99080077 CITY OF CUPERTINO --
BUILDING,DIVISION PERMIT CONTRACTOR INFORMATION:s'
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RUILDINGgryWgy'__7 MRNZANITA CT LT39 US 111M°"139080077
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owera•s'Q'"IBRIEN GROUP /V �� API'LICATI su rp '
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w O O ARCHI'rELT/EN IN R: - � � pO11.UING I'ERMI'1'INFO-
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FILING ELECTPLUMB MECH
Z LICENSED CONTRACTDECLARATION
OR'S '
5 -
III h amnnthat omfieemedunder - { Job Description
y prm'isia.of CM1apher9(cammcncing
P hlnti t n9pap 4Dj1,,)T1nen nc n .hhy nr.e •�j ; nlCfas a T �, ] 4�1 CORIDITIONED SPACE, 330. GARAGE
LieBMR
IECTSDI'LI Rder Cul11 he uncd Ism
p°
Licensed I'mfessumal
that I m-pUILDER DECLARATION
h.atbnu that I um exempt,tram the Cnmrnetor's :Anyu city
t I'nr Inc
!•Z< following maven.permit
t co LA puniness and ne,demob Clue:Any cant or county
x O which,1,irequires a permit re ire,
"bat intpmvc,demolish,or repair any fracture
. 3Q .Prior r'. h s re4 doe applitainl h fleriod,toilla signed11 nen .
(nomthoot r with
pursuantSe1 d P ' t.of me c I 1 r-ce : mll p1er9 � Sq'Ft. Floor Area Valuation
or
cing is exahSeuan 71u a)oreN Sof theBusiness exemption.
Any
union fJ' '
or that nc is exentpl rheefPPI and the Eco far the alleged exemption.Any l"'tion
of not mm e Ton by unity PPI d ll far a pannit suhjcmt the npplicam nh u'civil penuhy
- arnm ma.a than five hundred aannr,rxsnnl, r APN Number' t " 416 'a pe
.O L.,owner of p apscu,ormy employees with wages as their sole compensation,
will do the work,and Ihe.eeeare is not ate led or uttered on mle,(Sec,7a 1 's
Bathes.,and Pnof as Chale:'roc Commcmr•n License Law docs not apply m an- Required Inspections
owner of property Who builds ar improves Thersu
eon,and who doe, ch work himself - •
or through his own employees,provided that such improvements are sol intended or '
tittered tar sale.If,hnwnver,the nuilaing nr lmprovemenl itn,ld within doe year or. 101 - FOUNDATION
camplctiun,rhe o au`o nh hf,i will have the bunlce of proving Thai be did not hold or s'
improve In,purpave ar sale.). 1.012 — PIERS ,
❑I,as owner oflnc properly,am exclusively connecting with llcelnud contraearsm 'J03 UFER
nstnmt the praja,(see.71044.Basiav,s and rrareanintt,Code:)'[In Cmlmnmra 1.04 — REDA R .
License law apes no,apply In ao owner at properly who baud,or improve, a
thec .
and who contracts for such pmjeces with a contmeagsl licensed pulwanr it)the 105 — ANCHOR BOLTS
oC ntmclues License law. .
lam exempt under Sec. ,EanPefor Inas Gnat„h^ 1.06 — SEWER & 'WATER -
Owner Date '' ,20E — UNDERFLOOR PLUMING
s WORKER'S COMPHNSAT10N DECLARAfION
nnFmb affirm underalt r 2013 — UNDERFI_OQR MECHANICAL_ '
ya pen ya pernrynneanneranaw;ngdenm�adan,: 204 — UNDERFLOOR FRAME
Cl 1 have and will maintain a Carlifmxm or Colon l it, self-insure rnr Worker's
Campen,arinn, a, provided for by Section 370E or the Labor Code,-So, the X05 — UNDERFLOOR INSULATION -
perfonnanwpen
eent the work rot whichlhis nil is issued. _
°I have and wiu maintain wnrtiera Cnnhpeniation m,or.tn2e,t reytiirW by Seehhn 301• = ROUGH PLUMBING
3Vf1E of the Lalart Code,lar the pe,i,n»once ar me walk Int which olds penal is - 302 — TUB R- OR SHOWER ”
issued.M esCamrcussfa Euxmsecanierandpolicynutnher - 303 = ROUGH MECHANICAL .
°ttr.ier: ah X04- - ROUGH ELECTP.T.CRL.'"
IEICAI'IONO li%IiMI ISR( WORKERS'
cr MPENSATION INSIA 305 FRAME
rfhis. cdnmWcnn ¢lent it t ddollar
ISI Wlrn lass h - H01.30E _DOWNS
I certify fact in the perfmmance of the weirk for which this p.it is isucd.I e307 — INSULATION
shelf no nhaploy nny noasaa in day atpma,to becametabjee la the Warkars' • —
Compensation Lawn m
of Caliral .De �08 SHEETROC♦;
c' ✓
NOTIAppliCE' 309- -- EXTERIOR LATH
NOTICE TO APT'LICANT.Ili after making thin Ccnificaa•of Exemption,you ehnuld - '
Qbecame sun aalmme warkarn campen,minn pmvixn,n,arthe Lab or Code;you 1011°' 310 — INTERIOR LATH
liithwhh comply wink such prnvisinnx or Was pvnnit shall he deemed evoked. -
rat CONSTRUCT ION LENIII NO AGENCY
311. — SCRATCH COAT
nhereny anirm mtn them is a eausba<tion lcnlnng egency far the performance 31 — ROOF NAIL i.a
at be work far,whichlhis Iienail i,issued(Sec.71M17,Cls.Ca
z Leader,Name
Leader's Name 501 FINAL ELECTRICAL ENERGY
-
UO Irarity lhalthat,ereadhis upplicalimnund,wlelhnnhchboucinmarrotinnis 502 — FINAL PLUMBING ENERGY '
came"
.Iagree nscomply with all city and county mdinmarcsand state laws testing 503 — FINAL MECHANICAL ENERGY
Q U
to moduang esnsauetwo,and hereby malorim re,ar.,mmoexonhis city mener upon
{>{� W the above.memi tell pmpely tar m,p«tion pmm�aea. - ,504 — FLRIA!_ BU.T.I_DIRIG ENERGY, '
L Ta'/1 liabilities, y .In c T' old 1prow,whch yin..nnyeyyac �npparllaid 505• — FINAL ELECTRICAL �` -
C.7 Z Ciq q antes fi g f fa 1
tr •APPLIC INDERSTAN A W'IL COMPLY•WI I'If ALLNI NPO 57.16 - Iif' FST. ��
soon 1 R 1 _ Issued by: — �% "' V' Date
Sirna uc on a Re-roofs
HAZARDOUS MA'liiklALS DISCLOSURE S��' — FINAL MECHANICAL„ '
Will lheapplanounarramrenaldia,occapantwarverbmdlehWLalnosluateial Type of Roof- .
usdefincdbythe Cupertino MunicipalCWq Couper 9.12,unJ the lleullh and Safey i09 — FINAL GARDE
CWC.Section 25512(x)? Ili A pp
°Ye, /�rvhI All roofs shat f4 inspetS_�p(/��r�or [fo"aly Mc dtt%mat{eerii`al being installed. '
Will the applicant or furor holding occupant um cyuipmem or devices which If a roof is in led wi fl Ytist AA In r an $.et On;'J agree to remove
emir humNoudair contaminants a,defined by the Bay Area Air Quality Maoagemem, _•�,
• District all new matetri411ts forr inklW&FApp unnW96' :Inds and will comply with
°Ye - all non-pointCQ ce-reptWft1S.BATTENS
1have rent thecry Code matcriuls 'aI. ...I under Chapel 695..r the 604. — ROOF IN—PROGRESS
Calirornittl hhh Sttfely CnJe,Sections255115,25593,! 125534.l understand l hal -
'illheZui l g ncsnat currently haven mnan6 louta is shy re,Imm" ay In nonlythe
mapa II rcyuiremenu which I I he met print to i.n.,umm a Ccni me of -Occup h Signature of Applicant Date
ow ag All roof coverings to.be Class"B" or better.
OFFICE