00100072 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDR2§0757 MC CLELLAN RD PATTERAKIS PETER A YS`AUVTMOKRATI@0100@7c
OWNER'S NAMI?, AI'I'LICAI'ION SU 1 DAI'n
PATTERAKIS PETER AND DI OKRATI 10/09/2000
Alef1(lh E: SANITARY NO. CONN ROL NO.
Q ee00 ARCHITECT/I:NGINEI?R: BUILDING PERCH I'INFO
BLDG .[-];.Cl I1MII MI!CII
W
z
Z,>" LICENSED CONTRACTOR'S DECLARATIOY
y Job Description
w 1lil 7T atlinn Iha I an,licensed liner provisions of Chapter uommeneing
apd,j winslltioneInn-ffect.i.3annennai�e.andrmre,.mn.ae.andn,yneen RE—PIPE
—_ i%in full force and effect.s i License Class Lic.tr
3 U
DartS contractor
Ian
ARCHITECT used
DECLARATION
I undcnlullJ my plane shell nc uwA n,public rec-Ns
enaat p O Liccnwd 1'mlceninnill
OWNER BUILDER DECLARATION
RATION
I hereby notion rant I am.resin film,Inc C sloe,Co I.iAn c law far he
pwhichingrcas-n.19enion]03L5.Bainesandoac.dronli Code.Any tiny-ncuuny
which require,a pennil no Constma,ober,improve,Jemoli,h.un rtPair any structure
i3� path finisowdpralxnreyuithernopirrosol the
Conpenmin mfileae Law(Caemem
— that hebhanwdpanmmn 7VX lrc&D,iaanl olc.Imnara LicenseI.Lnwor,Co r9 Sq. FL Floor Area Vallm``I t
w+nmen ingwort docel 701goarhe Inson 3o rate leged t,snod Prn Anysxcase) Sb000
or Shun hair exctnnt Ihcicl'mo,and the hasn Ire the alleged cxempJun Any vi-latinn
or Sccnion]11la by nay rIrIll ed dollars
lin'n yanil nnhjcas Inc applinun m u civil Penalty
nrnm dime att,n net III red aalwrstzsleu. APN Number Occupancy Typo
35916011 . V70
❑I.as owner of the and
the structure
ru tare I%net ee wine wares fe red for sale
(S en.aaion.
will rc me work.and the ode Th is net tog's J or offered for snot Isec. to an
,wsac,of and P.,Who b Code:The Connector's.and Law dam not work h to an Required Inspections
L
,rug pmpeny enonmld.onm[,nwpat such.rndwhodnesne no,intended
202 — UNDERFLOOR PLUMBING
,w
ere,for
his we however.t holding that such imnear t,m to are not ore year or
nfrclm ran.alt.u;however.ort Hooding.i,denof nen)i,wild he do]ane yearof 301 — ROUGH PLUMBING
�nnpla.i.,me,wColnnlrJ weebase meHordenofprntlnrmannadidmitmildn` 502 — FINAL PLUMPING ENERGY
,Ipmvc tar n,tmn,e nrwdc.).
❑I.a,nwncn of the pat=nn no,exCla,ilely contracting with hcen,ed contmelor,to 507 — FINAL PLUMBING
n the
tracts f(Sec.71144. ctsim 4th and contractors)
Cense The Cont to the
Licen a law does not appy'1-an w r of PmncnY who build,or in p t mere..
and who cammns for such projects wild a a,mmnorty licensed pursuant to the
or's Licence law.
111 a.
❑I am exem umJcr Sec. _.B R P C(-Ibis mann /
40, toPerosli...
wner_ 0 ��
WUIt K11K'S 1'IiNSAIION DI?CI.ARA'rioN
1 hereby affrnundry_
, Ile, naliy of rcij"ry anent the Winning drelamtian,1 O
1 have and will maintain a Cenificme of Consent In mlf-insure for WorAers
oas provided for by Section 37W of he Labor Code. for the
performance of the w 1,for wnich his panni,in issueJ.
❑1 have and will rionw o worker's C-ntren.wtlon Insurance,as rcquined In,Section '
3700 of the Libor Cndq or the perho nance of the work for MIXII Ihia pun nit is
hued.My WorACI',Cntore sora Irwtu"c'c c'arricr and Pulley n usher Ire ,
Currier. PohcY No.: -
CHRI IFICATION OP EXEN1111'ION FROM WORKERS'
COMPCNSATION INSURANCE
!Ibis section need not be mmpincd If he,penin is for one hundred dollars
(5100)-1 less.)
1 emir,dial In the'CLummuce at tire work or which this permit Is Issued.I
,hall not employ any Persor in.any tlmmn,,w,as to n«ntne enniect n,0e Workers'
C...nlx,nehtia I Law,nt Call t iv.Dare
Applicant
NOTICE TO APPLICANT:If,after maAiny phis Ccnilicam of Ennttpninn,You should
literate object m the W..l eh Compen,alinn prov waro of the"No Code.You muss
2 fonhxim eomply wits such provisions ne this permit shall be deemed rtvoded.
CONSTRUCTION LENDING AGENCY
a } I hereby affirm that there is a conduction action lending agency for the perlbmh.ce
III the w-d.hn which thir hermit ix LwmJ(See.3097.Cr,.CJ
Q Isndcr's Nz IC
Q z Lender's Address
V 1 certify thin I have read this applicninn and state that the aMxx infonuanion is
correct.1 agree no comply wink all city and county nNinanas and slate laws nelaing
Q V no building Construction.and hereby amhrrine apssentanives ofnhi.s city n,enter upon
} the above uncounted property for Inspection purpaus.
rp. OA)agree no save.indemnify and keep baroness the City of Cupenin-against
V) Boni link,,judgnmms,corn and cxperoen which Hwy In any way awente against wid //�
tJ City In CANTUNDit RmeNDSAoforisILCO �G /x/�
APPLICANT UNDERSTANDS ONANDS ANU WILT.COMPLY WITH ALLN(lN-POINT issued by: Date L�(/�1NL)_.
5 URCE R�EGU�LA�TIONSy/�� 1- Y'
Signature Sof Ap,tc rPLu raetm O✓�F'3 Ume Re-roofs
IIA%AHDOUS s: T H SDS DISCLOSURE
will the applicant to future bidding„eeupam store or hal hwaw+a matcaal Type of Roof
as defined by the Cupcnin-Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(a)^
0 Yes ONn All roofs shall be inspected prior to any roofing material being installed.
Will(lot ttrplocal or noun,baildognoCus no etlniplen,ordevlee,which If a roof is installed without first obtaining an inspection, I agree to remove
,,it haeaedous air n..;u firroas as defiled by the nay Area Air ORAN,MU..e'emmnt
otall new materials for inspection. Applicant understands and will comply with
,eto re, ON. all non-point source regulations.
I have read nlie haotdom maedols requimmenn under Charter 6,95 of me
Cnlifnmix Heullh a-Safety Code.Seed...25505.25533 and 25534.I understand than
if the building does not currently have a tenial.thuya is my resrymsihlliny to amity the
°occupant or the requirentenu which maw be Incl prior m ismunce of a Cenincmc of
""pa"` PP Signature of Applicant Date
Owner i<edLgan Date All roof coverings to be Class"B" or better
or auducOFFICE