01050149 OF
TINO
CIBUILD NG DIVC,ISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10 50149
OWNER'S NAME: APPLICATION SUB DATE.
Alh�" GONG 05/17/2001
NPIP5NE: SANITARY NO. CONTROL NO.
p ZO ARCHITECT(ENGINEER: BUILDING PERMIT INFO
w C BLDG ELECT PLUMB MECH
ii I—] CJ I"1 GJ
Z yL,= LICENSED CONTRACtOR'sDECLARA'T'ION Job Description
O Z- I herebam
y Rrtat hI am licensed under provisions of Chapter 9(commencing
J with Section]000)ofDivisionJofineBusincssandPmfcssioneCod<.andmyliccnse ADD
Is in fui..
n force and cRee[. O
-of ¢ License Class Li,x
x O U Date Contmemr
wu a ARCfI1TECT'S DECLARATION
,. 0 JUN 2 1 2004
h� 1 understand my plans shall be used as public records
w
°'i p O Lieconed Professiowl
off OWNER-exempt firm
the RAnON BUILDING
1. I hereby affirm that 1 1. exempt from the Gonias o License Law for the
C? followinga(Section]o con5.struct,
Business and improve.
de Professions Code:Any city ncounty
f F O whimhTirequires a permit m m.flcq aper,improve,demolish, file
repair any t noncom.
$200000
uyl3� .Pn msu s e.also regwms the appl'c tf such Permitm Bleasigned statement _ _..
tWt bit,ethenumlDormant to Ihp pmvtcirros of the C traysLcense Law(Chapter 9r, •). S I.�Faloo[Area.�p -na to ; Valuation
(. acne g th Section']OPO) fDivision J of The Bus e{s and Pmr<ss,ons Code) { ,1.\ 139:6' OJ'9S100i:i`a
or that he is aaempf theiefmm and the basis for the alllged caranytEoi Any violation `
of Section 7031.5 by any applicant for a perain mbl<cts the applicant te a civil penalty '
of no,nmrc fluo five hundred dollars($500). APN Number % Occupancy Type
01,us owner of the pmpeny,or my employees with wago as their sole compensation,
101 — FOUNDATION
'-will do the world and the structureis not intended or offered for sale(See,76W." - PTERS - - ---- ---- - - - -
'Business and Professions Code:The Cina aesm,License Law does nm apply to or 10 3 - UFER Required Inspections
owner of pm,rIy Who builds or impmvex thereon,and who docs such work himself
se[through his own employee..provided mat such improvements of nut intended or .104.- ---'REBAR-
-offem]rearsale.If.62&cr.the Wilding ormipiovemrnr iswld within yearof -- --'-- -
completion,the owner-builder will have the burden of proving that he did not build or 105 - ANCHOR BOLTS -
improve for purpose of sale.). `
VVlA ___ 106 - ._SEWER & WATER _
—
con,oaownef paha p(Sec.7041.emwao,and contracting withlicensedcnnvanotar's 202 - UNDERFLOOR PLUMBING .
roma m<rmien(see.nus,Bnaness and rroressinns ade:)'rn<enmme[ors � s, ,
License Law doe.antiii noanowner ofproperty whebuilds orimprove.<merem. 203 _ UNDERFLOOR MECHANICAL
and who co cis for.such pmlects with a coatme[or(s)licensed pursuant to the
C
contmnnr .iconse Law. 2 04 — UNDERFLOOR FRAME —
olame Top,moorr •B',aPconfluTreaann 205 — UNDERFLOOR
• INSULATION
-- OrWOtKER'SCOMPENSAI'10}.'DECLARATION 301 — ROUGH PLUMBING
I hereby affirm under penalty of perjury one of the following declarations 302 — TUB & OR SHOWER
4 0 1 hove and win anammm a C<vircate at Content to self-insure for Workers 3 03 _ ROUGH MECHANICAL
Compensation, as for by section J]oo nr me I,aWr code. for m< 304 ROUGH ELECTRICAL
Performance ohne work,for which this pcm,n is issued. 305 - FRAME
I]1 nave and will maintain Worker's Compensation Iniumove.as required by Section 306 — HOEDOWNS
7]00 of the Latour Code,for the performance of The work for which this permit is
:.,sued,ply workers Compensation In:umnce carrier and Policy number are: _ __ 307_- INSULATION
c N l ,f i:i'a,l. l.i` FulillNo - ! 308f —r SHEETROCK
CERTIFICATION OF EXEMPTION FROM WORKERS', i 1%ar, + ' s h y't; )"•�1
CompeNSATIONINSURANCE " ., 309 'EXTERI..... H' _ _ __ ------
' (Thrsun Danced not he completed if the .it for are hundred di 310 '•INTERIOR LATH `• ' " '
:)
spool nr less.) 311 SCRATCH COAT
- ice y hat nine m itre of thewvBr,k orswhc th' permi H is. d i _313 - ROOF NAILS � •• ' _. . ._ . . . _..._
c IIp<`
To
cony Tr,i mai erra'�/1 neje amt mew kri 501 - FINAL ELECTRICAL ENERGY
.Appl t - - - - -- - - -- 502- -FINAL PLUMBING ' ENERGY - -'- - -- -
N E TO AP IC after m7kir,ThisC n f am of Exemption,m you shoulJ
Z ha
on" he k c x t p spnheLM cree.yaamds' 503 — FINAL MECHANICAL ENERGY
O forthwith comply such previsions or this per,ait snml be deemed revoked.
Z . - - 504 - 'FINAL BUILDING ENERGY —
'l") ^ `CONSTRUCTION LENDING AGENCY "
F' Ihereby alGrmThat them iiaconswctiunlending agency for the pzrformanic 505 — FINAL ELECTRICAL
a" of me work for which this permit is issued(See.309].Civ.C.)
yp Lender'srome- ... ..... .. .. . 506 .-- GAS TEST_ ..L
D-Z Lender's Address 507 — FINAL PLUMBING-.f.: —
_U(Q
I cemy that I have mail this application end state that The above information is 508 — FINAL MECHANICAL
'+ Ew come[.1 agree no comply with all city and county,ordinances and slate laws relaTing
to building construction,and hereby authorize representatives of city to after upon 509 - FINAL GRADE
y he above.Tarn...)Tied property for inspection purposes, 510 — FINAL PLANNING
tq .gree m sase.indemnify and keep harmless the City of Cupenino almost
m liabil Tes,J gmenrt,cuss an menses which may in any way name against said 514 — FINAL WORKS
V.Z City neon sec . gmming of this Arnott. - ('1
.Ib\ l DEP NDS AND WILL COMPLY N'ITH ALC fON-P01.'1'
Issued b Date
501 ,<CF Er I . NS. Y'
wmeoft
rometor,' .,. rV. e
Re-roofs
WLARDOUSMATERIALS DISCLOSUREa .TllthaDfuturebLippswenrh die Nous material _T,
it R
OOf
u rd fSed by the Cupertino
oMu pal Cod Chapter 113,and theHealth and Safety
CN 25532my? •) ..,' \J`•_..'. V.
ye, No Allroofssalbe,inspe.cs._[ed pri-osr.a toi._l.:... .••
._,..
any roofing material being installed. . -
w-n the appf tort Wilding occupant use equipment devices hien If a roof is insialled without first obtaining an inspection, I agree.to remove
e t d urn t T.as deli d by TM1 Bay Arm Quality Management
Distinct? all new materials for mspe ion. Applicant understands and will comply with
OY s , No- all no o'nt source re IOUs. -
1 have read the ho.oRal oni zl6ocomm,moda,Chapter 6.95 of the
CII Health&Safety Card eom 25505 5533 and 25534 1 ndersmnd th it
,fth Id down rot Ttht lsmY p 'bltyto not fy the "' "'- - - --'- - ' 6
oe pant f ere t hihmust be tprior To isw I Cein fcI of
°n 6 Qin oy Sign ure icant ate
".
Orapt an All roof coverings to be Class"B" or better '
. .. ._. 1 OFFICE - -- -