02040061 CITY OF CUPERTINO '- - f• •.
BUILDING DIVISION PERMIT CONTRACUIL2INF•ORMATION ;
BUILDING ADDRESS:
PERMIT NO.
BLVD 02040061
OWNER'S NAME:
APPLICATION SllB DATE
•JULIA HUOT 04/15/2002
.iONE SANITARY NO. CONTROL N0,
seO zO ARCHITECTIENGINEER: BUILDINGPERMITINFO
i BLDG ELECT' PLUMB MECH
yar•
C rr hereby LICENSED licenRACTOR'S DECLARATION 8 Job Description
z.O Ition7oRrm Dietlnm licensedunder provisions of Chcoadc.and
mmeneis
with 5cniorceandofecivision3of she Buxin ssnd Profeuionsfodc.anamylicenx ADD 170 SQ, FT.
rs in full fORc md'eRKt.
sWa Lisenu Cl., Li<. i;tgq� �ar,B��rCo
O U Dal Conmacmr
u O r`' CFTECi'S DECLARATION
g 1 and II be used as public records
s a o signal JAN 212003
,.s OWNER-BUILDER DECLARATION
I hereby Affirm that 1 am exempt from the Comracmr's license law roe the
? following season.(Section 703 1S.Business and Professions Code:Any city or county BUILDING F which requires o permit to construct. her.improve.demolish,w repair wy Immure $20000
�3 -p its ismar,ce.elxrequin the applicant fmrsuch pe tin Rk..1,01 wemema. _._. ._
__ ._
in he,is`,licens"ed pursuant m 0O)of
i%isi of the he Bus ass Lical raw on,code)
4 ({�'h�/�� ^�}_ —----- -
hemm�KM10 Wi 'S ) clld pryrOilO„s f011[) t h-:�•r 35r� `V._lG Vs
e mice"r orDivisfn3oraueuaineu t_ a "),j `..+, �� . Valuation
or Jut he is exempt,hciclrom e,M,he basis
rile allegeduemgib6 My violation �' t I t✓
of Smion)031'5-by any applicant foe a Rmat IbjK¢the applicmt m a civil pemlry
a ifs marc duan Bve hundred dollds(5500). I2"i:_C T.1 Occupancy T e
OL.,ow.aof the m rt.wm 101hpN 1�DAT ION - P y yP
p K Y Ycmploycawiae mages as their xle compensation,
Will"do,he work-kdd,he strucwr'c is not imm�did"or'bif red"ror'"silc-(Sec:7004,"'
102 -
'Business'and Prorenions Code:no Conmacwr's License Law does not apply tom 103 - UFER Required Inspec[idns'-"''
Owner of property Who buitds Or impmneca,hereon,and who does such work himself
m Nrough his own emphayeal:provided dui such improvemepa arc Om uncoiled Or 1.0:4,__= REBAR
Offer d f r sal If,now r the building or imp'ovmoent is sola ,thin one year o! - --" - --"- — ._._ ._._
ample nth
Offset..).
illhaveduburdcnofproving,hthedidnmhild.r 105 - ANCHOR BOLTS
mpraveforpurpose ormm.> 106 - SEWER & WATER
---- — -.
O Lsi awneror Ne n for .....__..... ........ ... ... .... ...
grope y,m ea sirens convacun -- - -
gw,Wlc a<ontmnor:m' 202 - UNDERFLOOR PLUM$7NG rc .
?
construct the project(S«.]004,Buvn«s dna Profemons Cade.)The Commaor s t. kC
License law does not apply,.an Ownm or property who bmi,,,or improv«,heroon. 203 — UNDERFLOOR MECHANICAL!``` 'L(taP
- _.and.who contracts.for.such pro)«ts.wmha mnmor(s)Iuemad.purauam-so.Nc ,
onwaor License La rr - rn ._ -___- --204'------UNDERFLOOR"FRAME
❑lam ex pt mneers« 205 - UNDERFLOOR° YNSULATION
r �B APCfw ehµfe,xn
o,.wer ( IENS ` L ° 301 - ROUGH PLUMBING
I:.e s l �._WORKER'$COMPENSATION DECLARATION
Ihereby afftrmunder p<wty:Or
Pic;.d,"y d, m
;� ,nq_r.nOwinga«Iar,tfM:-- 302 - TUB & OR SHOWER
nil'viW'wlt`mainuin'e'Ceriifica�l of Co�uem io Lilt-iMmrt yourworkcra 303 - ROUGH MECHANICAL
�,=^J Con,penution, as;Pru N d-for-by-Smion9NO of'Ne-iabor'C.de. fw-Ne 304 - ROUGH ELECTRICAL '
_ __ perfornaMe drdse'wmt foe wrdrh Nis permit is iaued..,,,,
305 — FRAME
G l hale and'will mahrmhi,Wo ,s Compew�ion lniviarce,urequirtE by,Smion 306 - HOLDOWNS
37M of ine'labm Code,for due perfmmnn«of the work fm
which this,pcmut u
islet My wodcca compensation insurance cairier and Policy umber ve 307 - INSULATION
9ktPolicy r.c. 308 !:- SHESTROCK,
j4CE RT(FIC- M'OEERF. NS FMWORKERS . ..
•i-q „.COCOMPENSAT{ON INSURANCERO ^ 3O9 EXTERIOR:•LATH
(ns u,on cJ a 4 nPiaed,f the pemut rx for ane hu,Mred dollws 31 d,} NTER'I OR' LATH' ',.h;i;- ,-. ..•--
(5100) less)
311 - SCRATCH COAT
i� 1 Am
erform bf th o k f ch tits -n, xrmt�s mm l 3I-3-_...ROOF`NA'I1J'-6m t o 1 any a e so c b e t lO,he W rkeri , ,gdpm`Peinion D„rI501 - FINAL EliECTRICA`D $NERGY
pp ....._._..__..5.02..__-..FINAL- PLUMBING -ENERGY-----..._-
Na?IIf art youhould ....y be,ome Co penxtonp mOfWaLabO Cine y ammat 503 - -FINAL MECHANICAL ENERGY
z0 fdrt-- sh-amply hh u<h pro ns o th s Perm t hall be dam d evoked
_ _. .-' F-INAL...BUILDING y , , .._..504-.---_. ...ENERGy, .
a ' y CON hoij is 1OY I:EN4(NG AGENCY _
hereby arRnn in„cure Liaciuo. o lad p agency foe she perfonne,kes 505 — FINAL ELECTRICAL. •' '
til -'Isnders Nsme _hien this permit iscd(Se -3W)Civ.C.). •. f . . •.,� :,
n - _ _.. .___51 .6 _, GAS_TEST _
p.Z LcndcraAddress - -` 507 - FINAL PLUMB3NG, - -- --
o icrorythazlplhave ilathssapphcau eMsmtthazthe ebove formation is 508 - FINAL MECHAiVICFiL[ -
ITa [nweak 1-yrte m mply m ell t e,d couw cod,
W r m<«,weuunw„Lung 509 - FINAL GRADE
� O to build np con wn oe,and hereby euNord rtprt ndican .r Ousmry tow, upon
�+ L7 Ne abosx me uonN property fo rasp«uonpur cu 510 - FINAL PLANNING
Ea L (We)spree to K&W demmf3,nil keep hamdcss de C'ry of Cupenmo a8unst
m cob nt e 3 dgmenw-cots arta a pcnses wmun y any ay sec a quvt tele 514 — F I NAL PU I C WORKS
U Z Crtyi c seque„de ditne pm Ing of d,Spegqnnt ' _ - r�
APCR ER G�DBk$'I,L�pS.,t,�b tt�Lj.cQitPLY ttTrH,ttL\S 1\�'c' ' I
Issued by: Date
spm Ican✓Cohwn.r `: ”"'�P t m - Re-roofs /
1 } -HAZARDOUS MA"fERYALS DISCLOSURE 5 ''�-.
s �'Wiil the ppl cant m fmrc bpudWdmB a«upan,st w heckle harBNo s masenal
u defipea by Ih C pcn'no Myn c Codd,Ch p e 9l3 and the H am.a sarety 'Pe of Roof, - . .
Cdde`S«t on127533(U7 n i rt c(/ '� � .. C ._
All roofs shall.be Inspected poor to any roofing material being installed
uni,be�t f W 11 th ePpl cant w fun a had {{wcuP,t u 9 Pm t a dm ccs h ch M
smit'? do s a r comem,na nes deGn d b Ne B
Jumm n � , YArtayurQualryManag mem If a roof is installed without fust obtaining an'Inspecnon,I-agree to ierriove
Y R remen awe, dss of
all.neW,materials for.inspecnon Applicant understands and Will comply with
all non-point source regulations
1 ertaa Ne hdardous masen,l qts h ° .—...._.
ptcr Ne `
Cebrorsu Health&Sara Cod,5«cans 23505.35533 aM 25334.I ay m ocaM het
Jtn`e 'd pdwrno,murrndYhareaunam:dot it ism m
pons b.. th
y a pp i o e requirements which must bc'met priors issiuna'aI C rtifcaare of - - - --_ - _ -- - - --- "'-'--'
....Signature of Applicant
_ ...
r
Date
roof coverings to be Class"B”or"better'
b.y
rte n
r I OFFICE"-
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'611
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