00080192 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS' PERMI r NO,
s.
OW'NER'S NAMEJ,0934 DRY EN r a:AION, • VWJ -
t Pk10NE:' TAN I .. < H SANITARY NO. /G
CiXz ARCHITECrIENGINF.ER: (4 08)996-9151 BUILDING PERMIT INFO
H-pOjO +' BLDG ELECT PWM1iB MliCll
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LICENSED I CONT ed unci R'p DECLARATION
C i C I h by ITmt het I n I cone B err -n ns of n'Cu 91 It'menc ng Job Description • y
�N •withfull sw BEI rD 13 it] B: II eevsi Cd fury lice lac
tan full I''ce nnJ c ect.
oucenar CI . 3�[F=£Yl.ic.x
a 0 y Date_ etas public
BATH REMODEL
O ARCHITECT'S DEC ON.
t•� undersrmt niY pinnn xhnll he used as Publs recnnlC L t
T
�p K Licensed Professional
nadeOWNPH BUILDI RDECLARATION
l2 `
w m I h by fl flual pl Ir dm Contractor's
oC ion I n fny(: tol rib ui Scott.7031.5,B J Profession,Code:Any try county
which cyto Wrier t n: alter.Improve.crawfish, r rep' n):w
O
� lmmyu e,lheappa for wchpnIIlbRukbulshtnaren,
is hrneisgjolowdunton mthe prissnrtheQtntmcrdsacie Lewt9 Sq. Ft. Floor Area
(nmm ngwith Secinn n ofDov3 ofthe B ,ane mfusCede)
orShat he sexempt mamfrm rntto,Iasi,frthe alleged mm prim Any violation
au:i[ion
'
of Soctian]Bns by;oheartfora pennisuMecv. he PPlennnnucvil Penalty
nnopiIitre mmf ore bmododdollar, 8500) APN Nu-mber Occupancy yp@
01,as owner of pmpen,,or my employees with wages as their sole compensation.
will do the work,and the mmcture is not intended or offend for sole(Sec.7144,
limumss: I Note..ion.Codc:'ph,Cmena"mr's License Law tinea net apply to on 3561.501511B4ired Inspections. .
owner of pmpeny Who builds or improves thereon,and who tees such work himself' .
nr through his nwn employees.provided that such improveni arc net intended if, _
oIrred for hale.If,however,the huilding ry improvement is sold within one year of
improven `iii,the nwrier.yaiiejtwdIhave the burden ol anvingthmhedefor build m 1.01 FOUNDATION
b purpose
o 1 102 — PIERS
0l.m owncroftk pmpeny,an,exeluviwly cnmmeting with licensee convert `sto ].0' — UFER �'•
unWnml the atiect(Sea.,7194.Bu...m,d and F...Nations Code:)IKe Cont.1or. .•a
License Law does not applydo an owner of progeny who build,or improves memon, 1.04 — REBR R .
and who controls for such projeets with a contractions)fcemedrpursaant to the
Compure,License Law: - 1.05 — ANCHOR BOLTS ..
0 l ant farina fuller tie. - If A 1'C It,,flat munml -
Dwtrr, Date 1.06 — SE14ER & WATER
WORKER'S COMPENSA'T'ION DECLARATION - POP — UNDERFLOOR PLUMBING
'l hereby affirm maIrr,c�,IIYofperjmy anent IN,rouowing decmmtina.: 203 — UNbERFI_OOR MECHANICAL_
0 I harp and will maintain a Cenificam of,cou.c'n to wlr.m:ure for Wnrkcr'a 204 UNDERFLOOR FRAME
ta
Cumpensntian, ns anvidcd lin by Saclinn 3700 of the Lubar Cads, for Shc -
perromnceoftnework forwhichthis permit I, .mea. 205 — UNDERFLOOR INSULATIONr
01 hone sad oil maintain Workcr'c Ctempemmion Imumncc,as required by Section 301 — ROUGH PLUMBING
3710 of the Labor Code,for the ruff nmamac ol" Im wowh
rk for ich 0W,permit i.
teed.My Worker sCon Partition m:ueancecartierandPolicy number are 302 — TUB R" OR SHOWER
comic' Policy Nm: .303 — ROUGH MECHANICAL.
CF.RfIIrICATION OF COMPEN1i TION INS RROMANO WORKERS' , 304 - ROIjGH ELECTRICAL ,
' COMPENSATION INSURANCE - '
(TM-weltion need not he completed ifth proof I is for one hundred dIla. •305 FRAME
($11111) rla:) '-
I <mf that in the Performance of work for which this 3116 — HOI_DObIMS
Tyra rra re > r ;1'ennttt nsaed.l X07 — . INSULATION
shall t en 1 n oom in n t m ur be o s b m m the Workc1 v
gotir,r^.aron ,df ;, '. . ,a a an .i me . ..308 — SHEETROCK r
rr
NOTICET PPLICANT:IL alter making this Cenifime of Eamnptior, hould
necameaubieetnnmewrorkeralttmpenaadonimminionsnfillLabrna,ae.rofnan _ 309 - EXTERIOR LATH.
O
forthwith comply with a,,ell prnrl<inm or this pem,a xmm be decree m,okal. 310 — INTERIOR LATH
F - CONSTRUCOONLENDING AGENCY
1 h 31.1 — SCRATCH COAT _
ereby affirm construction there is a consction lending agency for the performance
a ,
or tire work fnr which dd,permit in issace Spa,3097,Cir.C.) 31.3 — ROOF' NAIL W
Q 'I.ender'.Name
D z Lender's Address 501 — FINAL ELECTRICAL ENERGY
w POIstrut ythat I five read this application and nnllethat the moseimbrmemnia 502` — FINIAL PLUMBING ENERGY
correct.I agree to comply with all city and county ordinances and state laws relming
O v m building con,macticat,and harrhy maheriZO orprescapatiVeS of this city to enter upon
he 503 — FINAL' MECHANICAL, ENERGY
(Wel sl '
r� tbe i d pa pent f r br rely r rpo.
eet a„ I lY dk lI a..to City 1Cpdn' 'least 504 FTNAL' 'BLIII DI MG -ENERGY
.
xHoublS judgment, t. I expenses which wy LI tiny ay accrue agu'n.tsad' .,
U z City en. q ceoftn g t g of this parma. 50-9 F NAI_ ELECTRICAL'
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT �j�
SOURCE REGULATIONS Issued by: ��€'y L— S TEaT ' Date' ., —_ •i[��_
Signature of Applicant/Commcmr 'Date Re-roofs - 507 — FINAL PLUMBING
HAZARDOUS MATERIALS DISCLOSURE.
Will the applicant or mare baffling occupantsome or lmm0e noamon..aatedm -Type of Roof 508' — FINAG MECHAN.T rf--1 .
in Jcfned by the Cupertino Municipal Code,Chapter 9.12;tad Shc Health and Safety - -
Code,Section^_5532ImP 0No . t, 509 — FINAL GRADE -
.. All roofs shall bej IleiectedFp4tp1-14_�9T'114�f1ePk'fYld$�erial being in'stalled.,.
avis In=applicant or rnt�lle;nndtu;IG oecap:rtn one rqu'Ip{neta or devices which Ifaroof's instal ker� Ittt�u�flr4q�taiI�nlipspti �(,,agree to remove
mit havardous air conuaninons a.defined by the Bay Area Air Quality Management `} 'A d
,inn9 • all new rnaterials or inspection. pphcanrun ers[an S,[rid will cornply'with
11 Y,, "0 No all non sourceregulutions: , ' ' �'•
1 have read the hazardous materials requirements anter Chapter G.'15 of the i -California livahh&Safety Gds,Sections.55115,15573 and 2553J.1 understand thin -
if the huilding does vet comendy have n mtemk that It is my responslbi lily m unifyi,
o"
ctgtaut of fire requimmcuts which nln.I op pet prior ria iaa fmce nl a Caulhcate nl'
- 'Occupancy. - . Signature of Applicant ',"r Date
_3l _
et of aathorae gent D.ae All roof coverings to be Class " `fcfr better
0FFICE k