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00070032 t -� 'CITY OF CUPERTINO , 6i1lL15VL•"1vls.7Lt1HN DR PERMIT ' CONTRACTOR INFORMATION:' 00121717103 2 BUILDING ADDRESS: FERMI NO, DEGEUS , RICHARD AND LOREllD ' OWNER'S NAME: - APPLICATION SUB DATE PHONE: .''! -. - - . SANITARY NO. CUNT ROI. e zz 'ARCIIIrItCT/ENGINIiIiR: - - BUILDING PERM]['INTO t p i BLIG' ":rlPC'1' PLUMYMliCll ,LICENSED CONTRACTOR'S DECLARATION Fn� ADD—ON 'TO 0 z= 1 hereby h1Yrm that 1 am licensed under prwskms of Chapter 9 fann.mticing , p_I_a with Seen,,.7000).(Division 3.fair Bnsinclaimd ProfcomisCode,andmy license • .. 6 j�f-t is in full f...ra ad effect. .re o E U License Class �� 1 .Lac n E Data 7/O 7•o 'Cammdar ��✓✓— 1 , ,;'' F LL 0 .�'i "ARCHITECT'S DECLARATION • . 1 lunde.lad my PI I1TECT'S ECL R reI N / as }` �� Licensed edlr Professional - °�o OWNEk BUILUI: L-CLARATION , m-I retell ffinal that I am exempt In m the Cant :nm.{License Law Ior thea OrO , C3 following waster.(Section 7031.5,Bland Prolealons Cda,Any city lir county I C which reclaims a Permit to consul niter.improv e,demolish,or repair any structure prion.its issmnce,also reyuimarm applacatu forsuchpemtiun file asignednmemem an.,he is licensed amount al pmvsmnsofthe Colnracmrs License law ochapter 9 Sq. Ft. Floor Area Valuation' e (conmwncin,with Sall....TXX1)of Dlvikinn 3ofine Btwinpdad PCode) mm,liunx Ce) oc mm bu Is exempt therefrom and the haus or the'alleged exemption,Any varmi.n1 A _ f of Section 7031.5 by any applicant for a pennil subjects the applicant to a civil penally ' m:.....arc mnaane hundred dp,ar.65100n. APN Number Occupancy Type 01,as au ner of the property,or my employees with wage.its Ihcirsele comlwnsadon, _ FOUNDATIA ' will J d k nJ tiresiva lu o nor intended limited R 19cc 7(134,' -- ,. Business andoProfe,ion,C le The r ar,lo, Liecal Law does all, I11ym:m 1.02 •,—, PIEFeSquired Inspections -- 11 owner,f 1 mpeny Whobuilds or imp.vc:II rcon,and who Boas such work hill ' it rough has own employees.pravaded mat such trip senators am am intended o, 103 — UFE R offered for sate.If,however.the building or improvement is sold within tine year of t completion,the owner-budder will have the burden ofprosingthat hedid not build or 104 —'' REBAR improve har m,aae orsme.l. t - - _ _ _ El 1.a,nwnor or me pnondrtr.ramex.e..ivdy, eono-aedne wtm,eenrcd eon1tacros.t,t r' - . 105 - ANCHOR BOLTS _ .:n. cont t(heproject is 714 Bsne. 1P f.......C 1 )T1 c te:mr 1.06 —. SEWER & WATER License Law does not apil to an owner of prolai who builds or impurities thereon, - and h contract,f such projeae wall a contractor(.)licensed pursuant to the 202 UNDERFLOOR PLUMBING" Collaterala , oll rude See 203 — UNDERFI_00R .,MECHANICAL,. 0laamseraw. ,ltd PCfnr thio.reason , Owne • rale • s204', UNDERFLOOR FRAME WORKER'S COMP17NSAI']ON DECLARATION 205 — UNDERFLOOR INSULATION. Ihereby effort under penalty,oiPerjury one ofthe follow ingdeclarations : 301 — ROUGH PLUMBING ❑ I h 'u c rite t f 3 Coo Sol m al f wit,kehe 302 — TUB d• OR SHOWER Compensation, : .provided by Section Coo of n Labor Code, fit, me , •. . . drtnan« Dneworkfor whantmape t ..tied303 — ROUGH MECHANICAL 01 have and will maintain Worker's Compensation Insurance,as required by Section ,304 —� ROUGH ELECTRICAL 31(1(1 of the Labor Code.for the performance of the work for which this permit Is Iissue,].My Worker's Cmnposanon Journal carter and Policy former it 305 FRAME , Cal Policy N 306 — HOEDOWNS D n CERTIFICATION OF FPI MITION FROM WORKLNS COMPENSATION INSURANCE 307 — INSULATIO Crb ct mac 1 otbeenmpleurd fthePermit is future n ndredd hire t .308 SHEETROCK 4$100)"lis, I ;309 — EXTERIOR TWU� �' 1 certify that in thepert rat race of the xnrk for which thispermitis issued.1. ,y ' haltmot "'lye"ytf c�ui in any ma.ner sea mbvc-n%nnie�sft'om✓nkeri -370 — INTERIOR LATH- 20©� . Apprcanl ' 7 311 — SCRATCH AT `"' . ' , NOTICE•IOAPPIACANT.If.utter making d' nifctenf Exemption,gnu should Z necomexnnicclmmeWorkers Comrrcgeadollor isionxmtire-.borclar,you mn't 313 — ROOF •NAI'L r O O forthwith comply with such Ticknor,ser this perm,shell be dcemeA revoked, z _ 501 — FINAL ELECTRICAL Fy CONSTRUCTION LENDING AGENCY. - — x Ihereby affrnmmhim isacontriteneslending agency fortheperrnmmnce 502 FINAL PLUMBING ENERGY of the work fur which this,c mit is issued(Svc.3(19.Cie C.) 1-cader',Ntime '503 '— FINAL MECHANICAL ENERGY U z 1"`nderAddress.,R. 504 — FINAL BUILDING ENERGY V O Iccnifythat Ihimad this application and state that theaboveinformation is 505 — FINAL ELECTRICAL f two ter coram.I agree to comply with all city and county ordinances and nate laws relating O V tohuildingconmmelion,andhilradialrepresentativesofihiscitytoenteruion 506 — GAS TEST Wthe nbl r eminned progeny for inspection purposes • . . W (We)agree ,,al Indannify and keep Incmes,the City or Cip,dinongulnn .. StD7 A City into iaaemere. the and expenses wmen may m only way aenNe.,g.dna an1d FINAL PLUMBING U z City in nmseyuence of me griming of inn pcnnit. _ SOU@CERCGUUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: I MECHANICAL Date -- G SignammNAppncant/Comr.cal fnne Re-roofs 510 — FINAL =PLANNING HAZARDOUS MAI'IiRIALS DISCLOSURE Will the upphrnt.rfuurebuilding recall store orall nrairr xmaterial 'type of Rol 14 — FINAL PUBLIC WORKS as Jefine,l by me Cupertino Municipal Caste,Chapter 9.12,nod the Health and Safety Co1c,Section255321d77. -- `' ' 0y`, CI'+" I All roofs shall be,inspected prior,to any roofing lilaterial being installed. Wad pi t radial n ddir,ocsupanraseeq•T t 1 '.e.whell If a roof Is installed without first obtaining an inspection, I agree to remove' emit h 1 emanational, do ned ay Arc:Air Qa lay Managerial Dismct , .all new materials f ms tion. Applicant understai ds and will comply with ❑res all non-point so cc r lations., 1 have read the hvnrdons materials requirements tinder Chapter 695 of the - - Calllbmin Health&Safety Code,Sections 255(15,25533 and 25534,1 undnsuud met - ifthe bulltingdue,net cmrenlly base.al L that it is lily responsibility lonotify rho ' .up.. of Immortal which must be met prior to issuance of a Cenafidme of , occupancy. % - •��' nature of Applicant' .Date , a Owner All agent J �• �D�� 'AlL roof coverings to be Class "B"or better OFFICE - - 0' G EUS CbNC.tT 1 0 X11 EG/ 614151N9r5 lY _ /�G PdL ELI...j C(/N/�L^,C CA/3�.•�ET C/7E� coZ - Al Ee,✓ 20 p.7j C tCu in C/1 Ctoc A��,� .vcu r/ Cc Fcoo,< / OF [aor1l� APPROVED IN ACCORDANCE WITH THE CITY Ofi CUPERTINO CODES AND ORDINANCES DATE SIGNED MUS This set of plans and specifications This un be kept on the iob ath3,geseo of and it is ® lawful to make any on same without t+'ritien permission from he building Dept., ci y of Cupertino. The stamping of this plan and specifications SHALL NOT be held to permit or to be an ,pproval of the violation of any provisions eny Cit, Ordinance or State Law. aw mw Of VICE COPY