00050173 CITYOFCUPERTINO
BUILDING DIVISION " PERMIT CONTRACTOR INFORMATION:
.BUILDING ADDRESS - f PERMIT NO. ,
OWNER'S NAME: CAPPLICATION S {
105361 MANZANITA C1/34 %d ��50173
PHONE: SANITARY NO. -CON �tD N'O
-THE ;OBRIENGROUP 05/241�br�0
y, nC Za ARCHI'JEC IENGINEF.R: - - -' BUILDING PERMIT INFO
ty 13LDG ELECT PLUMB MECH
'o zy 6i° LICENSED COKfRACfOR'S DECLARATION,
5 o I I y a II ren l I I o f s J tan rete mcr 9 g Job Description
p=t J with S f 700b) f 3 ffl ll c, dl yf I ylcIwa -
p�,zCZ, Lc man d fl L M {VN �meun e
x'3 u F Date D C o cl _ '. ..
Wt w'O 4 1 oulco and my plan shalilbe used r public ruards • - " 3050 LIVING SPACE, 536 GARAGE '-
w C O Licensed Professional
OWNER BUILDER DECLARATION I '
I hereby affirm that I am exempt front the Cnmtacwr's License Law for the
C a a rnllowing tenam.(Section 7031 s,❑uslnuss mal I...rwinns Cndc:Any city or ant sy
which 9to...a,mult
a 3
prawario itsabo requiresthe ppli t for suchproo ,to file a signed stionment .
that he is licensed parricam to the provisions ofth c rot- I License Low(Chapter 9 S Ft Floor Area -Valuation
Icnnnw�n6wlh Scco
tt 7o00)ol'D'vn,t3uf th ,v
alhnns and Pmfsio
s' rs Ce tot �•
fir mm he is exempt,hercrrom und the basis for me alleged exonplum Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant a civil penalty '
of not entire than five hundred dollars($500) APN Number Occugq F Type, -
❑1,as nw a work,
pm the structure
nnY employees"deat or
ns their r sale(Sec.7lon, '
$$ X100 f�D��tt••Jnr-
will ne the work,and the ode The is nal ctor"N or se La. for sale(Sec. to an - -
on,inaav and property Who ends:The Contractor",and w od dnas-not apply to an � Required Inspections
owner a]fh his own
Who employees.
or Imided t at such improved Antes are
work himsintended
of
or Through his own employee.provided that such improvements arc nor ime y.n or
,omda for sale.IL however,the building or improvinocal iswin sold within one Year of '
inmrove or roTo,c r-hu ller wlll trove the harden of proving lhw he JiA new hui J or
mprove rrtrpuHrs=of sales � 1.01 — FOUNDATION •- '
❑Lae owneror the property,am exclusively contracting with licensed contractsto 102 — PIERS - -
cnn,rcia he prnject(Sec.7044,Business and Piolcnxlous Cndc:)The Contractor's
License Law does not apply to an owner of property who bans of improves themtnt.' 103 — UFE R
aml.who contracts for such Ptnjccr.s vim u onoaaodsl IicensIl purstmnt m bei
• 104 REDAR -
01amasen,ptanJerSee. B&PCft�rndsran.o't 1.05 ANCHOR BOLTS
Owner Date
WORKER'SCOMPENSATION DECLARATION, - 1.06 ,— SEWER 8• WATER
1hereby afr under Penalty rran none (the following declarations 202 UNDERFLOOR PLUMBING `
. °,113 e and will t r f Cruise tel If o tore for wa k tis. 203 _ UNDERFLOOR MECHANICAL. ,
Cmco pensadnn, If, Provided far by set , 371x) of the Lehamr code. for the '204 UNDERFLOOR FRAME
unnance of the work ror which this permit is issual.
205 r UNDERFLOOR INSULATI061
°I life and will Code, Worker's 1 atmuce.of i Insu insf,m hick'd by Section , {
3700 to me Lunm code,lm m fnrrmannec Lir me wn,k.ry,which pen»it is . 301 ROUGH ' PLUMBING
more,NJ Ys Cmnpens meta War orv: •
Carrier: branCetT s`�UJWk1V.. 302 TUB & -OR SHOWER
TIFICADONOFEATIM FIONP ktWORKE '303 ROUGH MECHANICAL_ -
CO ENSATION 1 SU E
(This secs m teal be ,,,I tone pe drs formic red dollars 304 — ROUGH ELECTRICAL - -
Islaooness.j 305 — FRAME
I tardily that in the peffni umce of work Ra'which this perank is le.uw,I 306 — HOLDOWNS,
shall nm employ,any person in any t omi so us m become subject in life worked
Compensation Law,of Cihfomia.Date 307 '— INSULATION
Applicant
NOT ICE TOAPPLICAN'1:ILnRcrnakinl,this CerRncmcot Esonmai.ta,you xh....d 308 SHEETROCK
O Cbecome subject to the workers Condensation provisions of,be labor Cola you must .
fndmimcomply wimsnchproxi,innsortnispcmtnshall bcdecmedrevoked. 309 EXTERIOR LATH
COt them i,.ammmthan NG AGENCY r
31.0 — INTERIOR LATH ,
iz I hereby allich This There is a c..ad(Sec.
lending agency far Clic Mrfntmanee — COAT- .
5 ,
n17 he,min,, f:forlumenhis petmhisnsucd(sec.3897,em,c.) 311. SCRATCH' COAT• .
a z I-endor',Nome
Lend .ode : - 313 — ROOF..NATL t
U C 1
mlythllh mad thisapplication d rr tntm b.ro information ois
501 FINAL
INAL ELECTRICAL ENERGY
corml l g i Ir with 11 ,y wIl, 'r d.t l t It
, muapn 502 FINR_ .'P_IMBING ENERGY'-
r L the M ewe e)efimg er d Pon,.,for im,goinhinprpowe ' - FINAL MECHANICALENERGY
d ly and ke p h IheCJr r Cumm o against 503
A Iwnll , g t,s .:anl xl cswhichy nany'ay' against ' 504 — FINAL
i
BUILDING ENERGY
C.) z City or cr acluenceof the raffin,ca his parout. z
APPL UNDERST D ILL COMPLY WITH ALL Nt.
SOS- - FINAL ELECTRIC
sou c Ecr no Issued by %e• .
—
ssnRe-roofs
HAZARDOUS
MATERIALS — FINAL, PLUMBING
HAZARDOUS ATERIALS DISCLOSURE.
Will the a,plemo or future huddmg occapam sntrc m handle has m
a aGdomodm Type of Roof .' .
us Jclincd by the Cupertino Municipal Code,Chapter 9.12,and the Health and Salary 508 — FINAL MECHANICAL .
Code.Section 25532m)
°5es No - All roofs shall be tt��ih t�cted I��i}b}M196nyq p�� arQrial being installed.
Will dour it con , far.,,h ifined p unuet.Air ew li 1 teesewhich If H roof 15 inSt811e(111"IThOu[ilI'9[(7Dlai n1111g'$nI CDlfon, 1 agree to remove
smith b confirmation,o defineJbym Buy Ama Air Qu mdc fcage m
oiwra ' all new materials fm3.ihspectFdN9lpli�hf slttf�RRKc�will comply with
ores o all non-point source regulations. "
1 have read me hazardous mmetials rcquimntenrs under Chapter 6.95 of the
California Berlin&Safety C d Section, 5505 25533 and 255.14.1 ruderand tl t
if theh lel : t ilyl - en t dcIi(I oym,, 'Rltyttn t11,th .. ,.
occupam q ent-- h ah d be mel pn r t issu cc 1 C ficin f
cocaine. fy� Signature of Applicant Date
! W a
Ovv meed agent - ta -All roof coverings to be Class"Bss or better
1.