00090181 CITY OF CUPERTINO �r
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: 06V0z
BU1LDINGADDRESS: I'ERhl n'N(',_
OWNER'S NAME. APPLICAI KNSUBIDAIS
2201 LINDY LA SWAN P001_S 00090181,
I'110N1g SANITARY NO. CONITROL No.
ISHAN. 1495 S WINCHESTER ,LV 09/29/2000
ARCHITEC IENGINTiER: BUILDING I'ERM11I"f INP0
tu (408) 866-6893 ruJ� rip_ MEaI
G y
LICENSED INSEDCONI'RACfOH'SDIicLARI Chopo Job Description
_o I hereby(fal tont 1 nn,licensed under prd kion.of Chuptcr 9 d an breast,
m F x'IthtIII Section7( Ith Division Jof the Bmincss and l'mfessiam Q,Je.and my license
-_� i,infdlf..ren,WeB.e�QS�1— —x1,{15 _ FINALES
z li.0 y S License Class Lies a
3 n y nine q�.ui( Comrxmr_
a. AHCIIITIiCr'S DECLARA'l1U SEP 10 2001
E—o, Iundcumodmy plansshall tw.owl."ublie rcaraw, ING ROUND POOL
—LL
ce ip p l.lcemsrd Proo,"Jomd
ff OWNER-BUILDER DECLARATION
wowI hcreny mhrm,that I am exempt form rhe Contractor'.Lieme Law Iia Ihe
F x /=�e.ae DING
i following rea,on.(Seals.9031.5.Rosin...and I•mlc..ion.Cost,:Any city ,
or ,Italy
'SC which acquires a pworat to construct. It p dearsolid.or mpir any.t aero
n3es y the pplc. If such permit IIsignedIRmrm
Ihmn .in
me d p fm r a l "l (Clapter9 S Ft. Floor Area Valuation
Prort its c1. ^.
(commencing with Section 701O of D%ishan 3 of the Business and Pmfc.- n Code) y' ^ U V
nr,hat hu,,exempt dworfnnn iodine basin for Ihu alleged exanpdon.Any violation i
of Section 7031.5 by any applicant for a permit subjects the applicant Inst civil penally
of nor drom than rive handred dollars ISM*), APN Number g Occupancy Type
C11.asnwneraflhe progeny.sur my enployee,will,wage.as lhcir s.I,compensation. J�1r� -2—;7—O/ /C_ $24000
will do the work,and the%mature is not tumbled or ollcnd for sale(Sec.7041.
Rim...vante Promi,,dr,Colic:'I he comment,,I-wenre Law dor,sen apply m n„ �T Requ,7ired Inspections
orr of proWny'Who Wilds or improves shoo nn,and who de,such work himself 356270 1.4. 00
though his own empluyeusprovided that such improvemi am not intended or
or"ed I'nr ale.IL hnwevm,the holding or ioquovanu:nt is sold within one year el
homplmion.dar,do enholdcr will have tirepinvitation burden of he did oat Wild or
nprove for Purpose of sale). '103 — UFER
[3 1,as owner of the propcny.am exclusively cnnlde,ing with licensed contractors In 1.04 — REBAR
m..mal the fit...I(see.7044,Rtl,ine„and Professions Code.I The Contractors
License lowthesnmapply ,,:mowoerof pr„,ny who baild,sur in,poweahcroon, 107 — POOL/BONDING
and who contracts for such fitters with a contras licensed punuam to the
Contractor.L.'ars, ow. 301. — ROUGH PLUMBING
❑I am exempt under tie. .If K P C for this reason
304 — ROUGH ELECTRICAL
(ywn" WORKER'S COMIIENsAnONDCCLARAT]ON 502 — FINAL PLUMBING ENERGY
1 homily arrim,under penalty sur.r,Jury ane..nbr rots..w'Il,g ae.mmaman
503 „— FINAL MECHANICAL ENERGY
I I have and will maintain a Cerdeeam of Convert m ant-in.um for worker. 506 — GAS TEST
Comp.,,,arm,, a. ....sided for by Seeana 3700 lir he Lobar Code. for W° 510 — FINAL PLRNNING
pe/rtnrmana of the work fur which This permit i..issued.
•,nI have and wilfmuinmm Worker'.Cmnpen tion la.urtmce.lw required by sri..l, - 51. 1. _ FINAL POOL
7 I of the Labor Code,Iia the performance of the work for which this permit is 516 FINAL BUILDING
I...cd.My W..kc,C....au�.edr/9,Invuemec carie,ttmgI Policy modfr afire:
Carrier:Sic.}ya_[�{—Policy No.: a >•�(]�YLCI_
CElil'IPICAI'ION Oil EXI:MI•'I'ION FROM WOkKP. S COMPENSATION INSURANCE
(This sacJon need nest is,........tried Ifile floor,is for are hundist dollars J
(Slap I...1
1 many that in'hepI a III k l which II 1 1 ed I —
shall s ply Y 1!e Y archade,a.as ad become willjoet I,, he N Acrs
Com I it I ILII UI \ \tj
APPbc I
NOl'ICETO APPLICANT:ICM'I If aftermaking IbCertificate f 1 sept n Y .M1ouIJ - Y ,
7hest abject th•W k C ,ll th Labor Code,y u nn.s
Q C's fnnhx thnm,ply w provisions
sh such pros s s or Inn wood shall be AecmcJ revakeJ, ,
F CON S'I'R UC I'IONruction NG lending
AGENCY n�
'Y > 1 hereby a(Em,that.hear its construction(See lending agency for she perto,nwnce \\1'
III the work for which this permit is issunl(Sec.91197.Civ.C.)
0. Q Lender',Name
p IZ Lender's Address
f..) 1 mail y the,I hove read this application and stale Iha,the above information is ,
E.. cones.I afford to comply with all city and county otdinences and state laws miming
Q V mhuilding eneloorinn.and hereby auhod,c reprnentnd—oftnin,city in enter urym
r she above mentioned proryny for inspection pmpecs.
[r 0.
(We)agree losam.indemnify and keep harmless the City of Cupenim against
V] labllhic,,lmoner”.corp rad expenses which may in any way accrue ag;linw xnid
U Z� City in conscyui of the granting of Ibis remain.
APPLICANT UNDERSTANW AND WILL COMPLY WITH ALI.SSEIf,Yf [SSLledb
SOURCERI LAHr Nti n �y/'e/aA y'i
z. IJ/(GIA/.fY
Signauror Apphe:u,trc tfaaar --- D c Re-roofs
HA' RIIOUS MArER1AI-9 DISCLOSURP.
Will the applicant or future Wilding omupma smm or handle haradears material Type ofRoof
the Jcilned Ity the Cupenlm Morrish Gdc,Christ,,9.12,and the lbohh and Safety
Codc,Section 25532(1" /
❑Ycs L All roots shall be inspected prior to any roofing material being installed.
Will the applicant or future Wiliing,ccupant use cynipmcnt or denims whin, Ifa roof is installed without first obtaining an inspection, 1 agree to remove
emit to,radom it ennumnmmx ns Jdf y the Bay Area Air Quality Management
Di,16,1? es ❑Na all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I have read the ao,iiaous nmtcl'ials rcyuircmmot,under Chancr 695 of,lid -
c.bh rm Ihealth A Safety Chia Sections 25505.25573 and 25534,l undenlnnd shat
if,he building docs not meremly have a,crial,that it is al,rx,rnmihility to nosily the
occupant of the m"anco-ems is reit 70mod he met prior e,owailce it a ch,l is c of
Q"°fancy' Signature of Applicant Date
0 e amharim aged q 11a -- All roof coverings to be Class "B" or better