00040078 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION-
RULE)ING ADURE,SS:. PERMIT NO.
OWNER'SNAau1875 EATON PLACE APPLICATIONS A':
Ie]IONI?: YEE SANITARY N )4/1 O,
O O ARCHITF,CI'IENGINIiER: - BUILDING PERAII r INFO
_EC I' PLUMP MECH
N u LICENSIiD CONTRACTOR'S DECI.ARAf10N
z 5 l eemb rfrrn mod rr,t fcroo,d ande, fChn d 9 c demo, Job Description
Ooh e- J yo pnPromo pert e
p_t�w ,wish Section t mid e f Division 3 of dee Businessland lhofessiods Cede.nnJ my license
m^ww is in full force and effect. -
woau Cl...Lmen.ei.i<.« REMDL 143 SGS. FT. BY ADDING A BEDRM AT c
3 u.H nam Cnmmnor
ARCHITECI"S UIiC1,ARAUoN
t=°g Inode„(nnemypl:,n..hannna.=da.minu<re....N REPLACE WINDOWS
eyes:.
Li<=.eePn,r=..iennl FEI_OCATE E. BEDROOM DOUR
i m.y OWNER-BUILDER DECLARATION {
I herchy often that 1:no evro,front the Connaeotrs U,,oa I.usv fo the -
!'[a following nnwn.(Section 7031.5.Business and Pmfessionu Gale:Any city or county
COo which requires o pooh Ineomaimprove.elenad
0u ,alter, lsh,nr rcpnir any evuemre
el
prior ht its issuance,also requires the applicant for such Permiuo f le o signed statement
�3� mot he is licensed numnam do the pm%Odors of the Contral License Law(Chapter 9 Sq. Ft. Floor Area Valuation
neuralng-ill Section 7001) fU '. 3 fm B dProfession,' Code,
Indeh : iol f ddM1tr f maIlyd pt Ay ' lion
of Section 7031.5 by any applicant for a Permit subjects th ppl nt to a civil Penalty
ofnot more than five lot ndwd for ars($500) APN Number Occupancy Type
❑I f1h p pc lYor toy pl y dlwages d tpr,rron will do the work, J file structure :not intended or offices!for ll(Secs 7014 -
Bus :an Profession,Code TheC fact... License L J :apply m an - Required Inspections - ")
oxo t property WhoIJ b p theme, J h J such h k himself
nr lh bh I s ply 1 I d tl t. h to t' t' tended or
offered for sale,If however.the middi g or Improvement is. IJ within one year of 33261.9133. 00 .
tac plt a - -h II 'llh a burden provingfA t1 ed not build or
p "a parpoo, f I 1
Gist.as OwnerofIheproperty, sus,ch,contract ingwair licensed social 101 — FOUNDATION
nnotmm he prejeet(see.7044.Baaiac.a and Prot a,mns Cnda:)me Contractor.
License Law'ares not apply to an owner of property wad builds or impnno thereon, 102 — PIERS
.
and who cmmmels for lace projects with a difte qs) licensed purwtim to the 103 — UFER
Contractor's License Law.
014 emt 1nnit Sec .H&P C far his naw
�( Q; : ',' ._ 6� �6G 1.04 — REBAR
(� ovine =. Dme
OR
. COMPENSATIONU:CLARA'[ 105 — ANCHOR BOLTS
• Ihereby affirm under penalty ofperjury one ofthe following declarations /. 106 _ SEWER & WATER
0 1 base and will control Cenificme of Consent,to self-marc for Workers LLL 202 UNDERFLOOR PLUMBING
Contpcnwdioo, .n provided hit by Second 370d
1 the moor Call for the-
pmmrmnacearmew.Afim hicbmi.sprem,i,oetcd �iI 203 — UNDERFLOOR MECHANICAL_
0 l havcand will maintain Waken Compensation Insurance.as req Co. ny Seenm, 204 UNDERFLOOR FRAME .
3700 sr,did Lab,,Cam.for ma pedntmnnce of he work ror wnieh mice permit i= "'05 — UNDERFLOOR INSULATION
iawted.My Workers Compensator,Innnranee carie,and Policy number are: G
carrier: Policy NO, 301 ROUGH' PLUMBING
CERTIFICA'I ION OF EXEMPMON FROM WORKERS'
COMPENSATION INSURANCE. X02 — TUB & OR SHOWER
(Lis kefionneed not Is,completed inhepermirnfor one hundred dollars 303 — ROUGH MECHANICAL
(M(n))or visa' 304. — ROUGH ELECTRICAL
I Bendy the in the peofo.tnanee of the work lir which inn hermit is i...ed,1 305 FRAME
chat]not employ any po,,an in any Tonne,ser as m hecn.na.object:o the Worke,s'
Cor,tpendfonLaw.nfCalifomi:rDaid 306 — HOLDOWNS
Applicata
NOI1ICE'1'0 APPLICAM:If,after making this Criifate of Exemption.you should 307 — INSULATION
Compensation subject to the Will Compenon prtwbions of the Labnr Coed,You must
Z0
0 Intl comply wimsuch provisionsonhispermitshall Ise,decreedmvoked. 308 — SHEETROCK - ,
4 - CONS'I'RUCI'[ON LENDING AGENCY
C ebyafrrtnmmthem i,ntm
ennaadenleddir,gageneyro,thepem
,fentnee 309 — EXTERIOR LATH
ofine work for which this permit is issued(Sec,3NO.Civ.c.) 310 — INTERIOR LATH
p, �-• Lender's Nanta
p 7 LerlAddres.s 311 — SCRATCH COAT
V I c=nily thm l have reml this application and utte dur,the all information is 31.3 — ROOF NAIL
Ing. est n,mets 1 ngrce to comply with all city:nd cuuoty ordinances and did,laws neladng
O r> to building constructions and hereby authorize represenmticesofthis citymcnterupon 501 — 'FINAL ELECTRICAL ENERGY '
w menoOve)ammmpve.hal ,imp=edion kepharmle. 502 — FINAL_ PLUMBING ENERGY
E•' y pVq agreemsave,art eilyand keep harmless in me Guyana Cupertino against
h Eamfdiea.jnagr,tnn....cues,and ex,roe,wnieh mor in any way narcotic.agabadsaid 503 — FINAL MECHANICAL ENERGY
U Z Cityi sequence of the gmming ofhn permit
AP (CANTVNDERSTA On A DW LCOMPLY WITHAy�NONy- �INT
s
OR .R^cYLAT�I? �/t 0C) Issued by? 504 — 'FINAL BUILDING O RGY
Stgnatano pltc nticontr'd -I Dare Re-roofs — -
112DOUS MATERIALS DISCLosURe �«-yp16 GAS TEST
Will me applicant or dome building scup m.atom or handle has.Nous mammal Type of Roof
rove,Section
me 32m)?rfl oManmq,al coact ena„de,v.a.:md me Health and serf"r 507 — FINAL PLUMBING
Cute,Senior,I'd Capaf7
°1c, 0N All roofs shall bSlhFpcae(FpfiNAAb..ra0Exrr0A9{J1T1Gt6Hal being installed.
Wit it
dM1e upplicum immusa F efiludg beaupnnty Aegdtpmen,nr devices which If a roof is instal"-dg•idmFfT7Rtf�kta63b1�IdE❑SpeCtlOn, I agree g0 remove
emit hamrJous air amtaminanu as Jefn¢J by the Bay Area Air Gold,Management
' all new material'QQlnspegnglNA><pPo(Lp1NNtrR$Qiids and will comply with
°re. ❑No P Y
all non- oint so a rules
1 have mail the hazardous materials requiremem..Order Chatom,6,95 of,he
P J f+.b— �`OY�1AL PUBLIC WORKS _
CWifmfnI lculm&Safcsy Cmle.Sections 25505.25533 and 25534.1 understand mat ,
Write huiiding ares net currently have a manor.the,it on.. .....l ibllity In only the
ovuryun of dhe regm....encs which must he over prior m issuance of a Ceni acne,of
eapaney.
• - Signature of Applicant Date '
`wPoser or lathort.cJ agum Date. All roof coverings to be Class "B'• or better
OFFICE