00100158 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING A104:1.0 MANN DR PERM IT N(L 00100158
O\VNF.R'S N IBAPPLICATION SUB DA'I'H
WILL, DERF_I: 10/24/2000
,ONI?: SANITARY NO. COM'ROL NO.
noel ARCHII'I?CDENGINEER: BUILDING PI:HMI'I'INFO
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Sv LICITSIiD CONTRACTOR'S DIiCLANATION Job DCSCI'IptlOn
5,4z 1 hcrchY nftinn Lha I ore IittnxJ under provisions of Chupmr 91cnm,runcing
�Fw wimscudott7wn oo3onnaBu,na,.amr t i� Ie. a,yrtce1 ADD 440 SQ. FT. AND KITCHEN REMODEL
J hl full force and �lt ` �
Clearns Clay ...��/ LICk—(9
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OWNER-BUILDER DECI-ARNI ON
=� nby rc that t retro m Count 1 1 f If
w
C (Section 7
i 11311 It esu I Code:
e Y'ly vy
x p whichhich g,I'll rad
,m , w 1, - p d I:h pair anytartivorrent
a - "l.,he I 1. y th i ,I Ina n ll 'g d.nt em
mane with
n m P' i helC I , I. t e l Chartere) S Ft. Floor Area V'{1Lt,5T.t O
,,ummcnungwthbnion'/wgllnfD'hao, 3oflw llm neuon,amin Aaons Code) y $1J/��Jm
,r IoW rte is 31.5 bl Iany applicant
nm me Bars Lor mu subjects
the
d Ulumant to Any violation
of Salton 71D I.S by any dreg doll rsr a pemhit aunjals the aprlicum m n civil penahy
.n m,,mmnhan live hundred dollars ls50ay APN Ni Occupancy Type
❑I,a,...er Bane rmfen,or o,y cmd"y 1)l, all wase•as hhci...le contrea.anon. 3260501. 1. 0171
will ulo the work,and the,tmcaoo is no(intended or uttered r,r sale(Sec.71H4, Required Inspections
Bucmce%and 1'rofe„ion,Code:'rhe Conv emr's Liccrne Law docs ren appy In an P
„fpro,emywhobadd.rnhnpme.mm
thereon. work 101 — FOUNDATION
...through nix own employees.pcnvldnl ma such Impmvnne",are not fide let o,
offered ret.ale.If,wwened the wilding or improvement is sold within one yew of 1.02 — PIERS
norledm,.mcownur.nailde,w,Rho:,the hlndenorproving that hedid not wildor
improve for purfow of ale.). 103 — UFER
Ll 1.a, of the pro"er,,anta,dttavchycwhania,w,,It licensed commetork to 104 — REHAR
comurce.the pmja,(So,.1141,Business cad Profession.Coll The contract°r', 105 — ANCHOR BOLTS
License Law dace not apply to an owner or pro,rt,who hunt,nr imPnne,thereon,
and wino con,me,v for such project,with a,ommnoaa recomd pumuaal to the i.06 — SEWER R WATER .
Com,ac 's Licwne Law.
01a exeatidatitle,See. _BA,PClot this fe-ii 202 — UNDERFLOOR PLUMBING
(Iwt"r WORKER'S COMII%SAI-o DECLARATION 203 — UNDERFLOOR MECHANICAL_
wwenyalro)under peualty,i.I crjurvoretit the billowing teclaoddorx 204 — UNDERFLOOR FRAME
+_j I have road w;II ,hheimain a Cenificwe of Coa.cnt to.eB-in.we for Worker's 205 — UNDERFLOOR INSULATION
Contpcnxmion, is. provided for by Ser 1 5701) of the Labor code, lot the 301 — ROUGH PLUMBING
performance of the work frn which this Nowt is issued.
❑I have and will an,ath Walk,, Insurance.a.required by section .302 — TUB & OR SHOWER
uf
owl of the Labor Code,for the performance or the work for which this pcaad i. 303 — ROUGH MECHANICAL
i...td.My Worker',Com,xluuliun Inanaun cunicr,nad I'llficyandidal are
O
Cando I'olicyNo: t`Jp 7 304 — ROUGH ELECTRICAL_
CERru'ICAnory OP LXEMPrR>N FROM WyRI(jil 49 305 — FRAME
COMPENSATION INSh10AB:I. 306 — HOL_DOWNS
olbi%section need not he cuniplaed if the Manit is for one hundred dollars 307 — INSULATION
(SIMM ur le")
Icertifybar inmeN,hornoweofinework for wovenmixrmmi,issued.1 308 — SHEETROCK
'hall not emphny any"a,.,at in roay nun cr,a,ax to recline,ah',w to the Worker,' 309 — EXTERIOR LATH
cran'nsainn Lows of Calif omnia.Dae
npriic:ml ho Id 310 — INTERIOR LATH
NOfiant AI'I'LICAN'C11,ul',ar nu0.ing in,Cenificam of lixetn,tlnn,you e
M1econal auhjm,to the Wwkds CumMnwhion pto,men,I,(he Labor code,you must
O0 fumtwdhcoutplyw,in such prloi,ion.or mi,won't,naRhedecmedrevoked 311 — SCRATCH COAT
Z �. C(INSTRUMION LENDING AGENCY 3131 — ROOF NAIL
I hcmhy alimuhw mere is u—n.oa lin lending agency for the rildla runcc
� ? ofthework for which this nni,isi...edsce.UrO.Civ.C.) 501 — FINAL ELECTRICAL ENERGY
a p Lemic„Niac 502 - FINAL PLUMBING ENERGY
.� z Ixnder'.Add.,,
U 1cend, hard Iwve lead nhi.a"rreatom,oil ntaetmltire be,,ind.......I,,u1, 503 — FINAL MECHANICAL_ ENERGY
S'. Est coal 1 agree to comply%ith all city and counts andireater,wd.,twe last,achuh, 504 — FINAL_ BUILDING ENERGY
O f, a,building cunamaGun,awl notchy mithori'ac repre.cmalives of the city m cover upon
ke mealmm
ve- cationedrn,pnrbnwradohllon"'e, 505 — FINAL ELECTRICAL
F
:Is (We)agree to save,indannifyand keep hamdess the City of Cupertino against
4 liabilities.judgamaa,cost and expa t,c,which any in any way a«roe again.,said 506 TEST
U z City in consequence of the granting of this fermi,. ��
— APPLICEA T UNDrR)TANDSA ILL OMPLY WITH ALL NON-POINT Issued by: 507 — �F PLUMBING Dat� '-2-5 _
ii-axe
ucon,'rr Da,c Re-roofs ~
HAZARDOUS MAIF.RIALS DISCLOSURE 509 — FINAL GRADE
Wtrhea,"hcaalorfuture whMgoceupant.awo,haanehwnNau,naledA Type of Roof
axdclmmbymeCupenituidl dei"ad Code,char,wxr.andtire Ic:dm andSafcly 510 — FINAL PLANNING
Calc,Sawlnn 255321ayt
❑Yc. Ed ILL, All roofs shall'bt4hspecE(J toRbP.Odf(ngtdQRL{gbeing installed.
Will meapNicant„t future buildingaccupaat use cqulp,aeov or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
emit haaanum
d ,air conawairanL, defined by the Bay Arca A.,Quullty M:uregwnem
all new materials for inspection. Applicant understands and will comply with
❑Ye,
El No all non-point source regulations.
1 have fwd the wrandous to:lwiulx requiremcros under Chapter fi 95 of the
Calforaw Ilcahh&&ticty Cmlc.Senior 25505,25533 and 25534.1 undervund thin
if the wilding does not currently hac a morn.,ha i,is my mspomihili,y In wally the
car at of the requirement,w�11 ,prior w Itim:thee 1'f a Cenificwe of
""'up'"`+'y A/—C (/s"/C r'� /'7(&—o Signature of Applicant Dale
cc or hwi d ca, Date All roof coverings to be Class `B•' or better
OFFICE