01030176 crry OF CUPERTINO
IWILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRUSS: PERM11NO.
OWNER'S NAME: APPLICATION Suit DATE a
r
T 07�/Pq/PV1V1I
DONE: SANITARY No. CONTROL NO.
Gte% ARCIIITEMIENGINFEW RIRLDING PERMIT'INFO
C O R D El
FCr PLUMB It
C�
mF z C J l=1 IJ lJ
0 o m 6 IJOINSED CONIRACIOR•S DECLARATION Job Descripti ❑
O l—O I hereby acorn,nim 1 baa uea,eed under p,o,l,;nnr of Cl,aplur 9 @n..ma:neing
FSC' withSacl inn 711G111 ofIts,..w..n rel the lAaainew um4l'mG•„lust Codc.Dud my license
. 'an rnau roreoamla '�t�
a � .:.a,aid> I -`/�rjr(/i�}1` I 2ND FLOOR BALCONY REPAIRS/RESIDENTIAL
w { �rClhail'f[CI"S IIEf.LAHAItf IN
u O I 1 rmderxund my pWn.a,hall he abed n.public record,
cO Licen,ad Prufc,donnl
OWNER-BUILDER DECLARATION
I hereby affirm that 1 an,exempt found the Contractor's License law for the
Inllowing reason.(Section 7191.5.0u,ioess and Profe„icon Cede:Any city or county
x?O %]rich requires a p,riii Io cunnus,alter,improve demolish,or repair any structure
de poor go its issuance,also requires the applicant for suchperninu file a signed statement
that he is licensed pursuing to the pow cines of the Contnxnr.license Ww(Chapter 9 Sy. Ft. Floor Area Valuation
(c..noanciog with Section 7000)of Division 3 of the Reiner and Professions Code)
or that he is caempt Ihcrcfrom and the wois for the alleged exemption.Any violation
of Section 7031.5 by any applicant Gtr a proof subjects the applicant a,a civil(marry
.1 ofnIs, ban fee hundred dollars($5W3. APN Number Occupancy^ype
❑L as owner of the property.or illy en,ployces with wages as their sole compensation.
will do the work•and the structure is not intended or offered for site(Sea.](N4. 362 1 200
Irvine red Poufe, s Code:The Contnenrs Llcenxe Law does con apply to an cywred Inspections
els a s;�,t
of property uroo�nnild,m in,prn a,mereont.and who dors such work hlnacu ,
...luongn m,own cntpinyeas.pa vided that such;ndprove nmte are sot branded or 101. - FOUNDATION
oR2red Int xa1c.It.I (ever,lie handing or;mpourendctn h,old w den one year of
nnlna;on.theowner.hodder will navc,bc wtrelen or po'no"halltedipt,�'n �E� 1.02 - PIERS
in we k 1 .' f, 1 1. 6
EJ La, It he p I sy i Ir dourulin, uho,,nwdL'ouralroll in
� Y 1.03 - UFER -
„s( t me project(v 7094lin 1_.- Code) rn e t 2001 104 - REBAR
License Law doer d q,,1y n an g tuner of property who hard,In mpnve. G
and woo nnnnas for,urn Pn,jm'n with.contramor<el licensed passant to he 1.05 - ANCHOR BOLTS
Cnnraaors Ideen,e law.
0 Icon eumpt under See. .11 M P C fat this uS ILDING 1.0E - SEWER & WATER
Owner Date202 - UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARATION
203 - UNDERFLOOR MECI'IRNICAL
41 I berehy affirm under,penally of perjury ane of me following declarations:
204 - UNDERFLOOR FRAME
1 have and will maintain f Cenificate of Consent m,c Ldhor for Work the
nanpcnw)nn. he provided m, by s«nen J7W of ma bonne code. for me 205 - UNDERFLOOR INSULATION
herfn..nanm nnna%,.,k for which this)ebbs i,lsu`e. 301. - ROUGH PLUMBING
have and will mrturinWorker,cotn nsatmnIn...ance,n,regwredbySection
30=' - TUB R OR SHOWER
r(01 01'the Later Code,for the perf oneduce of the work for duch this permit is t_
toned Mrr Wn��I{,ICInpart wear:ndeemn;crg,ndPnfiv,.,I abe,add: 303 - ROUGH MECHANICAL
CFpt a n-N0t : 1;MPNo __91nONIROM RKY.+ 304 - ROUGH ELEC"f P.ICAL
70
COMPuNSAOONINS URANCE 305 - FRAME
rIIlls etcinl Iheen.npleadit he to, Iisin,one handled douars 306 - HOLDOWNS '
(R 101)or Ida.)
(Bendy thin in the ped....of the work for which rens petm;i I,issued.1 - 307 - INSULATION
shall nm employ any pcnam in any nanner.n as(n beconc subject In he Worker: 309 - SHEETROCK
Conn,nenion Law,of Cahr...in Date
Applicant 309 - EXTERIOR LATH
NO11 ICE TO APPLICANIUL after...kin,his Cenifican,of Handpnnn•you shoal,
borne hithost to hre,s
me Wn.Icr%Compensan poon%of the l:raa Coda rna(rna 310 - INTERIOR (_ATH
0 fonhwifaoogdy with such provi,ion,or this permit shall be cleaned revoked. _
z—' y CONSTRUCTION LENDING AGENCY 311' - SCRATCH COAT
I hereby adirnthat there is a construction lending agency for the Perlormance 313 - ROOF NAIL
G Q .1 hevokfor wweb(hi<piisi...ed(See 3(YJ7.Ci,Q 5@1 - FINAL ELECTRICAL ENERGY
lender'%Namc
7 Lender's Address
U O Iccndy "Ile have read tn;sap,kraidoand>eirdre he abovemdonard„n is 502 —
FINAL PLUMBING ENERGY
w correct.I agree to coanply with all city and county ordinance,and nate law,refining
S03 - FINAL MECHANICAL ENERGY
O LJ to nuddiaay ca i,vucpon,and hereby nu(horire repuennniven ret its orty to enter tWo
y normo,c.naenaoiedoopenyFrnspetaorparpow 504 FINAL BUILDING ENERGY
(N) y' Its. d ry' dlive,1' I.'. deC'IY rC I 1 �ugtlr,
Z uabdl 16 l.e I air 1 1 third, ay' 'nyvvay r 6ht,asaid 505 - FINAL ELECTRICAL
V City an cornet awret(hu gunhng"Phis feell
APP
"NIR
) ILLCOMI'LV ITfIALLNONIVIMI' J 6'-'QGAS TEST
Sit •e I ION >=4�_ Issued by: Date
s of,y,pb-nt/ 46
mm�a,n, Date Re-roofs _
OA'/.ARDOUS MATERIALS DISCLOSURE
509 - FINAL MECHANICAL
Will tie at,Iicant or future building necapet store or handle hvankm,mncrial Type of Roof 509 - FINAL GRADE
nn defined by the Cnpcnino AfumaP CWC Chapter 9.12 and the llcAth and Safety
Cede.Sano,25533(0)! rte jhlf]� �s�pj.lh 7AIr;
0Yes All roofs shall be'I cted r l0 an b15YrYJ 111e7lerial being installed. -
Willtheapplicanto,future lw;Id;ngacupzntuse equipmentor&-viceswhich If a roof is instal ledlAthuut�l N%9JQIA6i4tspeL4f;9,Klggree to remove
emit lwnnlam:nr aonmminam,dor cfincJ by the ltay baa Air Vuxliry Maanapcnan,
;,:rich all new materials for inspection. Applicant understands and will comply with
❑Yc, KI No all non-point source regulations.
Ihave rend the leorrdnn.,materials requirement,under Chapter fa95 of he
Cahoon ia fleahli k Safety Code.Seel 1,25505.25533 and 25534.1 undersptud that
if the hwlding docs dol currently have it tenant.(hal It i,my,apu.nibility(o not il'y the
oI,”, of the anctun which anus net prior w mut a Ccnilia r,of
Oce gay.
soon
�-rZ.-.0 Signature of Applicant Date
naris,Mllion- rear Dale( All roof coverings to be Class `B” or better
OFFICE