00090087 Ji
CITY OF CUPERTINO 'BUILDING DIVISION ' PERMIT CONTRACTOR INFORMATION:UILDINGADDRESS: PERMITNO.
WNER'S NAMBi4;_1. F INCH AVE APPLICATIC0@MjX Vf{tAf1TIYYr�Hf]NE: 11llNTO AKABORI - SANITARY:�a3/15, GVJ IUr�:,ORCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB , MECH
LICENSIiDCONTRACTOR'S DECI.ARAI'IbN Job Description
O z-, 1 hereby ullinn that 1 am licensed under provisions of Chapmr9(commencing
FyC wilh SCedra7000)of Divisino3ot ma HmincsxnnJ&nlushiaw Calc,and myliccnsc
Y J is in full force and effect. ,
License Cloys � Lic,p
3 LL F Date Commaor -
C�oy ARCHITECI'SDECLARATION ADDITION TO BACK OF THE HOUSE & ALTER K '
tor1 undersand aty plain shaE be used as public menet,
I
OO LiccnscA Pmfchsiunal
tai o
OWNER BUILDER DECLARATION
1 hereby,frim;Jtnl 1 mu exernin from the CnmmLiccns,Luw for fire
C billowing maxsnSxion]BJIS.Bovinesnd lufenio ;CoWe:
Any city or county
sa o which re:lu res it front to construct,;glee in,ese,den le,h,o,rep,;,ray structure
a3� prior m its toremer.,dw,.,sires flcti,lic,m formch perrou,fileusigaed statement
that he is Focused Panama,In he penvi„ne-dhe Commerce,Lieenae Law(Cm Sq. Ft. Area Valuation
(enmmenem,with Section 701Mp of Division 3 of the Bminesr and Professions C:xlcl
or Inco he is exempt therefium endure basis tonne allegedenemprior.Any violation
of'Sectio 19031.5 by uny appliam for a pnmit sulgee,the upplieum Io a civil penalty
`f not mice than five hundred dollars(S500), APN•Number OcciW4nic6Twe
ill
wus ownerofthe hely,or my employe es wishdoges a.(heir sole rnmpenwtion.
will Jn the work,:aid
W fire ztmaurc is not imenacJ or uR""for sale(Sec.]BIJ,
Buhlnew and Pmfehaions Code:rn,Contractn,.License Law arms am uPplrIu ar 37505021. BFAuired Inspections
owner of property Who builds or improves thereon,and who does such work /
or moneyed fib his awn employees, building
or such vement menlx um nn;immndetl Forest
offered fur hale. n huwevee IM building la improvement is sola within one year of
eoo,pletion,me ow ler-h^dde,d'.It have the handrail pining that he dm not h ]if 1,01. - FOUNDATION
improve for purpose of sale.).
CI 1,as owner of the pmpeuyout excwai.elycommctingwimrcc;rmc:mtmelman �. 102, - ETERS
p
csmsuuif,he roject 16ec.]ora,Business and Pratessiom Code:)The Commcmr:s 103 — LIFER _
late lawsees out apply no an owner of properly wlm bullas or improves therm"' ®� 104 - P.EDA R
and %no contract%for such pmjectn orf
with a commcts)liveried pursuant to[be '
Cnmm,or's 1-icer"Law.
❑Iamexcept�u�ae�r_see. B&PCf this reason 105 — ANCHOR BOLTS
ow^er /vr( ste o"1f"W106 — SEWER & 14ATER
WORKER'S C(MI iNSATION NECLARATTON
202 — UNDERFLOOR PLUMBING
Iherebyaffirm under Penalty(if perjury one othe fulkideclamations: 203 — UNDERFLOOR MECHANICAL
❑ 1 nave and will madiu or a Certificate of Consent m mlf-insure for WorkeLs
Compensation, as provided bar by Secnon 37M of the Labor Cole, for e 204 - UNDERFLOOR FRAME
perfonnanceoftheworkforwhichthispcomitisiomd.. m 205 - UNDERFLOOR INSULATION
❑I have and will armulain Worker's Comfcmntion Insurance.as required by Section
37.)of the labor CWe,for the performance of the work for which this perms is 301 — ROUGH PLUMBING '
issued.My workers Cmopersadon insurance carrier and Policy^nmbe,are: - 302 - TUB 8 OR SHOWER
""`ef' Policy IO 303 — ROUGH MECHANICAL
CERTIFICATIONOP Piney o, FROM WORKERS'
COMPP{JSATION INSURANCE 304 —. .ROUGH ELECTRICAL
('this It used not he completed if the permit is butane hundred dollars
ISRHpnrleas., 305 — FRAME
I c,rtily that in the performance of the work for which this par o t is Issued.I 306 - H01_DOWNS
slmll mil employ any pers:m in any,tanner so as m become,abject m the Worker,' 307 — INSULATION
Cope o,flum Luws of caliromia:Date
Apubemd308 — SHEETROCK
NOTICE TO APPLICANT:IL ager making this Certificate of Exemption,you should
mm
eoesurjemmtheWorker aeomemuaonlowisio:,alleLahoCode,vo:;ant 309 - EXTERIOR LATH
0 forthwith ermply with such provisions or this pc not shall be deemed revoked,
E i CONSTHUC,ower END(NG AGENCY
310 — TNTERIOR ,_ATH
a > ink for vildun mat uremia:,ennaf(Sea Dndirgag,n,y b:nne partnmtame 31. 1 - SCRATCH COAT
onne work for dltmn oris PCrmif is ixaum rsec.v»7,cin.e.)
31.3 ROOF NAT L
y p Leder's Aume
= Z• JLeader's Address
C-) O , ICertif m;:tIhavereadthisa 1 501 — FINAL ELECTRICAL ENERGY
la. Certify pp icnuon mW rdin mm me dswc of recon is
0 E`. ,,,rbuild 1 agree m comply with all city and county,emo ordinances and nut,laws miming SO2 — FINAL F'I_LIh1B I NG ENERGY
O U con se g ..f dun dh sin m I - tt ea ret. Irt ror fon
} W the a me d os pertvf .pet; picot 503 — FINAL MECHANICAL ENERG
` st
lr ((A liahlites.Orgme jugmet,el ndrefpyand khihrmy., mnywayfceperag,insts�d 504 — FINAL BUILDING ENERGY �(�'—
C,1 City in consequenceof the grunting of this second.
APPLICANT PL
UNDIRS'IANDSANDWILLC( I]'H A1.1,NON-POINT 505 — FINAL ELECTRICAL
SOURCE REGULATIO ♦ A�� �� OQ Issued by: _ Date le- 24-00
Stimmim of Apple. oncrctur r` Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE 507 — FINAL PLUMBING
Will he applicant or future hubding occulter,stem or handle hicarki material -Type OI ROOF
as defined by the Cunt Municipal Code,Chapter 9.12,and the Health and Safety 509 — FINAL_ MECHANICAL
Code.Section 25532ad!
°Yex IN" I All roofs shall 1 specte I m nis . aterial brio installed.
�F J 1
Will me apphcaul or rumre wnamg m,upam axe eyuipmemoaesic,s»men If a roof is instaall� w1IhoY1[ ilSPbbthi �lection, l agree [o remove
m it o"anlnus air com:nnina ro as defined by flue Bay Aron Air Quality Meargement ���}}}{{{
Dihaiefr all new materia51f4,iffspEtTAAIApRIt• t-Srlind will comply with
°res "" all non-point source regulations.
I have read the Immedous mmerinls reenactments order Chapter 6.45 of the
Culrozo Ilcahh&Safely Cn le,Sections 25505,25539 arta 25534.1 rude...and mat
n m,has laing Jaz not currently haves¢nam,mot o is my responxibility m nmify the
Occupant of me mymo m,-dmclt moa h,,a,af pe;,1,yf I„f.,,n,Cl:r a cmiecma or
Occupancy. ALl(t p W�/ ."(//�-,w-1 Signature Of Applicant Date
roseate,monitored gen, Date All roof coverings to be Class "B" or better
OFFICE
CITY OF CUPERTINO
- -
BUILDINGDIVISION PERMIT CONTRACTORINFORMATIONE,.:
BUILDING ADDRESS: PERMIT NO.
"OWNER'S l, APPLICATION SUB DATE —
PHONE:
5,ANUARYNO. CONTROL NO.
ARCHITECT/ENGINEER: PHONE# ' IBUILDING PERMIT INFO
LDG
B , ELECT PLUMB MECH
0 0V-A &E
F a CEJ o +'{ . ..G .). - _
I�� _
wTIONSi3 +r9 4-DATE INSPEC TO ARRANGE INSPECTION
SvE�-'� t i'�" t JOB DESCRIPTION
f t' v �' ,d;i CALL 777-3228 MONDAY-FRIDAY 24 HOURS RES ATION/PIERS/H.D.S. BEFORE RE UIRED INSPECTION.JOB ADDRESSmp ' Q FDWL ❑ KITCHEN REMODEL
yROUND AND PERMIT#ARE NEEDED WHEN PHONING. C ADDITION ❑PLUMBING RE-PIPE
`�Q BACK-CERT ❑ MULTI-UNIT ❑STRUCTURAL
oiL, RESIDENTIAL COMMERCIAL OTHER MODIFICATION
f 3 aNE SLABS/PREGUNITEINTERIOR ❑CHIMNEY REPAIR
- HAZARDOUS FIRE AREAO CONCRETE UNTIL`ABOVE'I7AS BEEN`SICNED=.`" IMPROVEMENT ❑ SWIMMINGPOOLS
GROUND/SLAB ❑ YES If yos-I uaneoland'bnl it Clm. A roof assembly is ieymred, Cl BATH REMODEL/REPAIR❑ DEMOLITION
PLUMBING Cl OTHER
< ELECTRICAL 13NO Initial LC.B.O.#
'aso
i 3 3 ADO;NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED — (EXISTING ROOF COVERING COMMERCIAL
PLUMBING 11 NEW BLDG/ADDITION ❑ DEMOLITION
MECHANICAL Number of existing coverings ❑ TENANT ❑ FOODSERVICE
ELECTRICAL IMPROVEMENT
'Po be removed To be retained ❑ OTHER
FRAMING VENTS
INSULATION
;PLACE NO.SUBFCOOR'UNTI�AI30VE'HAS`!.BEENSIG ' D:'.'-" TYPE OF ROOF COVERING
ROOF SHEATH/DIAPHRA,M Z,' ,.� '�_ EXISTINGH PROPOSED-
PLUMBING ❑ Built-Up Roof ❑ Boilt-Up Roof
TUBS&SHOWER PAN p ❑ Asphalt Shingles ❑ Asphalt Shingles
MECHANICAL O ❑ Wood Shakes ❑ Wood Shakes
ELECTRICAL/POOL BOND ❑ Wnod Shingles ❑ Woad Shiagic,
FRAMING/STAIRS/E.EGRESS — Ihcr(Specify) ❑ Other(Specifyl
INSULATION/VENTILATION /-111! /� Provide I.C.B.O.Report No.
OVER NO ONTILABOVE'HAS;BEEMSIGNED:='+,;,="l.(� Provide Mfg,Installation Specs.
.XTERIAL SHEAR/HOLD DOWN
INTERIOR SHEAR/HOLD DOWN '
SHEETROCK/SHEETROCK SHEAR I INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP
EXTERIOR LATH/W-SCREED
SHOWER LATH ,p� �Gt@ LLO-'✓-
,:NO,TAPE OR PLASTER'UNFIL'ABOVE'HAS-BEEN SI Dl-.Ii-,,
SCRATCH COAT U
SEWERIWATER,
EMPORARY APPROVALS
OCCUPANCY
INALS 11
ANNING 777-3308
GAS TEST
"'RA DG(P.W.777-3354)
W FIRE
ZHANDICAP
L) p ELECTRICAL If-G
OU PLUMBING ` r
} 4y MECHANICAL [J
ENERGY
VISUAL FINAL ONLY
BL'ILDINC
iOCCUPANCY.OF-BUILDINGJS'NOT PBRMITTED,is
UNTIL rBUII DING FINAL TS SIGNED BY BUILDING
NSPECTOR e 'x1 ` ,.�,._ ': t ' } ,t ` . •J, CERTIFICATE OF OCCUPANCY C
PRE-INSPECTION: PLYWOOD: IN-PROGRESS
NSP. DATE INSP. DATE INSR DATE
TEAR OFF INSPECTION: BATTENS: FINAL:
INSP, DATE INSP. DATE INSP. DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
APPLICANTS POSTING COPY