00100124 '. -:CIT 'OF CUPERTINO�
tsun of vc•otvtstory pER1VIIT CONTRACTOR°INFORMATIQN .
BDILDINGADORT0914' dRYDEN AV 'RTLAS HEATING PERMIT No. 003.00124
OWNER'S'NAMF:' ' '; ' •' I • PPLICATIONSU T . ,
SMITH. STEPHEN, G� AND B413ARA,-A 7.55; •'SAN ''LAZARO RV �. JJ.8lc0Zk1
ys
ZONE: } (408) 739=1DS1E SANITARY NO. ( CONTROL NO
' '
u�W O ARCHITECTIENGINEEIi:-- ` - - BUILDING PERMIT INFO -
m C
"BLDG, . ELECT PLUMB, MECH
as
Z 5 y Z LICENSED CONI'RACTOIi S DECLARATION ` ." 3 ''IOb Description
'
lately fl r o Ih 11 disease' d p l n. f Chapter 9(comme cmg p
pz�P arms r eI I ffD nrnneda d d ,yl REPLACE '.FAN ` ADD RICt�AND� PANEL UPGRADi
oos a to yy
Sn lall f force dmfet - /{'�j� ( �6 e �,
z ¢ Lic a Ll s.' Lc # ( J 1V ` ;h '
u ' am m Conduct.,
ucmr
p ARCIiI'ILCt'S DECLARATION
I Jct 1 y pl 1 11 n J :public N. v -
0 LicenwiiP f. I -
OWNER BUIL UER DECLARATION -
w00/M a,
C� d rn d 'pt'I n-G t Lc
h y ¢ ' p inlmirldth , demolish, occur, Y.t' Ie L l the
following 70 : d Pr. i Code A y air,in court,
Ise ln
mi . Pion also caprices the applicantl hp tett ll britt 1
_
is. 'hat he I t l u
-
the provisions ofl Contractors ILaw(Cn p( .9 S FL Floor Area - Valuation
(n lg withs t Pntror lL' B of he Businessman[P r , .0ar, 9. - - 4>i
,,that he is securedlt In t I d he best,for do allegodh m An, winfirso - -
-'[o7lSection 7
tm]0r9a1t 5thbeyad 'n,pl tl maphemintnhr t.thealll poo poll perelly
„lapt more than five h ndred dollars S500> APNbl OcupancyType
1' . GG -
-
will do d- work,u dstructure-' tintended rffacie J f (S 'I
Bd v e - I i W f Code D Contractor's 1 en:e L d t apply In
a
w fp pow co n da ,t a a 1 h rt nedor 204 — ' UIV1Jgtt,FLOUI�. I NAME
owns,
......h sal oxo hotly , rind t: 1nimprovements t t intended or
dar,daem srie.If.however me mining ' tpmvemdn her he odeyearuild m - -30 i. — ROLIGH F'I_UMBTNG �.
omplmfor(lie wllunave he baNen orpr,wme d,at neaia nom build or - ��-� ROUGH MECHAN I'CAL
improve for purpose ul ah1aJ. , - _ J" -
❑I the, p ny JIycontracting with r 304', — ROUGH ELECTRICAL
malum the notice,(Sea 70",Ban cess and Pmmss o is C Aa.)The C nmamr x 505 '— F1NAL ELECTRICAL
Licensef d t pl ly t r owner f property who hu Id. improves thereon,
an ,
d h t t f p j t'will tmemgsr'-tic n m d pursuant the _ i V; c ,, "
Coit chars rutse Luw 507 FINAL 'PI_I lMBING rte :
❑I.'In.rm,aerrorSo, ITwPCfor Iti,ora.ox. 508 FINAL-MECHANICAL
Owner Dam ::' 514 FINAL. PUJlBLIC WORKS, ...
WORKER'S COMPENSATION DECLARATION
' the rbYofl rnf pnahy of pej Y,neat oho toll g1 I niona: - .- _ "
I move and 'll ...chronic 6 Crouraore ,I Consent In self-insum Jet Worker's 1 - -
Con p I u.,us pn,mial for by Section 3700 of'the Labor Cork, loo the ,
pert rmance of the work for which Ibis permit I,i,,crad
❑I have and will is nt ' W lm :Ciarpensation hassfource,as undirad by Section
3900 01 the Labor GNe [or the perfomtande of the work for which this peradn's - '
issue 1.My Work r C ,uosii.lyt o Insurance earner and Policy number
n are � 1'
Car a 'al'cy No.: -
CEkfILICATIONOFLXCMPfIONPROMW RKE,RS' v -COMPENSATION INSURANCE. -
(Tti: i rt cocaine trecomplcted ifthe permit is for on hundred dollars
- (51W)in In,,.) -
1 certify that in the performance of nhe work for which mr,permit I,Issued,I
.hall no employ any person in any in net at as In lu none sobjedn'to the Workers' ,
Crar tid Laws of Califf ma Dune ..
Applicant
4. '
NOIICLtO APo the WrI If Acrnmkation rCeniflwta of Labor Code youshould
becomeh comp y the Workers Qanns tir this pmv ions at don Lubar rev e,you must '
,Q O forthwith comply with such provisions or this permit hull be Jeemnl mvokcJ.
` a A - CONSTRUCTION LENDING AGENCY '
Ih by fl fladdisom".am"nor, Idog ui yf nh paR,.m n
W.� Athe work i' hlh Pern't is'nted(S -3097.Civ.C) S _ - v
Lent Name
Lent Address - .
V a s ,.
�+ 1 teetotlh Jd . ty tY and e renounce,
blit rd
W F� , t 18 t pIY 'u allob p ri ore -d' d o t 1wIng •. ,•
Q V the building t' and xbyuulhorepresentatives Po city benter upon -
9 nlon h to f ds Pe ty f p a rp . : -
a M'r'6r t , d ry andkeep l I tanyaw fCup i g t - - -
4 C Id j dg t. t J p of this
hl h yin ry y nyalnst d
' V ,'� Cit .cyteo nl nM1 y nuns,fthl permit. - �,. •. - r�iD'�
P NT UoryrypplIpp�nE STANDSAN ILLCOMPLY WITH ALL NON POINT Issued 6 �,•(
SO ft( R:G1111AtoIONS Y' t Date
VV w
sp rc t r,r nate ' Re-roofs
HAZ RDOUS MATERIALS DISCLOSURE
_
Will the �d am trfuture bamang .. p. tst rhandle hicandmsmat 'al Type'of Roof -
vsdefined bythe CtpennoMunePdCode;Chapter 9.12 and the Berlin-and 5f-ty. >" _
Code,Section 25532UU° . I J " ' '
❑ve. o N,d •n 's . All roofs.shall be inspected prior to any roofing material being installed.
Will the plicamor f tam building ocpdpaid useciryp t de ...Inch 'If a roof is-installed without first obtaining an inspection, I agree to remove
nit ld'. J roan � t, ,dlmad by the Bay Area QualityMnagcm.e, - -
isnfnn -i, all new materials`for,inspection. Applicant understands and will comply with,
.,•v - ❑Ye „oNo' I . - * all non-point souredi'egulations. '
I 1 d t n d u t t I mens.an 1 Chirpier ris or me, '- - - -
pCal'1 allealthdrSeldlyC It,Section,25505.2,5533 d 2553,L I slide....added -
ILme num nbdoe:wt tlyl 1 n th tl:' Y I b'rtyt flY the - ,
arca, a reenact, 1 must be mpro-m . LaCiufr.mor
.oecn an y. - Signature of Applicant " Date '
owner. a no— ago - Data • - All roof'coverings'to be Class `B" or better
OFFICE x