01030175CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRENS:
PERMITNO.
7964 MC CLELLAN RD 4
PSG NCING INC
01030175
OWNER'S NAME:
APPLICATION SUR DATE
T
03/29/2001.
HONE:
SANITARY NO. CONTROd. No
AKCIII'I EC fiNGINEER.
BUILDING PERMIT IN170
III.D(1 111.ECI'- .PLUNK MUCH
IJ 1=1 I= [-1
LICENSED CONTRACIOR'S DI; IARAT]ON
Job Description
I hereby affirm that I an: licensed under provision. ter Chapter 9 acommclial
with Section 70011), vision 3 of the Busire, and l y mry1s rL.anJ my yrem,
in lull force and cffcap_ 7�(� (/—
uamwic•Igs Lie.r x7o —
2ND FLOOR BALCONY REPRIRS
Date .L/�� � AR cnmmcnn t7//
ARCHI rIiCI"S DEGI.ARAr1O
1 undcmmad my plant shall w used a public records
Licenvd Professional
OWNER-BUILDER D17CLARAr1UN
1 hereby affirm that 1 am exempt Jinni the Contractor's License Law for file
'
allowing rcawn (Section 711315, If and Profm,ious Code: Any day or county
which regnum, a par ail m snnsfm,% aher Improve, dcmnli.h, or o pair any .varum
Prior In t 6o rop ... esdul,pp1' f lor suchpermit Io file a signed sidearcal
that lie is licenwilpolcurn to the portloor, ofin c rral Limr,c Lev, lchapre9
Sq. Ft. Floor Area
Valuation
hoonnenemy wits section 7000) of Divi.,..3 of she hoine, and Pro o,s a ps Codec
of men he is exempt theocrat and the basis IF rhe alleged cxnmptinm. Any violation
of section 7031.5 by any applicant the a permit cobbles the applicant to a civil penally
APN Number
Occupancy Type
of not mom than five hundred dollars (s500n.
01, mowro,ofine pmper tin my employees with waal their wile compensation.
IALA
362121401
Required Inspections
will do the work, and the saanum is not intended or ortcrcd for sale (Sec. 7(W.
Rosins and Porfessions CNet The Comracmr's Liver. Law Lines not appy' , of
r of property Who build, or improves thereon, and who Aces such work himself
r through his own employees. provided that such impromanal am not intended or
liw
101 .—
FOUNDATION
offered for .sale. 11: howeverthe budding or improvement is sold within one year of
the own,obuimer will have the harden of proving that be did nnf build or
1.02 —
PIERS
imipletion,
mps a for pamow of sale).
103 —
LIFER
01, as owner m the pfopemy, ion eselmindy cLnnaefiu, with licensed comraoorsm
ems
n,hvcl fine project (Sec 7044, Rax Imd'Profex . CNca The Con mems.
buiice meson.
1.04 —
REBR R
Landoh Law dare I( ,such mon owner of pmperay who lir hop
soil who .,mets roti sad, unjemn wide u unnnpmngsl licensed 121IW ':
�Y
LED 105 —
ANCHOR BOLTS
❑lens «empr wade sec .n&rcroti this reason
01 an,r L trade See
106 —
SEWER & WATER
Owner Dare_
MAY
0 2001 202 —
UNDERFLOOR PLUMBING
WORKERS COMPE'NSAnDICLARATION
203 —
UNDERFLOOR MECHANICAL
I thereby animp under penally of perj,y one 'if he follow;ng deelamoinna:
204 —
UNDERFLOOR FRAME
0 1 have and will maintain a Certificate of Content to self-inxnre for I
Cninpmp.afion, for by Section 3700 of me Labor Cale I e
DING 205 —
UNDERFLOOR INSULATION
as provided
p'dmtmtm'e of thc work for which mi, pennif is issued.
301 —
ROUGH PLUMB I NG
X.1little mai will nwlntain Wodei,Com,houninI In,rune, ns rcqulmJ by Section
302 —
TUB R OR SHOWER
Ilfl of she 1,1s r Core, for the perfnmranee of file work for which fills per it is
i,xnedMy'Wlor/k/--,chapennyMInIan.sanm,,;,,,0;aiidrYnucyyhamherGarrt.
tl �—/0'�
303 —
ROUGH MECHANICAL
Carrier. V _�'Cnwllcr Nn.: /sag_ �
304 —
ROUGH ELECTRICAL
K
I;HrI A'nON OpIi%IiMI'rIQN 1M WORKERS'
COMPENSATION INSURANCE
305 —
FRAME
('Use, section need not be mnrplened if the peri, is fill one handled dollars
306 —
HOLDOWNS
(S IOIU lir Tc.s.)
307 —
INSULATION
1 tend, that in ,he pedormam'e of he work for whim this perms is owed. 1
shall nor employ any person in any ,saner .n as to wenn subject to the Worker:
308 —
SHEETROCK
Cofnpematiom Laws of Canfnmia. nate
Applicant
309 —
31.0 —
EXTERIOR LATH -
INTERIOR LATH
NDIICE TO APPLICANT: IL after making this Ccnifcam of Exemption. you should
becnn.emdymmthe Worker',CmI.p.nsat...Isionsorin, Label Cmle, you n10st
Ibrfhw lm mm ply with such pm Noss or in, per nit 11,111 w deenvd revoked.
3].1'—
SCRATCH COAT
CONSlem is ,lonl LIiNU1 N(i AGIiNCY
1 wmny alhilllp that dorm i,s nm leafing agcncr rat me perb,rmlpncn
313 —
-
ROOF NAIL
d (Sol.p
,if the wink Jim which this pomdt is isnuuA (Sec. 31X1]. Clv. C.1
501 —
FINRL ELECTRICRL ENERGY-
I w�ndcr'v Namc
UndusAddress
502 —
FINAL PLUMBING ENERGY
1 hardly that I have read this application and store that the above information is
rows
503 —
FINAL MECHANICAL ENERGY
correct. I agree it, cmody with all try and century onlinansxs sad ,am relining
m building comamcdon. Lead hereby aumnnie representatives of this city as enter upon
-Inspection
504 —
FINAL BUILDING ENERGY
the aluveptantioned property for purposes.
(We) +gme to save indernnify:,ad keep families, the City of Cursminn agaia.r
505 —
FINAL ELECTRICAL
liabilities, judgment, costs and expenses which may in any way aecmo agalnm said
City in a nwquche of the granting nl this permit./
'RSTANDS`�r�.aEy)WILL COMPLY Woo LNON-PoIM
-
GAS TEST �K
Date _y
ADPL ANTU
Sot- I RP' ION ✓2�
/
Issued by:
1,07 =:F=RilRI= PLUPt NA
y
iQum of App ma onbaeor Date
Re-roofs 508 —
FINAL MECHANICAL
MAt17R I ALS DI SCIDS U K Ii
Will the ::p cant or I hum bail ding occnp:w her „t final hafardous mmcri:d
Type of Roof 509
FINAL GRADE
n delined by file Cupertino Municipal Gait, Chapter 9.12, and the Health and Srety
Cede. Section 25532(a1? ��
0)'e^ 'F,"n
IT
All shall be tettp'ectedi0f
T 1�I I s
103n}Fr6tlYfliIh�i��F�((,}��Ib�,¢g g installed.
devices
roots
is installer Without
ftr;*6ni�nYMt4 fPcckSHIS�T�ree to remove
Will file applicant or future wilding occurcmr use equipment or which
emit hazardous air conmmmant as defillod by the Bay Area Air Quality Management
Disfdcl'f
If a roof
all new materials for inspection. Applicant understands and will comply with
O Yes "o
all non-point source regulations.
rials mquirecunder Chapter 6.95 of the
1 havo read the hvardnm nm¢mros
Cullfarnio I Icahn & Safety Cede, Serious 25505, 25533 and 25534 1 trader smnd thin
if IIIc wilding does not currently have a Imus, that it is my responsibility to nrnily the
�� I thJe jyuir-ments which moa w met prim missuance of a Canifleme o1'
°`wp.�p`K'✓—�—.�/
Signature of Applicant
Date
-� I
All tool'
coverings to be Class "B” or better
Ill„sir. .fgcnt Dam
OFFICE