00060091 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING,TOOl JOHNSON AVENUE PERMIT NY100600'j
OWNER'SPROYD, SUF. - APPLICAT 131 G
14HONC: - SANITARY NO. CONTROI.NO.
OO ARCIUMCPHNGINFER: - BUILDING PERMIT INTO
u— BLDG ELECT PLUMH MECH
N z 1--1 I-1 I:—_I
LICI�NSED CON'rRACI OR'S DECLARAl1ON
z ? Job Descriptio I
O z4n Ihc,cn,nff rn,,hullnor liccnxcd under prod,eionwof Cnopnr4rmmmracing 1 ^ GARAGE
I—w wdnt 111' 7olalnnnxl.,nr3nnbe Ba.int,,:Ira Prnre„innw cede.:,nd,my ua,,.e 1667 LI JING SI-ACES •cc
q'x le unit roe nnA dYocL <
5 K S Liccnu Cine, U,.#
Say Dale (DECLA FINALED
ARCIII Ii the S DECLARATION
u O¢ undcca:uul n,y plan.sh:Jl be , m public acrook
}J
a'.a.a o Lieensed hmfea,i'rf'” OCT 1 6 2001
°%%i OWNIiR-BUILDER DECLARATION
W 1.4 1 hereby nrtirn,Nm I air, cmpm l frothe Contractens
or',Lice Luw for the
tlz billowing mason.03cmion 70315 el3a, i xs and Professions Codec Any city or cowry
E C O which require,a Permit to conwmn.alter,improve,demolish,nr repair any sou lure
i3= prior to in i,oranna als�mluires the applicant for such permit to file a signedsmlament
'hat he isEecILD
nsedpupaamtothe pmxision,„nheContractor,Liceno,Uric 7ttapter9 Sy. FL FloorA a gYa i1a bfl
(comancroing with Section 7qM))of Division 3 of the Buunm,and Profession Coder in that he is exempt Iherefnrm and the ba,is for the alleged excandind Any violation
of Section 7031.5 by any applicam for a permit.obi the applicam u,a civil penalty
of not more titan Inc hundred dollars 0500). _5 I)tLMh,M 7. 00 Occupancy Type
I -Ova of theproperty army employees with rages as their.om compensation.
1 do the work,and Ihe.Imcmre i,nm intended nr olrered far sale(Sec.71W.
l3 ine,.x and Prnles.inn.v Cole:The Cnmracmr,Liver a Law dee,..I appy'',,an 1 01 — F0UPRdquTr€dJ)Itispect ions
caner or prnpeny Who build,or bnp,rxes mec on.and who does such work himwlr
thrm,ght hi,non voidnyec.provided that inch improvement,are not initial or 1 02_— PIERS
ollcrcd for sale.IL however,the building or in,poweacnl i,cold within one year of
complotion,Ih<ownenbuilaer will have fire burden of proving that he didnol build or 1.03 — UFER
i,npro”tat pnq,o.,o 'ale) 104
'
104 — P.F_BAR
❑L:,.owner on,,l(Seenr.run Bu,inively,d od,,job,Coee,rwmhen....Irnr,m 105 — ANCHOR BOLTS
mOnbc ,rte o Jct,(See 7Ma,—tat, s and erry whoh hold,
in nu,n Convnam i.
and horarl,,ex ,mrupalltn.....1,onrprnocnrwonnnEd,nrEnFt, ,,11 . 106. — SEWER & WATER,
and who mj,cano ILC Lich pn,jec,x wl,n u u,mmdartx)licensed Pur nuns In:hu
01 at,,xcl Licr le Lu❑lam e,x{emrpi.n�mmt Sc,e, Bra Pctm mi.rca.m, 202 — UNDERFLOOR PLUMBING
203 — UNDERFLOOR
owneulGGu4/w ):Ile ! UNDERFLOOR MECHANICAL
WOR 1AFt oMP1iN&V70N DEcl.nanno" 204 — UNDERFLOOR FRAME
I hereby affirm under Penalty of pejury one of the following declarations: 205 — UNDERFLOOR INSULATION
O'D
C I have cad win marcor f cby Sece nr 3700 o In R4v,rre Code.woke.e � 301 — ROUGH PLUMBING
GmPtnsmi ad i Pnrvidei rat by ivirm i 3710 nr Ina fain,. C,rde, rat I,
perBrair=of work for which his pe.it i,i...cl. 302 — TUB R• OR SHOWER
Cl I have and will maintain Worker Compensation Insurance.as required by Section 303 — ROUGH MECHANICAL
3700 of the Labs Code.for the performance of Ne work for which Ihi.pem,it is
issued. 304 — ROUGH ELECTRICAL .
Caner: PnhcyNo,: 305 — FRAME
CER I IFICATIf IN 01:EXEMPTION FROM WORKERS' f'1
COMPENSATION INSURANCE 3OFi — HOLDOWNS
(Ihix o,,tians need )(be bal if permn is for one hundred dollars 307 — INSULATION
IS IINI)nr Icxx.l
308 — 51IF_ETROCf
Iwn,lrm:,,y,n`....r..cry ree..r me wore:❑n wren do,pe i.board. ,'x-,09 EXTERIOR LATH -
,ha11 not t do nun m to becnmc nuti ce,m,nc Workup'
Ien„nr, xr'
Cnmpci r,,liun Law,rl'C,JiEmuu.])aid
APpllcant 310 — INTERIOR LATH
Ndl'ICI;'POct tot ,Work IL Cher envoi In lw Cvruins otof Laborli i.Cor Yout,ranJ
bort extmiuiplymewnrheracemorso,In,pmxiamn.mmeLfmnrbe...oal ms, 11 — SCRATCH COAT
zn,rmoifn emmmly ,in rich prnxisn,ns m suis permi'.nau rte dee:mea rexnked' 313 — ROOF NAIL
F rn
CONS'IRUM]ON LENDING AGENCY —
� ; Ihereby unin"'hatthem is a construction lending agency for the performance 501 FINAL ELECTRICAL ENERGY
:d of the sockfor which]his permit is issued(See.3847,Cie.C.) n 1
L C Leadc,,Made 50e — FINAL PLUMBING ENERGY
z I<nder,Addrexx 503 — FINAL MECHANICAL ENERGY
U O 1curdy[hill lhave mail]his application and state that the above inthnmaio"is504 — FINAL BUILDING ENERGY
cored.I agree Io campy%ith all city and county ordinances and%fare laws refining
O [) it)Wildingconamction.:ndherebyauthorizerep'esenm]ivesofdiscitytoenterurym 50J — FINAL ELECTRICAL
>, W the aMno,ncmm
ned property Ion osiarstion purpua>.
t.. O. (We)agreeinsasc.indemnifyandkeephmolesstheCity(ifCuperinnugamot 506 — GAS TEST
vJi, Hal ludgra:nl,,coos and expenm,which may in any way meme against said
z City incmncquemeofthe running ofthi.,pertain. 507 — FINAL PLUMBING
API IC UNDIiRSTANDS AND WILL COMPLY WITH ALLN1;dIONT Issued 'jil .. _Date
sou, pG I nnnn.�,- Y 1614 1L.Al
d��L
sig,amrcm npphcnm%Cnnmcw' Da,c Re-roofs 509 — FINRI_ GRADE
IIA""/.N2DOUS MAI'I?RIALS UISCLO.SURI?
win
It,apllicnm,orUnite building nn:mpam,WmmWudlk moral inucHal Type of Roof 510 — FINAL PLANNING
,.delinM by the Cupaninu Mn"icp,:a Code.Citable,9.12,and the Health:rod salty,
Coale,seedy,25532fo1' 514 — FINAL PUBLIC WORKS
V_N^ All roofs shall ti ect a t a n r f t x al being installed.
��y1` p— (RCJt r Y. Mf lb Il.�S I_
Will the Lipplicun,or 11111111 bonding ocOpant awe cqulpnrem n,dexice,which Ifaroof lS inStaj l-4,wi thou 1Sto t llx. 1 tnspectiol bean installed. ve
emit haznnloux whir e�n anninunu a,delhod by he Be,Ams Air Gnarly Mamtycmtm �I/L I � g� tG�)p1q gp ��s
r.,deu all new materialk insp , {411. A fV�eF'tiUb�KtL4 s and will comply with
0Y`'x all non-point scftf&4 reguffi.A... fff�Vl III---tf
I have read the haelydmus maderni is reyuiremcros mNcr Chapter 0.95 of the
California Ill k Samy,Code.Sections 25505.25533 and 25534.1 understand that
it the bt ilding dnex not currently have a tenant,that it is my responsibility to notify the
auric an f he require Berm n'hich moa W not prior to i...anec of a CeriBcme of 1
O ccapan / ��,,, Signature of Applicant Date
!lE. Jte All roof coverings to be Class "B•'or better
f ,nmixtd assn' • Dam g
OFFICE