 — UNDERFLOOR FRAME
perronri or Om work for which mis venni, is is,rcA.
205 — UNDERFLOOR INSULATION
e and will maintain Worker's Compensation Insurance, as required by Section
nr,ne Labor Code, for the performance or the work for which Inn pennil is
301 — ROUGH PLUMBING
issued, My Worker's Cotnpenxallon lnaunmcr carrier and Policy manner ore:
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302 — TUB 8 OR SHOWER
a/1
Camery�yl oBe"[W
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AE
CLTfOIdCA'1'1 OF IIMN P ERS'
3
30 — ROUGH MECHANICAL
IN
' COMPENSATION INSURANCE
304 — ROUGH ELECTRICAL
'Nis section need not he completed if the permit is for one hundred dollars
($IW)oness.)
305 — FRAME
I certify mot in the perfornanm if work far which des permit is issued, 1
.306 — HOLDOWNS
shall not employ any person in any ma r so as to become subject to the Workers'
enmpenwron Lowx of California. Datenne
_
307 — INSULATION -• -
Applicua
NOTICE TO APPLICANT: If, milermaking,his CeniEcate or Exemption,ymr should
308 — SHEETROCK
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becomesubject to the Workers Compensation provisions of the labor Code. you mus,
hands,i,h comply with such For,isinnx it this permit shall he deemed revoked.
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309 — ,EXTERIOR LATH
CONS I RUCTION LENDING AGENCY
310 — INTERIOR LATH
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(hereby north, bar is a construction lending agency forth performance -
or the work for ahicnthis etmnisissued (Sec.7(197.Cis. C.)
311 — SCRATCH COAT
Fp z
i,hi aer niiarexs
313 — ROOF NAIL
U C
E.
1 certify that I have mind this application and state that the above information is
coemet.Iogre,,commplywithulrcity:mdcountymdinance,and.,amWwsmmm'g
501 — FINAL ELECTRICAL ENERGY
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to building Construction, and hereby authorize representatives of this city to enter upon
502 — FINAL PLUMBING ENERGY
�ryy
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mean(We)arineJpmpndemifyandkepmpmses.
andClfyand kcephamtles,, ,an City of CmC
503 — FINAL MECHANICAL ENERGY -
C.7
es mlgreemwostve,
Cityinca,ju,.Cnc,,risBuamogorIxwldrheBayin ages said
'
504 — FINAL BUILDING ENERGY.
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City in cunseyuencr �m)('the greening if 1
Iway.Leen',,gains,said
All .TUNDER3l'A' S VD\ LLC 1PLY WITH ALLN POI
Issued b 505 — FINAL FI Ff1TRTR0 Date
y L
GUL IONS
Re -roofs —' —••
.st are of pp'ea (cion act„ 1
HAZA ous MATr:RIALS In 'Los RE
507
507 r FINAL PLUMBING
Will the applicant inporm building useupam nt adle hazaenus mamrial
Type of Roof
by me o Mnnm;pnI "aider”.`, nd etc xe:dm tion safety
508 — FINAL MECHANICAL
..id?
Axle, Sediun 2551200"
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All roofs shaffibI9nspedrell)Ift t(COWDIDfing material being installed.
Will the applinmt nr lumro hue ldingn pant on' equipment or devices which
umhict? ens mrcnnutminunwmde'n ry mhc i{nYArraAlr Quality Mtmvgemmd
rnarmtY
If roof is in%1Ibd witIFFbJ1\MLt opp�lpj9jj`1�{�pNpjpection, I agree to remove
all new mate s Dein. and will comply with
°Yes °
.(THEY TIT9HL''.11wo I.
all non -point source regulations.
I have read the nazablom' mamdulo regrio mmrtx under Coupty 0.95 of the
California Safely Cala Sections 2.1505.25533 7Y.lundenotif
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yrespond them
BrbuldingIficdn&
it
the building Jcesnot currently haves nsant, teas is a responsibility enotifyme
that
atupant of the requirements which mus, he met prior to issuance of a Cent "'core,f
A
an`I
Signature of Applicant) U Date '
Ownermraumoeardagent A
All roof coverings to be Class "B" or better ,
OFFICE