00060029 CITY,OF CUPERTINO - °^
BUILDING DIVISION , - MIT CONTRACTOR INFORMATION-
0060029
HUILDINGA R.S . PERMIT NO,
. . s .� '.
OWNER'S MPBHTBrS(7
AI'1'LICAI' '
I Q r
SANI'T'ARY No. CONI ROL-NO, _
a z i ARCHI'I'EC R NGINEER: �. BUILDING PERMIT INFO
'BLDG ELECT' PLUMH MECH
,w,z I ICFNSf CONTRACTOR S DECLARATION D cl'µy�qB
oz-� In by B olbtl ear d
Gp " IC6II 9(c .g INSTALL SWIN�P�3i MCIIJL .
NC with Section 70NAul'D' e.3 of the Bu v..t l Pnfuksn,Gelumadanyl nota k _ +
arc m.E is in full force and effect.
Liver.Class_I_ Lic,p 5/
LL LL m ,Dam •- G" O O Qnucmjl..f� -�-/ ,)
ARCHD CC'I SDCCIA ANON -
t: O g - I J t 1 y pia M1 II be used :l bl rd
T
Wpp Licensed P f:a nl
OWNER-BUILDER LION
a [ 1 hereby f that Ia looters from Centr
I Law for the
' _
/
l:Z Business und Donfiessones Cod Any city our
wh I y sp iIont I illal,I'llonve.J Ystructure
'
6 C3$ poo I I .p pnh t I -t n e f g J I apt eel
roam IntwJp tell , provisions nl t Canneries 1 La on,Cartel
- Sq. Ft. Floor Area• t . I
Rumination,with l direct
]Olro)at ie vis an J of the 1,gashes,and Prof n.An ons Cole) ,
• nrdntl Pt 11 t- nJ 11 Na,fah 1161 . pt A ) Ivnon "- � -
ol Section 7031.5 by any mpliand,Ill,a`p 'I aunjetl'lire lipplieam to a civ l penby - -
ora Immthan fisc hundred dnllan(55001. - A' qil - occitiqW,T pe
01,ns ole1r.1 the r on n to with tat rev ux lhcir,olu can ctsvtion, _ ... .. ,. - _
pop y nnnY, P n int y p t
will a the work,and he ede The is nal intended Li en a Law for snot apply]014, — Ut-
Bunions ander,,Who
lit,The Contractor's License Law does h a man Re aired inspections
apply 9 P
o� ofh his sly Wha InBdx art hnprovet Ill and wd+eats nese wink himself or 104 REBA R
m�nongh his own tntlaoyet..pmeidw Inni.I�en impn�ltmtmt ore nal i��le�tdta on - -
uttered for sale.If,however,the building or impro numt is sold within one year.1 - 147 — POOL/BONDING
completion,the msecr-builder sill have he burden of proving Ihm he did not build or
improve borma sva„f sale.). .- 301- - ROUGH PLUMBING• -
01 fon p )ant _e I . Iy t l' s 'rel d I meta 304 ROUGH 'ELECTRICAL -
consumer thep lest(Se nus B d P r Care:)Th Controller',
IG ENERGY
Lic e Law mn.n not apply I t r of pe petty who build: d improves thereto, 502 — FINAL PLUMB I
0 owns
andut conuem,for well prniwla won nomnrnln)tmIlscn6nl pnvnuum m the -
canmlmornLicense Loss. - , 503 ' FINA!_`'MECHANICgL 'ENERGY' '
❑I nm enempr under See. ) ':H&P C fmlhls reason 506 GAS TEST '
Owner—WORKER'SCOMPENSATRTY'DECLARATION 510 — FINRL 'PLRNNING'
I herehy aftire under wrally or penury out of file reuaw,mg aeelmllonx 51-]= -• F,.T.NAL POOL
ea
C 1 ensaand'as m.id,d f cemiRemeof crmenh.o self-insure Labor Carl for
line - 516 FINRL BUILDING -
c.
Cnmpms,vrcol as ped,kor .for by Section 3]W of the Lahnr Colt, for rhe
perfoniiunce ul'Ihe work iia which this count is imcA,_ r
❑1 have and will maintain Workers Conpns lion Insurance,as requital by Section s
”,of the Labor Cale,for the prfomnnce of the work for width this pond is s -
nut,MY Work"'Cmnlselle ion lu,umncm carrier and Policy norther am:
Carrier: Policy No, '
CEK1'IFICATION OF 17XESIVI'[ON FROM WORKERS'•• . 't _
COMPENSATION INSURANCE t I.
1'Dris section need net be completed if the permit is for one hundred dollars
(slamo le',)
I certify that in lh parlonarrame of the k fee which this parbil is i,,.ad,I .II
shall did mpl );my pe - Y t dye me h)et t the H ken'
Colpen:f I ws of CJIon .O 1y` 6--1 aQ_ - 1
NOTICE TOAPPLI ¶,at emktdy Itts�ade6 np�ion.year should
bee subject or the Waukee.Compnsut er Provisions of the Lid,Cash.yen most
0 romranhwi@comply wish ouch Wmisinn,.,,hisprmil shall he deemed mvnked.
F CONSTRUCTION LENDING AGFNCY
1 hereby afGrn Ihm there is a construction lending agency for the ptbrn
rto e
.W " of the work for which this pormit is Issued Isce.3097.Co,C.) -
G Q Lender's Name
5 Z Lender'.,Address ,
UO - r .
II agree Ihm I have mrd this al,oundl...nuJ acme that theal i jmo"'eion ix ,
mrcd.1 agree m comply wLh all shy unJ nmmy rnlinanwn unto xlnte luw.v'relming '
O [) mbuilding conswetian.and hereby aurnunm mprenenmtives rf this city to cn¢rurym -
', ry the ad,ove-mantioned property f nsp f purposes. s
a (W) b- t 1 ly dkeep h lh
Its the City fC pot ug r't -
Fti V] liabl I Institutions,covt d expenses which may 61 any way name against said v I
t.7 Z, City in cor so umce of the parealm,of his pi I F ^r
APLICANTUNDERSTNDS NDW�sLCOMPLYissued,WnmALLNON-POINT idb Di12�f�L — I"
)URCE REGI O y'" _
ign;nnre nm%a?;n - " - ~ utas Re-roofs .
HAZARDOUS MATERIALS DISCLOSURE
Will the aplthcamt or fmme building occupant sthrm or handle hazardous malan;a 'type or Roof - p• -
as lefincd by the Cupman,Municipal Cafe,Chapter 9.12,and the Heehh and Safety -
Code.Sermon 25532(x)?
❑re: 0"" r - All roofs shall be inspected,prior to any,roofing material being installed, '
Will the applicant or mon,lwildldgocfupdm rw eyuipmcm or Jes-ices xhich 11'h roof is installed without first obtaining an inspection, 1 agree to:remove
'h...Mo.,vin contaminants as defined byline Bay Arca Air Quality Management
I.bl"ave, , r all new materials for inspection. Applicant understands and will comply with
all non-point source regula[fo is. _
1 have read the hormhu s mammals noplreniamv under Chapter 695 af.,he. ,
11 Cmiturnia Health&Safety Cade,Suctions 25505.25513 and 25531.1 understand that
. if Ibuildingdnesnot knrmnlyhuvpttenun6lhat it inmyaspon,ibilityunwtily the
npam of the requircnoonls which must i e a,pne,,I issuance of a Cenifcme of r C�
Occupancy I tt p iCe i Date
O, tg nam - All roof coverings to be Class "B" or belle'r