00050109 CITY OF CUPERTINO
BUILDING DIVISION PERMIT, CONTRACTOR INFORMATION.-
BUILDINGADDRESS: - PIiNMIT NO.
4
t OWNER'S NAME: APPLICANAMW -
PHONE: - - SANITARY Cb.- - O.
Z ANCHITECI'/IiNCINEIiN: - - BUILDINGPERMIT INTO
S _ HLDG ELECT PLUMB MECH
LICENSED CON'TRACTOR'S DECLARATION t '.loescron
b Dl ti •
,Zza. m _ „
O Z—zup 1 hemby arrr n Ih I 1 the
B d Pr sot ns Code,an dm license
pv_�tps
with Sedloe700D)emal effect.i.' 3 fine Bu Jfn,feasionsCWc.and mylicenve ,
n'n full force nnJ eR a - -
z a License Class - Lic,d - -r,
o a u Date comn,mm 277 I V I NG SFA 493 GAR. SPACE
t- C ARCH[ DECLARAq'ION . 5
. I understand my plan zhall he uwd as public records- . -
�
W�O a
O Licensed Pn,Icssional '
p' o
' OWNER-BUILDERDHCLARATION,;
1 hereby affirm that 16th evempt frons the Comracmr's License Law for rhe -
C?< following reason(Section 7031.5,Buouni,and Profession,Cafe:Any cityor county
F a which requires a permit to conswet,:Jnr,improve,demolish,or repau any suuetur
.a a3o pri�rmitr lsxn:mre.olio tcyuires the npplicnm livsuch permit to fileasigncrismmm t _
mm he is licensed pursuant m the provisions none Contractor.Lic use Law( pt 9 S t. Floor Area ,Valuation
(commencing with SaYJon 7")of Division 3 of the Business Prnrn:' ncrala 9. -
or that be is oumpl therefrom and the naris for nae alleged cPion
orseenoa 703Is by env:mnnrtttn lar tis pm,nh x,tnjem,too pluwa it civil ty _
orttnr more mem five hundred douaras50o), . ;' fAPN Number pe
01,as owner of the pn,feny,mmycbrPloyecs with" age,uvlht,innle rnmpcn.unm
will ratio work;and the nruaure is net invent or ot'fered�tOn sale(Sec.7 4,: .-
Business and Pmfesllons Code:'I'be Contract,-. LlnemtaLaw docs nm aptly to an - equired Inspections-
ownerfpnpeny can him prove ind n J h rknm.eB
or lhmugh In man employees,provided th such p I t' tended or ,
offered for:m 1f n m n Id's Id : e y a of 101 FOUNDATION .
to,fiction the,cane m me-w'Innr en, neon v tg mmb dd mrht ddnr
uu,ewehafttr{mxeof.tOc.7.- - 1 — PIERS - .
°I,m owner of the fropeny,am cwsi.eI,amlra,Iing wi i'enmd con m eters m• 3 — UFE R ,
n:t r'It,fumed(Sec 7041 i, I P r " t, p The C t act,2s
Lit L I'e,mt„ I to un owner f n ho'hi'Js nr list 1'04 '— REBAR
'1PY pnpt yw pnvc<thcnnn,
r and who contracts for such projects with a ea mracmrrx icened pursmm to the
contracmi License law. ; 105 — ANCHOR BOLTS ' -
❑Iame,emptunderSee. _,R&11Clarmi,reaso" I 10E - SEWER A. WATER
- _ Owner N'ORKF.R'sCOMI'Date O' [CLARATION 202 — UNDERFLOOR PLUMBING ,
Ihereby urrrmttude,Penalty ofperjurrouc(if the fouo,v-iagdeel:ra' 2203 - UNDERFLOOR MECHANICAL
22204 — UNDERFLOOR FRAME
❑ I n JAl mat wan Certificate f 3 t L W,tker:v' 205 — UNDERFLOOR 'INSULATION
• er
Compensation, p deo f by Section t7W f theLabor ,dc, for the .
pert ante al thework f rwhiJtm xpermit .v issued.
r
+ °1 have and will maimato worker,Compensation bo once.as ntquired by Section 301 — ROUGH PLUMBING
37dH of me 1.1hor Code,for me Performance of the work for which this fiction is 302' — TIJB & OR-SHOWER ,
issued.MyWorker,Cmnisma Iroaraneeeuric, adponeynumne,mc: 303 — ROUGH MECHANICAL
Carrier: PEMPTIOicy hIWORKERS'- '304 — ROUGH ELECTRICAL -
CERTIFICATION OPIiXEMPTION FROM
-a " COMPENSATION INSURANCE -
rrhis setr�nn nobd not be eomfmtpd if tete peormit is for auk hundred doile"' 305 — FRAME .. -
(siannneav) 306 — HOLDOWNS- -
' I certify that in the ferfumanceofth (irk for hichthi pi is issued.1 307 — INSULATION
shall not employ any per t in ty nun so s t,bet,ue xuh)eu ,the W,kis r: `
Compen.aronLmvxnfC:dBumia.Date 308 — SHEETROCK
Applicant .
NOTICE TO APPLICANT If, ftr wk ,this C,Aifi.,O or E.ebr`uiu on,n�— ' 309 EXTERIOR. LATH
benne..hj,,unlhe W k C tp :t I of Labor Cole,you oust
O2O E,rmwmrntin, ith....hfrom.br,x„th.ferout,hllN.deemedrevoked, 310- - INTERIOR LATH
F ^ CONSTRUCT ION LENDING AGENCY. • 311 — SCRATCH COAT -
aI hereby infirm beadico,is a construction leading agency fur the perfomuatec ' _ _
w ore krowhiehti nor issued(So,.v)me've) -313 : ROOF NAIL
y q Lea Address
501 — FINAL ELECTRICAL ENERGY
= z LenJers AJJrcss _ -
U 0 1 wYthat Ih. . .Jth'. pprr t LTI tnatd an f mato, . 502 —, FINAL -PLUMBING ENERGY -
;: .
eti in r l d ction.rand, to II city and ty d nee d. ' erlupon 503 — FINAL MECHANICAL ENERGY
U ntobuilding ,n Grin Jh hyity an Zr
hares fish tel enter upon
meaMve-menree I.pmpenyfor unniry and keep .504, —. FINAL BUILDING ENERGY,
p�., f% rwe>aereemcase,inaemnins andk«phanmea.the air nreupemm.agmtt,t
n mtyudcs,wilotaent,,too,tramith1perrittttarinttttywnyacurngagalnrraid 505 - FINAL ELECTRICAL
C'uy in cunseyuence al the gmming of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-Pi
SOURCE REGULATIONS. . q issued by: 506'— GAS TEST Date„
i. _
FINAL PLUMBINU
�trre fnffur nAZoARDtmr - - lite Re-root's Y5.08 — •FINRL MECHRNICAL -
H,VARDOUSMAfFR1AL5DISCLOgUkC r
N II the pplicanl nr fmure FuiWing ar pan:I n m nazaN u.material Type of Roo •
md•fined by the Cupennn Muntpul Code Chine,9.I2,ad the Health read Sudety 09 — FINAL GRADE
C,ale,Sect 25532(a).' T , '
°Ye °"o - - All roofs sha59W in7peFtX or RJa"(W@ material being installed.- _
Will nowt"applicant future building by VicamyA,use,i, ptiteut„t Maravwltwh If a roof is Jr5AtAed-wifRJMAl:st RAIDKOn idQRK9n, I agree to remove
tnith u l pplica ts .d f ed by Vic int uArc.Ai,nc Quality g nen
niut tall new,matf forirtFy�fB[IwnPA I11D@Djn"A Inds and will comply with
°Yc' °N all non-poin ., gca�'e rtIsBATTENS,,
1 h lid the has rdu: tis rant Is req, mnwnta t ode-Chapter 6.95 of the ^
California Iit
Heuldt&SafetyCode:Sec ,25505,25533and25534.Itomob,tundmat 604 — ROOF':.I-N—PROGRESS'
Of the building does not currently have a tenant,that it is my responsibility to notify the:
cecufant of the requirements which must be,met prior m issounce of a Certificate of -'
occupancy. - - -
+" - - 'Signature of Applicant a Date.". .. '
Owner or aamodud agent Dnte : - All roof coverings to be Class'.`B" or better '
• r u ; ,