00050170CITY OF CUPERTINO
CONTRACTOR INFORMATION:
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BUILDING DIVISION PERMIT.'
BUILDING ADDRESS:
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PERMIT NO.
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-OW'NER'S NAME:
D If
6S ?160.
APPLICATION SUB DATE a.
05/24/2000
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SANITARY NO. CONTROL NO.
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ARCHITf:CTIF-NGINECRi •, ��: v
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BUILDING PERMIT INFO .
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BLDG HLECT. PLUMB MIiCIf
aLICINSED CONFRALTORS DICIARATION)
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'; Job Description
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the by ff nn tl I ml' ni.ied Irp fCh 11 9(cng
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c unh3 ct n7(xlo) fOi Il f@e Bu .. IIP Jnyl gnu
� is'n fall l e
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3299 LIVING SP.
� ARCIIITLCT'h ❑[CLARAtI
,587-BARAGE
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I unJerstanJ my plan> .hall be used ax public records
9 I.iiemeA P lessiounl
OWNER-BUILDER DECLARATION
hereby affirm that I am' exempt from the Contractor's License Low Tor the
Is
following reason. (Section 7071.5, Business and Professions Cale: Any city orcouay
Which squirm a puri..:. t wmmtumt alter, 'Improve de fish, or.,, any vunOur,
primo Issmdce. also regolres IM1c applicunl rnr avch hCrmit to Ito a signed aB:lcmem
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Sq'FLFIOOrArea
Valuation
' that he is licensed purraticat to the previsions of the Contractim's License Los, (Chapter 9.
(commencing with Section 7001 of Division 3 of lbe Business and Professions Code)
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or that he is exempt Therefrom mal the basis for the ;it leged exemplimi. Any violnibn
y
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Of Semon 7071.5 by any applicant for a perish Object, the opplicunl le a civil penwly
nrnamnrethan five hundred eoJmr,aslxn. ,.
APN Number ..
.. - OccupancY Ype.
❑ 1 f the property, or mY mploy with wages as their I pe smion,
will do duc w Iand flic no"for, icor intended I,, offeacil f (Scr. 7044,
' Bu n, J Profession, Cal 1 he Conl I r s 1. unto Law does not apply man
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I Required Inspections
Owner of property WILL buildsOr.mpmvcs thereon, and who does such work himself
or through his own empinyca, provided thin such improvements are not intended or
onbred fm awe: C tali er. ane building ,, ouprovca mul 1, Sohl within ,at rear of..1
@ 1. — FOUNDATION -
omple.infife owaenhwWer will have the huNf pnrving that he did mu lacild or
mil o
,
102 — PIERS .
mpm.e rorpu.pou er.,we.)..
❑ 1. har efine property, ton; exewahuly convecting with ranged contractors to
1.03 — UFER
mtruel the protea (Sce. 7(M4, Business oda Pmlasaioas Cndel) The Cnnlnletor'a
1@'(1 — .fREBA R `. -
License Law doe not apply to m owner of property who builds or improve, Iheremi.
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'and who contracts for such projects with a commaturts) licensed famainl to the
1 @5 '— ANCHOR BOLTS
Contractor's License Law..
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sloe eci.npl under See B& P C for Its, reason
1.@6,— SEWER 8 NATER
Owner ' • _„arc .2@2
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� — UNDERFLOOR PLUMBING
WORKER'S COMPF.NSA'1'ION DECLARATION
2.03 — UNDERFLOOR MECHANICAL '
• Imob, ofloounder penalty OfPerjur fthe fonawin'gdeclam0ons:'
❑ 1 have aoil I]; maintain a Certificate of Cnnsent'a, �elr-imaure for worker;
2@4 — UNDERFLOOR FRAME
Cor,mmi„n, as pro,-coed for.br Section 371() Of he ).ala. for r the
2@5 — 1_INDERFLOOR INSULATION
,if ..aof work for which I his it k.:weds .1 . I
aaY
3@1 —_ROUGH PLUMBING'
❑)hoe he aborCmaintainWorker's Compensationl. arks akq res by Section
7700 of the Lahr Code, for the performance f .h work for which this perms s
3@2 — TUB 8. OR SHOWER '
.I"ald M c f I m - 11 �Pp1/r �I/jl�b�yre'',
' 3@3.' — ROUGH MECHANICAL
Comer. /y CEI:.rIl9M1A^9'Md��w4'K/-
cE FICATI N FS
304 — ROUGH ELECTRICAL
IONTI(hRHOMWORKF.RN
E s no RANGE
305 — FRAME
` (This sectio a need not be cmnplauw if the permit is for one hundred dollars
(SI(1(Ilorlcss) - _
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306 — HOLDOWNS
I carat, tial !II ole 1>cd I.mana nr the work rue which this fcnnh is i:auea, 1
307- — .INSULATION .
nm
sholl•employ any person in any manner so as to become subject to the Workers'
3 @B —y SHEETROCK
Compensation Laws of Cmiromia. Dam
NOTICE. -
NOAppTICE IO APPLICANT B li ski dII C n I oft "
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3@9 — EXTERIOR LATH' ..., _
becomemnjcet ill BeWorkers Compensation nh 11 cal y must
most
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'31.@ — INTERIOR LATH
,f
fnnhwnh comply With h p ooh. permit shall be Jecmbd revoked.
CONSTRUCTION LENDING AGENCY
'llcrebyan
3,11• —_ SCRATCH COAT
....Ih40Ges,r', nnso I 1 ling ogu ll flue pud'ormnnce'
•of
1.3 — ROOF NAIL y ,
th Work for Ih penny. kwed (ScO. 31197,Cs.C)
Lend- -
LmdercAJdress I
501 — FINAL ELECT RICAL"ENERGY
ICenIf, nuallhave Lead III, a,ic:ninnaidatmcthat (he above information is
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�,. 502 FINAL F'LIJMBING-ERIERGY
conect.l agree to comply e'ilh iffriry and county mdinance and stem laws relining
503 — FINAL MECHANICAL ENERGY '
to building construction, and hereby authorise representatives of this city to enter upon
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the above-mcutimed pnlper�y na ln.fecrmn mr-cows. •
c — FINAL BUILDING ENERGY
(We) agreo wove. lndenmify and keep hm .les. the City of Cupertino against
Iiabilitiea,' dgmems, rocks and expenses which may in any Nilly accme against said
. 505 — FINAL ELECT R I CAL • '
City in quence of the .arm, of tis permit
APPL rUN RSTA SAN ILLCOMPLYWITHALL N INT
INT
cr
506 — GAS TEST
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Issued by: Date '
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Sign rGumCo ' a
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or App re
• IIAZARDOUSMAYERIALSDISCLOSURE
Re-roofs
508 — FINAL MECHANICAL
Will thcappficent orllnum bwldingnCcupear shwa or lmmllc haaiminm.aalcdal
as defined by The Cupertino Municipal Cale, Chapter 9.12, and lhi Health and Safety
Type of Roof.
509 — FINAL GRADE
Code. Section 25532a)7
"C7 Ycs.
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Ail roofs shall b85itl pe 7t d�FAMI r'6' i Irl��ilkj Ierial being installed.
Will the applicant or tarsen uilJing oceupom use equipalcal or devices which
If a roof is instalga W itfiouE-flip. %taihii hnTdi RiVIPagree to '
card hoeallous eirwmamina I, as define) by the Bay Area Air Quality Management
District'
No
pkqt remove-
all new materials for inspection. Applicant understands and will comply with
all nein-point source, regulations:,
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I has read the ha timimis mhieriala requirements under Chapter 695 of the
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California Health & Swimy Cale, Sections 25505, 25533 and 255.14. 1 uadermand that
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iflh b dee In dy In I n t th Il my re f n hl'tyI .i fy,.h
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ovcup 1 r bdd'i I ter 'I s I C Ili ;t f
Oce, e) -
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Signature of Applicant Date ,
own mmlrxed:ldent -
•.' • All roof coverings to, be Class "B"'or better.