00070185CITY.OF CUPERTINO;, t -
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BUILDING DIVISION PERMIT -CONTRACTOR
INFORMATION:
BUILDING ADDRESS:
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PERMI'1'NO.
OWNIiR'S NAME. - " DENISON AV -
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APPLICATION SUB BATF.
ONF.: DHININY AND ITTIELAI'--
.SANITARY NO, COMROL NO.
ARCHITECUENGINEER: _ -
BUILDING PERMIT INTO
3IDG ELIiCI' PLUMB MITCH ,
LICENSED CONTRACTOR'S DICLARATION
Iicensunder....' in lir Clmpler Y (emu darri.g
I hereby uf.nn ,bel I um W I
Job DCSCCIpllon '
With Section 7000) of pill sloo 3 of the Business and Pro@ssl... Cads, and my liccnw
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in full force and effect.
I' in
' Lica"
TEARING DOWN' RLL OF EX:HOUSE`EXCEPT' W
Date S DECLor
ARChallhe se DECLARATION
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'.BAf'I'. SAME FIUT ADDITION 737 ADDITIONAL,
I unlet„:,na my plans shall he used nF ptmla raemm,r -
Licensed Proc,,k ed -
.. OWNER BUILDER DECLARATION ♦
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I hereby alarm that I am exempt from the Conmacuuk License Law for the
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folloW ing rt a. (Section 1113 1.1, Business and Pmressions Cee: Any ails, in county
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which requires a cecard to nmamm, niteq in.mprove, demolish, o, repair my structure
ruins u, its ,,o ance, also require, be applicant Ior such Iw,ditd ,, II Ie a signed lalmorni
S Ft. Floor Area
9'
Valu tion
that he is licensed pursuant to the p6mosionv of the Completer's License Law (Chapter 9
(commencing with Section'IIXXR of Uivisisnt 3 of the Business and Professions Code)
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or That he is exempt Ihere fon i and the basis ler the al labl exemption. Any Ololution
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of Section 7031.5 by any applicant for a permifsubject, the op,heam to a civil pcnally
of nor more than rive hundred dollars (S5W).
APN Number
Occupancy e
❑ 1. as owner of the prnpcnY• lir mY cmploYees with wages as Ibcir sole compenxaion,
will do the wi,rk, and the structure is not intended or offered for sale (See 1614,
Bu,incss cad ProfusionsCode: The Cnnlrnnm:v Llnme Law ane, nam apply ,, an
owner of property Who builds or improves thereon, mal who dws'such work himself
- Re u red Inspections - -
31. E,2904 8. �f� -
or through his npl y president th I such improvements Tom at immidearl or
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offered fI If M1 'he building or impla,cm,al I, sold within end year of
c,, ,len II -. c,lbuilift, 1,11I the n le. .1jglh,h did ,n Id r
p Trp To. r 13 -
101
— FOUNDATION
.,be, of th p pe,y I'' ly indicating withlicensed Oniffacturt,.
102
. . PIERS '
'col +Tu t the prabect(S lWJ Business and professions Codw)"pre CI ,
Li rose Law does not applyl fpnpmy whon Ia% or improses,th
103.
— UFER.
and tracts f h pnjectn with I moos) e 1 p n t the
ce tr ct r l L
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104
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— REBAR
❑Ia,l exempt under see. B Pee thdv reax„lt
1,05
— ANCHOR. BOLTS
Dal�9 r%�
weal f•s cD�iPlsni -"- SA. TION DECI.ARA ION
11ZIE
— SEWER 8 WATER- -
Iherebyamrn,mlaer nmtyor rjuryoneoitherou„dmgdeabtralons:
2022
--UNDERFLOOR PLUMBING
D 1 have and will mulmefn a C'mr.re of Consent if self-msmm sir Worker,
203
— UNDERFLOOR MECHANICAL
Compenmdnn, ay.{novided for by Seatl3n',1701 or the* Labor Codq'for the
- - X04
— UNDERFLOOR FRAME .
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performance of the work for which Ihis permit is issued.
DIhall and will and .main Workers Canada L nsatimmsmm once,regdired by Seclimi
205
'— UNDERFLOOR INSULATION
3100 of the Labor node, for the performance of the work.for which this permit is
301.
— ROUGH PLUMB ING
issued. My Workers Compensation Insurance carrier and Policy number me -
302
— TUB R OR SHOWER .
Cartier: policy Na:
CERTIFICATION OFEXEXIPTION FROM WORKERS'
303'
— ROUGH MECHANICAL_ '
COMPENSATION INSURANCE
304
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— -ROUGH ELECTRICAL
aitis semion need not he completed if the Emend is for ooc hundred dollars
(slBotone.s,)
305
— FRAME
1 certify that in the performance ofthek for whitdi this parboil Is issue, 1
306
— ' HOLDOWNS -
,ball net. mpl y y person in a, former t became bey I the Wmkcrs'
Cone foo Laws,I c rl ,inLure.
' 2,07
-,
r' INSULATION
Applicant -
NOTICETOAPPLICANT:If. after making this Certifiicateoffisemption.you shorici
1 308
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— SHEETROCK -
bec nne,ob,co f the Workers Compensaloa prvisiunn nI flat LaborCode you nn61
a,rmwith comply with such provisionx or this penny shall he deemed mvnked..
309
— EXTERIOR LATH . .
CONSTRUCIoNLENDINGAGENCY
310
—'INTERIOR LATH
1 hereby alum, Ill., there is a conmmmion lending agency for the perrerommed
of ork for Ih ft his Isarmit I,': u oil(See 3097.Cn c)
311.
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- SCRATCH COAT
Lenr d N m
Lend Add :.
3].3
ROOF NAILIc
rtfythtII read his apinl¢ation end slate Ill., thculwrc nnormat kx
501..—
FINAL ELECTRICAL ENERGY- '
I agree In u„ ply. wall :ll city and e,unly ord,ntcev, coin 1. w, rarttidg
building
502
— FINAL_ PLUMBING' ENERGY
m mmted,o n. and hereby..to lire repre ... aises of this city,,, emer upon
me aM,(We) Tone propefty
chs,
,
..� 503
— FINAL MECHANICAL'.ENERGY
".indmerify magi kepunnnil. of Corsair an ;tguinu
"i't, to a,ve,inderom,peodkeepmoses. ,he
liabilities, judgments, cos,. and exPensen which many in any way accre against said
SO4
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- FINAL BLI I -LD I NG ENERGY
City in consequence of the gmming of this permit.
APPLICANT UNDERSTANDS AND WILT COMP YWITHALLNON7 1
SOURCE
Issuedby:'. 505
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— FINAL ELECTRICIefte
9�°�
Lr�
/s
mreorApprcanden506
st naGAS
mmmn o Dew
',Re -roofs
— - 1
HAZARD SMAI'ERIAISDISCLOSURE
507
-'FINAL PLUMBING
Will the opplicm, m home, Wilding occupant smm m handle haraNma. mmcdal
Type of Roof
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as defined by the Caperton Municipal Code, Chapter 9.12, and the Health and Safety
508FINAL
MECHANICAL
Code, Seat ion 2.95320)?
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❑Yee ,' ❑Nn
-All roofs shall bec5l4l%cfSd
FtiLW(alan��:material being installed.
Will N1,1111said or(umre hui Icing occupant use equipment m devices wh sh
,3` If a roof is installRIAthout E&NAa iMgQhlkk1lNQ ion, I agree to remove
i, hazallova air contraction, as detinet by tire Ray Area Air Quality Managemcm
”"°ores I
all new materials 51. fiispectfeiii\ftpliW
(IindetstddGR146will comply with ,
N„
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all non -point sour6VftgrdBtl%0OF PLYWOOD NAIL
have rind the ha arrdous titmerixls requirements under Chapter 6.95 of the
Cabb nam Healy, & Satiny Gide, sections 25505, 25533 and 25534. I anduntaml aim
603..—
60 3..
— - ROOF,- BAT TENS - '..
if the building does nal currently have a tenant. ted i, is my rupansmility u, notify the
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Ircupam or the regvimtltens Which muni be amt prior m isnuanca m(a Cent cmc of
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ofCupency'Signature
M o►:
of Applicant
” •' Date
Owner,,,. t.edasentDa,e
7 All foof coverings to be Class "B" or betier ,
OFFICE '