00100157 CITY OF CUPERTINO
nuu.ornc nrvtsu'" PER CONTRACTOR INFORMATION:
BUILDING ADDIiUSS: I'IiRh i r bf).
Y OR BIRGITTE ISHAK 00100157
VNF.R'S NAhIU: APPLICATION SUB DATE
10/24/2000
(INE': SAMY OR — SANITARY NO. CONTROL NO.
O iaY ARCH]'1'ECl'/LNGINIiER: BUILDING PERMIT INFO
O O BI.DG L ACT PLUMB MUCH
w—
auG
Cis
. 5 I.ICENseD CONTBACTGIcs Dlac r,of Clued Job Description
0 y v,C I herons ulfinu,het 1 umttns
Iic0 mPro
ater vision.of hapler0[eammvmmmg -
f,h1-w with Swom7flabof Doision3ol the Business and Profesions Code.and my license
a m^ is in full force and ellem
s a I.icc ,eclat I.it.# BATH REMODEL
X 3 a y Duron. • ed as purr
ARClll'I'IiCT'S ULCLARATION
C=0 4 1 unJcn,nnJ my plana shall he used as public rcnnJ,
E�y^
u K p O
Licensed professional
c.3: OWNER-BUILDER DCC�RATION
I bees.,attmot,nal I on exempt from she Cuni...i, o License Law for the 1
Smuue;ny reason.IScdion 703 L5,Itu,inm,vest I'nt!iu.0 Code:any city or umone Q
F O which declaimsworth, Wn h 1 d I.h p Y , w
r=
aC c pnun I I. rty ,Mapplicant f hpc a fl .6 J ,,them
tet mineslicensedpursuant r ,n p of me Contractor:L . I (Chapter Sq. FL Floor Area ( Valuation
oconnuminci ng with Section 7NXB of Division I of the B,u ne s and Pr fieW n%Cade)
or than he i.die to themrro.n and be nasi.Iter the aheged c,colpli Any colmimt $2000ofgenion 7031.5 by any apprean,for a pernin object the applicant h,a ,,it eally -
of sol more than five hundred dollars(S501). A PN Number Occupancy Type
1.n
y 11 do he owner it
he or mrcmpbycevwho wit, s as ollro,v rmisale(Sens7B44. _ _ _
o •will do,he ward,and the ohl Ire ix not lureis Li en e Law for sale(Sec. to do
Ba.h,esa ane en,Whons ill-,Inc c,eshereon.and.m Law does hworklhi fn am Required Inspections
w r of propsow Wh,Hudd,err improves atsuchand whodoessuch t int himself
or for
his awn employees,t banding or,such vement mcnm are not intended or lot — FOUNDATION
offered for sale.If.however.Inc H rose T or improvement n xaM within one ycm of
mn....et,the owner-naddr,wiu.m,ve me burden orprod+tg n,a,he did mit nnild n= 1.02 — F'TEP.S
n:pmvc for purpose of senna
0Las nwmmothe pmpeny.am«asa.elycommeins.mnlicensed rmnossra,n 103 — UFER
Linstruct the project(see.7044.Bminds,and Professions Code:)Toe Contractor's 1 04 — P,EBA P,
icense Law lows not apply to and owner of pups,whit builds or improves thereon,
T who "ItIM1.. 1„r saes prnc
,ien,with a aomrnmo Llicensed par nam tf the 105 — ANCHOR BOLTS
Cnnvacfnrs Leena Low.
❑tat,, Inmdc BMPCfor this reado 106 — SENER 8 WATERwner—Dene l0'21�� 00 202 — UNDERFLOOR PLUMBING
l)MPENSAI'ION DFCLARAl'ION
203 —' UNDERFI_OOP. MIECI-IRN.TCAI_
I hereby amrm ands,penes or perjury one of the following dedamjore. 204 — UNDERFLOOR FRAME
3 I have and will maintain n Certificate of Consent m sell-i....d f Wmrker X05 — UNDERFLOOR INSUI_ATiOhI
Cmnpensxtion, err provided for by section 3700 of the Labor Calc, for the G
pc,6...a err Ise work for which Ili,permit is 111-d. 301 — ROUGH PLUMBING
Cl I nave and will maintain worker's enmpen.aaon Im,umme,.as rdpiu and by I s«d '— �
3700 of the lbor Code,for the performanmol
ce of,he work for which this p ;ion 30` TUB 8 0 P. SHOWER
s
issued hly Workers Compennaimn Insurance varier and Policy number arc: 303 — ROUGH MECHANICAL
Carrier: Pones No.: 304 — ROI-1611 ELECTRICAL
CERTIFICATION Up aRBMPTION FROM WORKERS'
COMITNSATION INSURANCE 305 — FRAME .
(nis.secam�,
onneedmcompper
letedifthenitisforinehundreddollars 306 — HOl_DOWNS
' (5lnm or le.r.l
I verify that in be perionnined or he work for which his perms i.issued,1 307 — INSULATION
shall not employ any Fcrsun in any manner au as to hectnne subjen to Workers' 308 — SHEETROCK
Cor,tpcnsation Luwn of C:,IIfomin.Dam
A,,I.,;” no,dd 309 — EXTERIOR LATH
NOIICL'10 APPLICANT:If,. ter making his Certificate or Lsempdon.son,
ecomerobject.omeWorkesCompcnsamrnproei,innsofhel.alsoCome,you must 310 — INTER.TOR LATH
o Q forthwith comply with such provisions o..his permit shall he deemed revoked.
Z 311 — SCRATCH COAT
Vi CONSIRUCHONLICNDINGAGLNCY
C 'y' I hereby mho,.hat throe is;t.......memo lending agemy for he performance 31.3 — ROOF NAIL
of he work for which,his pnn,it is issued(See.3d)7,Civ.C.1
i p Under.No. 501 — FINAL ELECTRICAL ENERGY
Isnder's Address
0 502 — FTNAL PLUMBING ENERGY
I' ,lyn flbu i Irl pal ':n 1 rf nlmll h f urian L.
w F.. <mre, 1 g ,.,,Iv 'd n cry ,d ,y r Hasanneldwe F cafng 503 — FINAL pIECHRNICRL ENERGY
��� —
oU in building i ,'onand leerr hr p mre.rnn city to enter upon 504 — FINAL BUILDING EIsIEP.GYE:'�
} O, the aM t I gree do save.
f inspection purposes.harmless
ti0. ( .jm1flndoll, vc.indemnify and keep hihxr dydo theCityway a,r.e,vm,asmast
id —
fin Eandhies.indg,nems,co„s and eape.nse.whim.,,ay m any way acetas:,g:dnsf said 505 FINAL ELECTRICAL
U Z eity'm coo. aoma none gr:ani g onhm pemhi,.
AI'I'LIC 7 INDBR.' ND WILL COMPLYWITHALLNON-I' INT 506 — GAS TEST ��l7i/�d
souxcr. B.AT s. � - Issued by: Date/47
"granteol'A sd 1nRIALSUISCLOSURIi la Re-roofs 508 — FT.NAL MECHANICAL
Will he.,pphcani or more baildingocet,m store or handle hooddos.mnerial Type of Roof 509 — FINAL GRADE
as defined by the Cu,mun,Municipal Ce.Chapter 9.12,and the heath and Safety
3_
Crde,seclian2S5w17 Cold. 91.0 — FINAI PI_Abila ING
oyes / bo All roofs shall e i s ecce [�(r fo�k!�Y�'1 o n I t is bein r installed.
Will he nppfnam ormlT.,a,nheup nen.pam me nl.dnmen,or device.shish If roof is ill aTl�dl'wliho t lYFPlabtat'ih�R� fins �l Iagree to remove
mit Inml air ammminanr.as defined by,be Bar Arco Air Quuli,y Management
na,rin7 all new materials forinspection. Applicant understands and will comply with
GYes KN. all non-point source regulations.
1 I'd',real nhc h t'jul .coned:ds u,"ormnntf......”Chnpnn 1.95 of hes
Cadfamin Hcahh k Safav Cndu.Sections^_5515,25533 and 25534.1 unJcemnd that
if the building docs not cuvendv have a tenant,that i,is my res,tomibili,y to notify the
occupant of he mquirenams which must be met prior to issuance of a Ceni ficmo of
Oecapanc
I� Signature of Applicant Dale
All roof coverings to be Class "B" or better
OFFICE