00070021 cl or cuPrRTuvo
BUILDING CONTRACTOR INFORMATION:
nuu, nc Dlvlst°` PERMIT
IIUILDING ADDRESS: r PERM I'I'NO,
�' n��2l�GF- �vl�gEizS
OWNER'S NAM1Ii; - AI'PLICADON. If 1 Fitz :
('HUNG; �� ^ /1 SANITARY NO. COU'IRa1.N0.
c� A O& -�s l 9 : l 6 tJ /��1 4�iadS
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ARCIII' iCIIrNGINIi igIC /� �/}� ,^ —/ IIUILDINGPIiRMII'INFfI�I'�5 Vso—ITV o�V� / y BLD] nili�'' 19_UM1,IiChB-C1'LICENSED CONI RACfOR'S D1 CLARATION ,���,,.{�f,1 hereby a inn that I na,recn.ed ander pm�:aim,,oI Chapter's(eammeneins KTCHN REMGr1JCtM&TFICATIONSwith Scolinn 7001)nr Di,i,,i Sof the Hnsine.e anal Pmteaans Cadeant Raxavein full force and ofce Sic
ce icen,e]n%% 3dI �jreo /17eeDate =6=Q,� Cnmennr
X 3 a In ARCHITECT'S DECLARATION
= F^1�t/y'lerlwa-n`ft n�t�ivwpla�r:r41 M mcd a.public records
ami 7 Lice:f.��,11'Mlc."I1311a1' � �/
ca OWNER-BUILDER DE( ARArION
e•+�— 1 hereby aRnn that I um exmnp,from the Connector'.License law far the
b< following at(Section 7031.5,Amines,and Professions Carte:Any city ar county
F❑ which trances a permit in t ct a II r,Improve dcmul sh p' S swoon
pool 1, rtio II :a I,ta,ncnl -
Ihathe ,l,nroedInavionttothept sof theConaations Liccoc t (Chapters). Sy. Ft. Floor Area alae 1
(commencing with Sellion 704)111 of Division 3.1 the Businessland Profmsiore Cmle)
or tent he I%exempt therefrom and the Iasis for the alleged cumption.Any violation
Of Section 7031.5 by any applicant rim a permit subjccn the applicant to a civil penalty
of at„time than rive hamlmd daunm(2550) A PP(' Occupancy'type
❑1,as ow,tier of the property,or Illy employees with wages as their sole cumpsavallon. .
will do the work,and the drncmm is not intended or offered for%ale(Sec.7114. 101 —
FOLff Business and Profemions Cade:The Contractor's Licenw Law does not apply to an eChOus
owner of progeny Who build%or improve%thereon,and who does such nmrk himself 1.02. — PIER through fi,own employees,provided that such improvements um not intended or
onerrd for late If,hawe,cr.mr,mdlditig or ino,00 mtieal is ,,It .,,[all sae ye rr of 103 — UFE R
nnpleaon, heowner.buimerwill Woo the bmdenofprovingthat brahfact haudor 104 — REBAR
improve fur puruoe of%ale.).
❑1,asOwner othe pr,lady.ant exclusively contracting with licensed contractors ill 105 — ANCHOR BOLTS
iimmruet the pmjw(Sen.7141 BtOiac,s and Profusion,Code:)'rne Contmcuds
iecti%e Low domnrr apply to con Or nn'peny wbn baildsa,hrrpravcx thereon, 1.06 — SEWER- &. WATER .
and who an one,for such ptajcu,with a eana'a,9a,N)Incensed puree Ir the ;y ,1
Contractor's License law. 202 — UNDERFLOOR PLUMBING
❑If�m�e.cromanMrti Pefor misemun 2Qi3 — IINDERFL00R MECHRNICAL
°'r'w'`""'w"]eK1iR'S C(lMl'E 1C'ATII� 11 EIA TI� 204 — UNDERFLOOR FRAME
Iherebyaflanunder prally 01ferjitryOne othe following dedartion,,. 205 — UNDERFLOOR INSULATION
❑ 1 have sad will amintain a Cedmcatc of Causer,to self-imare IF worker, 301 — ROUGH PLUMBING
Compcn%arnn. as provided for by section 37)0 of the Labor code, for the 302 — TUB &. OR SHOWER
perfarnnmuu of the vmrk lar which this)mein in k,acd.
❑1 have and will animal.Worker's Campensation Insurance,a,required by Section 303 — ROUGH MECHANICAL
37x1 of the Labor Cade.for the performance of the work for which mie pen,dt is 304 — ROUGH ELECTRICAL
issued. fy W;l,cr,Comp cation Insurance carrier and Poliev number am:
cavi Na: 305 — FRAME
ICER IIICA'flON lllr 11 :V P'PION IlA1M WORKI:I2S• 306 — HOEDOWNS
�LWM1fI'LIN 1U�[.1 U ANC `a����(�ya G
rrnS..�ec1/rte:dnmbecomplmeLl"In nh is dmd dol 307 — INSULATION
Mlkumlms.l 308 — SHEETROCK
I acedy Ill.,in the vermmu,n,,of the wank far which 11, ,all,is issued.l 309 — EXTERIOR LATH
,ball let employany M,at in any norm,so as m hemme subject ,,.,he wbAen2
Compensation Laws Of Califomh.Done 310 — INTERIOR LATH
Applicant
NOTICIITOAPYLICAN'r:lr,afmnnakialldi,Cedihcam of ii,tan va.you should — ;IANICAL
AT
Ixemne%ubjeel,the Workcr',C punwtfnn proviso:,of Iho Labor Cuda yon next
Emhv;n,comply win,,tire po....iatis m this par, t�% ad be deemed revoked. 313 —4CONSTRUCTION LENDING AGENCY 501 — TRICAL ENERGY
jIhereby efhnn thatthe.is a eanmruetion lending agency fur the peffarmaneeGING ENERGY
ofthe wrd lin which this permit i.s i%%nod(Sec.3g)7,Civ.C.)cnalc,'Ny11c 50 — ENERGY
7 Z Lender's Address -
U O IcerrifythmIhave mad Ilk application and, e,%late that the above information is 504 — FINAL BUILDING ENERGY
Ba F
correct. m
cct.I agree to comply ani city and coes)aulamocand smm laws rehiring 505 — FINAL ELECTRICAL
u^bullding amsrumioa.and thereby mrthnd,e mpamsontadvr,nf his city to enter ligan
thcah-c-aaa ac.1"nperyfonr,%peclion ompa%e` 506 — GAS TEST
6a (Ws,)agree m save.Indcrm,ify and keep hurndcro ma Cay of Cupertino ag,ca,t
fA liabilities,judgment.,casts and expense%which nmy in any way creme again%t ;,it 507 — FINAL PLUMBING
U Z City in consequence of the granting of this permit.
APPLICAm'UNDqE7RfAND S�'rdSS? WILL COMPLY WITH ALI,NON-POINT Issued 508 — FINAL MECHANICALDate
q
—tiulu7curAppinu,Jc�memm [).at Re-roofs
HA]ARDOUS M6rERIA1.. DISCLOSURE 51.0 — ' FINAL PLANNING
/
Will iheappucamorfutumbuilding occllwatsome orhanmcha..ardor,mileiA Type of Roof
as defined by the Capedlno Municipal Code,Chapter 0.12,and the Health and Suety 514 — FINAL PUBLIC WORKS
Coda Scnlnn 255321:07 -
❑Yr, re< All roofs shall be inspected prior to any rooting material being installed.
w0l the applicant or future buildingcecupam use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit haerdou%air contaminants as defined by the Buy Ana Air Quality Management
District? all new materials for inspection. Applicant understands and will comply with
D yet, all non-point source regulations, .
I have read the haraNnu%nationals r,rimicents under Chapter 6.95 of the
California Health&Sanity Code.Sections 225505,25533 and 25531 1 understand that C
if the building does not currently have a meant,that i,is illy re,ry,mihility to minify the
oecrpant of'he"ttiremenm which must be met prior in issuance of a Ceni fi.m of
Occupancy.
C Signature of Applicant Date
f w rtnoarJ gens — Data All root c (rings to be Class `B" or better