99080096 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: - -
'BUILDING ADDRESS: PERhII'INO.
_ OWNER'S NAME: - ' - - APPLICRfIONSUB DATE
10497,MANZANITA CT, L'T43 13 ' 99080096 '
• PHONE: _• .- _ SANITARYNO. C(I\1'ROL NO.
THE OBRIEN GROUP 08/1.2/1999 ' :' ''
I]O O ARCHITECT/ENGINEIiH: - -BUILDING I'IiRA1n'INFO -
u BLDG ELECT PLUMB MECH
¢S m= LICE' EDCONTRACI'OR'S DECLARATION. _ Job D(',5CCIPIIOD,
O Z. I hercny old, ., 1 am 1 unud d m n. f Ch m,,q(commencing _ . .
F �w m t o 7fg)fd f l M1 III B d Rayl my l cone - v
xyY� L'inf 111 del 5
u�3 SaF License Contractor
M _ _ x
UiITf CT S DI Cf AR TI Y
g te r j ..naln,a,see :mcal ree,ala . .. 3787 CONDITIONED SPACE, '740 GARAGE
WO Licensed I'mfesdomi -• , -
n o.o LL OWNER-BUILDER DECLARATION•
I hereby tiftion,lh,I a.esen,,fr Is,Contract L telwfmlhe - -
G C
folloliu,r,a n (Sec, 7031 s mal I I' Code'AnY dity 'ot,tY
which requires a perm)to construct,alter,Impnwe demol.h, tepidr any structure
3S
poor to its issuance,also requiresth applicant for suchpermit I file a signed.tatenent
bar he is licensed l :mam to the priwision,ofm Contractor,LLm,echper v Sq. Ft. Floor Area Valuation -
(emnmeu,i,with sum on 7000)oI:D'vsniJof the Bus'ad,,and Pn,fuason,Cr Aa)� _ .
,,,,bar he is exempt decoct man and the basis for the allegedlaam.Any vionninn `
of Section 7031.5 by any applicant lin a whoil subjects the'e,x Uam Io a civil petiully
„rno,none hat Bsehundred douars(s50B). `.APN'Number Occupancy Type
[D 1.a , of the rt r ro r employee, 'n E n rep ri u - $377485
will J Ili k d 11 tra re' t t d d B red f le(S 7194 -
Ummes. I Pcrrfics.iwrw Cod`ne Cantractur's License Law d not apply loan , _ Required Inspections
ownerofpm,peny Who n Id - prove therem,and -h d h mlkhimself
offferedEedfor
awn enplY . r Jd,1 1, h p t I lnddm . . - .
or rule If,hoo,elm.the hu'Idtng or im,o,,ment'. . If Mthir ore ye,of .. _ .. .,
completion,the ownernuilder will hove nNcn o
the bf provinb That he not did buil)ina
p e<rmmtpnsearsal<.). 101 —. FOUNDATION
1:11,oa ownor Hone nropcity.ten esemstvely<orem,1 g win,rsmhefn,cd eamraemraa 1.0� — PIERS' - -+
- emum It,, (See.7044.Business un I rmfe..I is Co,c)due Canvacmr'x , p .
andwhLawtactnmr such oano,:n with a;orty..honullaetie fursnitenon. 103 _ UFER
Contractor,
o who contracts for men project.wnh a mmrrumrts)licensed mnrsuam m the ,
Gommm xe License Law. 104 ' .REBAR .
111 am exempt motet s<e ' ,B&rC for lt,lst - v
Owner Date' 105 — 'ANCHOR BOLTS
WORKER'S COMPENSNUON DECLARATION - 106 — - SEWER .R• WATER
Ihereby mfirm made,p rallyofp y(me,fthe Sol lowing declandoonsi )' 202 _ UNDERFLOOR PLUMBING
0 1 n and will maintain Cenifica, fConsent m Ir cure f Worker's 203 UNDERFLOOR MECHANICAL
Cn .nmm, at a. pr e d f by Sect' 37W of the Labor C de rt r the
j,edomua,cul the.vf,k fur wman th,, malt la'Ixauerl. ' 204' — "UNDERFLOOR. FRAME .
0 l have a ad will mammm workers Compensation Insurance.as regaired by seedan' 205. — UNDERFLOOR 'INSULATION ..
tan of m Lakeifto
fmmam«car me work for wmeh Th.p m a is 301 ROUGH PLUMBING
' u70) kcma ra a xnJ Irklfor antherhi, - •'
cam= � P I 30� — •TLIB 8• OR SHOWER
.XEMP 10 OM WORKC S'
TI IN RANcr: 303 — ROUGH MECHANICALTh.,saln nceplead if d,c ermit is far one tmama aalwm 304 -- ROUGH E_ LECTRICRL .
(slBa)one.a.) - _ 305 — .FRAME.
1 certify that in the erfouniono,of the k for which ths pennot is issued,1 -
'hull m t n toy any p rso ' y ,cat b bj u t tee Wa kern 306 HOLDOWNS .
Canpena, nl.r.'efclr Dole°° ' 307 — INSULATION '
Applicant
NOTICE TO APPLICANT:IL uhcr making thisC<nlficmr of Exemption,you should 308 — SHEETROCK t�
become subject to the Worker's Cbn,jmnsmim,pmv cons w the Lrshor Code,you mint
+' O C anlhwdmcalmplywfit,aacnpm.h.ians•o,.Ihispenndshnnbedemoed}c„'ked
Z 309 — EXTERIOR .LATH
CONSTRUCTION LENDING AGENCY ”
R > ' Ihereby affirm fund them 1saconstruction lending agency for the pciformanc< 37.0 — INTERIOR LATH
of wild,or wldm,mis pemdlk issued(Sri.3097.elm G') ' - 311. SCRATCH COAT
S Q I'nter's Nmve '
p z lender'..Address - " 313 — ROOF NAIL
V I cenil that 1 lite read This u Verelan erd nate mol the aMwo iamm,nllan i. -
enmeal.I ngrce Ie,cdlnply with 3111 chypmW county nNlnauas end carom laws raluting
FINAL ELECTRICAL. ENERGY'
O V Iabuildingconstmcbon.andherebyamborDercpresentativescliffscitytoentermain 502 — FINAL PLUMBING 'ENERGY
W .the abo.x-mentioned pai for impection muHious.
o w<) g I ue a ry and keep ml.s mec'lytfe pill ougama ,503 — FINAL MECHANICAL. ENERGY .
Vm b11 a" j 1 t . ,I 1 , . . Ir4 y'I:Iny 5 againsl.c;a 504 — FINAL BUILDING ENERGY -
Z City noose c of th,gramnk,r lhi. 1.
t SOU`I'B RF A ON DS WI MPLY WTm ALL NON- Issued by: D8t0
nawrc ofnpmr, onnamor - ate .'Re-roofs 506 = GAS` TEST
HA71ARDOUS MATERIALS DISCLOSURE
iiVill the applicant or far..Wilful,.,.Wt ,.a handle Round..,nlat,d.i Type of Roof 507 — FINAL PLUMBING
as defin<J by the Cupcnine Munierpal Cole,Chapter 9.12,and the Health and Safety,
Code s r 25532ror 508.— FINAL. MECHANICAL-
❑Y, - - ' " All roofs shall t 'iqspectt�dtogpW ng material being installed: `
Will thepplcant or fmureM1 ddmg occupant ,illi t rde ces which I
If a roof is ins I qlu pf1k'&,ob%I We�gection, 1 agree[o remove
moth J onru,inanls n;Jeaoed by t By Area Air Quality Mnagencm ��}}'-, g
I>.I I❑Y all new mated, r ins ppQ�,LAp�Lic::yLy el'SLtg rid will-comply with
all non point so I regul.mloos. UFi 1 WIJnr
I have read the hamrdnua mt er els requirement,tender Chapter fi 95 of the 602 ' ROOF PLYWOOD NAIL
• Cullfaralu I Icallh&Safety Code.Sections 25505,25533 and 25534,1 undeomnd tent
vm,an ld ms Ane avealenanl lnit ,y repo nllyhmocalf, - 503 - ROOF BATTENS . ; .. .
nccipam n a ry m t. I' h Ip - issu c J niacate f -
Occupant - - - -
Signature of Applicant Date
Owner or au,hortmd agent _ Date , All roof coverings to be Class "R" or better - ,