00080149 CITY OF CUPERTINO
nml.DtncDIVISION' PERMIT CONTRACTOR INFORMATION: .. -
Hun.Dlrvcnnollgj57 LOCKFORD- CT PI:RMu NO , 00080149 , -
OWNVR'S NAME: ; - APPLICATIONS ATr_
ORTH DIANA L �Ibp/.ci,/2000,
PHONI? SANITARY,NO. CONTROL NO.
CZ ARCIR I[QI(ENGINEER: BUILDING PERMIT INFO
GLECf. k 1 h1
.PLUR •• MLCEI
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Z �,Z I ICFNSI DCONTRACTOlt S DF.CI.ARATION , - - fob Description -
O z�� 1 hereby 1f that I I' rowel under provisions of Chapter (commencing
gFqyC; wlh Section 7000),qD lima3 (the Bu ne:.ad Fmfesstons Code and mylie...c - , ADDITION 382 �C'LO. FT .'infin
!9 z 5 a L cc dl f�e.,�t JC��C--1.._u
3LLN Dt PIN'ALED
nRCIIITE( S DLCI:Aft ION
1 midertaridory plt'.Irll he used it,pubic records A
aoLicensed Pnal FEB 0 7 2002
ONNFR HUII DER DECLARATION
herehy ani,m that 1.,it sculpt train the Contractor s License Law for the
i-a 6 following reaven.(Strums 70315 Business ad Prof.. n CodceAny city orecamy �1
SOo whl t p - 11 l( t Iv r' r J III cop y , ore
BUILDING'
IYG „ s
of C p i t s I requiresme ffli amu hpermit, n signedstatement 1Y
thin be S Ft. Floor Area ' valtJ I'fj
'3^ em.n licensed!P n . t00) . f i C tmc1,' L U.....Core) $�/�00 -
(a lm,he i tcsv.,, even 70n and the
:is D of ei Bus n wiiw.eAsimn'Cmdd7 �'
or that he is exempt say pli and the hon for 1M,I,11a, ,fi,anon.Any I olation
winalt
! of Section 7113nby audrn&anlfornrenne yanjceuthm,gtpllmnn titacivil pennhy. - -
�mrnot pnmrentarE.enandrmdmuan(sslg». 7APNNumber Occupancy Type
3622E040. 0001.n,o,ner6fdretrope,1, rmrennIn c•ewithwegitsa, hit rsale com enation,
will do the work,and the stmcwre is not intended or offered for sale(Sec.7011.
I
Huninass and Profossiom Code:The Cnmr ran",Licenm Law Joe,no,.,Ply 1.an UUI d I�,Sp�eCt1011s'
owner of property Who Iniilds of improves thereon,and who does such work himself 101 — F05NUIV I UN -
or through his awn employees,provided that such improvements are net inendrd or ,
errered Icor lade.If however,the hmdeing or improvement',said wi lao one year of - 1.02 — PIERS
completion,the owner-builoler will have the burden of proving that he did not build or r - +
talons.fa ,oposcafeile.), '103 —.- LIFER .
0 1,as owner of the gio,uero,am exclusively contracting tariff licen,sed!contractorso 104 — RF_BAR
eons,mcl the p.,,,ccl(See.70u1,Basptass and P,nta..iema Code:)The Cormnuou's - 105 — ANCHOR BOLTS
Liecow law does not apply to an owner of property who Wilds or improves thereon, .
,Ind woe compacta tar ouch pntjecla wim a cenmactmns)licensed nllnaarI m the 1106 SEWER" 8. MATER
Com,nnmr'.Littnem law. -
OlameremPtunder 5oc. .B&rcfortmsreason - `-202 — UNDERFLOOR. PLUMBING•
Owner '' ENS 203 UNDERFLOOR MECHANICAL_
WORKER'S COMPENSATION UECLAkATION-
.Iherebyarrr,trunderwitahyofperjuryon,ofthefonmwdngdeclamron%:r 204 = UNDERFLOOR FRAME
CIA nave and will maintain a CemUcate of Cori In self-insum for Worker's 205' UNDERFLOOR �T NSUI_AT T ON '•
e"inpemmi"n, as provided far by -Seen 37M of he Labs Code, for the 30 1., ,I •ROUGH PLUMBING.
` perfuvuutce of the work for whirl,his ureal s issued. - -
- , 302 —,'TUD,t & OR SFIONER
p 1 nave and will m:dnlain W..ker'n Cm,npensminn hrmr:mce,as retained by Scclion 4
3700 or the Labor Code,for the performance of the work far which this permit is 303 — ROUGH MECHANICAL .
issued,My Worker's Comperemion Insurance carrier and Policy number are: - 1
cartiert Pdne;'�o.:�>, q
-a - 304 - ROUGW ELECTRICAL -
� s�s��'IkCElR pIN CA I1O�BXEMYf]ON FROM WOR h'HRS' - 305 •�.,FRAME '
Y'All. W� C(lMI'CNSATION INSURANCE , 30F, '-- aI Dahlbls
r'rm.aee400:t d con he coh,plemd itlna penton is rbrmnc Ltardm,l deu:,rc -
FI
' (sloontrleaa.l 307, INSULATION,
1 cenify that in me perfer„Sance of tie wink tar which this Pertain is issued.1 - 308 : 'SHEET RaCld -
shall n I employ any Person in tiny routine,s,as m become subject a the Worker'
cnmpe„aaJo,tLaw.ercdnn,rnia.o,llc ;309, —: .EXTERIOR LATH
Applicant
NOTICE.TO APPLICANT If.after making Ili,c"Ictue iffL pr , ...a should 310 — INTERIOR LATH .
O phecmamsub)csl m the Worker',C tpcni f pr - n ot[lie L M Code.fola trust
fnmhwthcomply with such p .ons this .t hall be derroodrcoked- - 311 — SCRATCH 'COAT -
r CONSTRUCTION LENDING AGENCY 313 — ROOF NAIL
I herehy affirm,lam,here is a cmmwefon lending agency forms,performance
z
w ntmework fnrwnichtthis perritiaIssued usec.3o97.cv.c.1 501: — ^FINAL ELECTRICAL, ENERGY
o . _
a 1C"def''"am° 50c F7NAI: ''f'LUtIBIIJG ENERGY
Lrndcr'x Address
U O pp Ica ,
r"l certify that lime read hdse 1 t n andstmmm naa"n e the etwo,irfonis. - ' 503 - 'FINAL MECHANICAL ENERGY .-.
n
P1. E e:Erect.I agreetocomply whM1ebcity and e"4,m,Ysenban"cmou":istatehow,lerupon ,04 — FINAL BUILDTNG ENERGY
O C.7
to building rnmwctian,and hereby authorize represenmlivex of this city center upon ��
W4 the alwve-menseredproperty her hacpecdonparpow 505* — .FINAL ELECTRICAL
P. (We)agree to...c,indenmil'y and keep humc.s the City of Cupmimnr,irmr o
Uto liabilities,judgmetne costs and espensy which may in any way octane against mid _ 506 GAS, TEST
�y chyLICANTtmcmconnhegmrrmgofililsltef1 507, — FINAL PLUMBING
APPLICANT UNOERSTA SAN WILLCIDPLY WI'1'fI ALL NON-POINT Issued I.by: Date
'e SOURC F II ATIONS k y
Signature �XrpEcary m tr eC� " n:r Re-roofs 508 ^ -
HA ARDOUSMATIiRIALSDISCLOSURE509: — FINAL- GRADE
Will the applicant or future Winding otcampam mancer handle Wombars thowmal Type of Root' .
a,dcraed by the CupeAmo k1unicipal Code,Chapter 9.12.mid me Heath and Safety 51 0 FINAL' PLANNING
Code,Secular 25534(a)P
- °Yea "" All roofs shall be it*ectefFpTMAb al�1�fi�iFmbt�+being installed.
Will the applicant future building occupant use equipment dice which If a roof is installed without first obtaining an inspection;I agree to remove
c nM1 J rot 1 -define)bythe Hry Arr Ai Quality M1lawg ,em -
n 1 u all new materials for inspection. Appllcant'imdei-stands and will comply with
or: �No all non-point source regulations. -
I have rood,he Win i mmerials require -tits under Chapter 4.95 of the
Califted.Health&Safely de,on,
2 5.1 and 25534,1 umlersmnd,hat -
it he huildingdie,ro ell vn ly Mweu amnmphut lis nyes mothLllvyusmtllythe ,
ace.ani of the requirem t. ,K st be,met 1 4,m ....are of a Certificate of
° "" ' Signa[ure.ofApplicant -- Date ”
Dateffs)f , All roof coverings to' be Class "B"or better ,
OFFICE