01010124 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: FERMI"f NO.
c'''Tc_74? R I'IE=UI.rIR .R
01.01.01.24
OWNER S NAMEl APPLICA'I"ION SUB DAI'li
IiR 1.1..71. ,1F11'1<:il•17.D f!1:1./.30/YP)L1:1.
PHONE: SANITARY NO. CON'I'Rol.No.
O ce 2 ARCHITEC IENGINCER: BUILDING PERMIT INFO
FOO BLDG F.LIiCI' I'LUMI3 MLCH
a
1 P SIID li nsed rude,'DEC.,arcIUN
5„� Lc.N c N Job Description
z=o I tt nby affirm J,' Ian licensed It under Provisions of Chapmr n Uonvneccow
m I-ty with Section]IXXB of Dmi,i ,lnl,he Bueinp,s anA 1'ndcccinm Gd•,unA bca„c
' ,,full (nocund ental
pGcln.. 1.'.r.a yj� (3_¢__-_ RDI�.T.TIf:1N (11,11) f2fIIC1Df:J._
O O Uace/” or
�� AHCIII'I'FCT'S DECI1ARA ON�-Sw "'� adv oJ_
�P � h..
ti us I understand my plans shall be used as public mcordl l y•j),^ �
Licensed Isndasiannl
y o a
OWNER-IIUILDIiR DECLARATION -
J_m I[nearby affirm Ilia,I an tact,from,he Con,ranor's laccase Inca for the
t_-z following,e:uam(Section 7031.5.Business and Isrofosion,Code:Any city or county
`F O which a - Ica t lo,orshomalle,inarreiderrolush.or repair.,., „n /
au printa t .1...at us the IN of ch pa a Msigned:un m,
'
thin he I,ho.watp :ear d ,,owikion,of the Conc.ha, . Law(Chapter 9 Sq. Ft. Floor Area Valuation
(counne acing w Sec n 7000)of DMW ,3 of the Bur' and i'ndesv'os Cady)
,,What he 1,camnp,tharel'min 1 1 the hnci,fnr the alleged csanpdan.Any violatlnn ,•_^f f„
of Secnou 7031.5 by any applicant to,,,permit object,the,,pliant ,,acivil penally
or mit tame than rive hundred dohnis($500) A PN Number Occupancy Type
0 1.us ownerofinmpeny.
e po y memployee%with wages us their sole cnmns
peadon. L"5 ''
"ZrA IJ
will do the work.and the uruaum is out intended or offered for de is,,,7044.
lhsinr„and PPfessiun,Crwc:'ITC Counanor'.s License U.doe,nut apply to an Required Inspections
„caner of property Who builds or improves thereon,and who dues such work himself
t through his own employ«..provided that such impmw<mces are not headed lir 1.01. — FOLNDATION
offered far side.If,howm'ea,the M,ilding or fair mvanen is.sold within one year of
ml lnian,theowner-hu;IJerwlllhavetheburdenofpnwiagthatlie(lidnotbuildor 1.CPf -•• faI1:1`6
ngnuvc In,purpose of salt.), 1.03 __ U i-M,
L asowner of,hc pSec.7lir,escluelvel: cnntrae,,l.w11b1lmnad en theist,
,manse,tap ties n tape.moan owdneo and ertd'cedmb asor [Ine ecstntaors lI%K1 I'i1i_IiRfi
and who
Law dors urn apply n,an owner with
a cora who bullas se pursue thereon,
and who commas for such project,with a p„nrnama)ba„wa pursuant m the 1.0a AI ICI IOFi L71_TS
w.
01 no pa's pipunde Sec
❑1 an,exempt anger sec. B xi r c for this maatiil flag — S'F-44=Fi & WR'I'Ek
Ow net nate 2W — L1,ft =RF'LOL7R F9_L1MLAING
WORKER'S COM PUNS AI'ION DECLARATION 2.0,3 ' L1,ff)1 T-L00R VE:C:I'iRhLCL;RL-
I hcrehy afdnn.ndcr,wnany of perjury one of,he EwoMir,dpduraJnn,,
204 -- 1.1151DE:fiF'LC)nFi f-'Fi(-I*11:=
a I have row will andialain I Catnap of Con—ii ,,,,ad.ln,ate for Worker. �f%y -' 1.11gIAfiTl'I_.fJf:U INSULATIONCmalmtcrlan, w provithd lot by S,,fl 3700 of,he Lahnt Our, flit the pen„rtn.mee ar m�work m,,(,'tali mm pemm s:cawed. 301 — RIJUGiH Pill-LIMING
01 hove and will muimain W key',Compensation Insurance,aw acquired by Section 302 '- TUB R OR SHOWER
370t)of the Irbur Code,for the wriom,ance of,he work(lir wfish,his permit is
cad. 1, wooer,Cam cams h„,a(�eepanerarta1•dl'xynay 3CT3 — RIDUCTH t EGMICRI.-
Contra. O ITI�cylea.: l(/OGd(O �IWf — FUMH L-'I._EC:TFICRI_ .
CC MEGA 1I IDN 2 r Ex CMITION I 9 MWURR1iR,
COMI'IiNSSFION INSURANCE; FFIRME
(Tic, eatia,mrd mit no on,,feted it the cannot ,f„r„tic launched dollar, 3K, .... 11,
I eerily that in,Ire perfornoracc of the work fn,which this penNr;,faced.I 3f%) -• IlslWLRTICn51
,hall a„,colic,say"on in,my,panne,ao e, it nerame subject to the Workma' 308 E HEIETTirC.)Cl/
Applicnsaion L,wz of Glrfnrnia.Une
Npp ICE 309 — EXTERIOR LATH
NOTICE hj AYI'LICAM1T:IL Curr perking his Certificate of E.aemptio Code,you.Would
hra,me.mbjccnnwINsuch po Comppnr tins provisl sha of thcconedcked, mutt 310 — .T.NTIS;IOR LATH
O O fouls,fit comply with.wen provision,or this permit shall be dccmnl makeJ.
Z —V] CONSIRUCIION LENDING AGENCV 3:1.1. -' S'CfiY-1TC.1-I (:SRT
aI nochy of oto that them in a comuuenon lending ugcncy Ila the perrnanunce 31..3 -' fkV)F 15187:1...
_ of thew„rklk,rxada,d,iwpermitix;,xmd(see,nlw.Gip.cl '501. F'1NRL_ E:IJL” RICAL E 11MGY
0 I.endn's Nauru
z IwMer,Address 5E. .F'7:151RI_. F'I_lJl*RUIG f:CTIFR133Y
U O 1 ceni( that I have read anis a lication and sone that the alms inl,,rmn;on is
ii Es limed.I agree to crnoply with all city and county omia Ince,and,tate law.relating S(%]w3 -- F7:15181_ I'IEC.Y-IRN7:Cf71_ ENCFUY
O m adding ,ruction.and heahv owhndu,represemm�ves aft,,;,city m enter upon C
,; meanowe.c.00npapmp<n f in,,coinnputs),e,. 04 — FIIJRI_. . JILDIN( 17ff_I�GY
F0. (We)agree a save,indicatory and keep hard the City of CupeNoo again., r_
W liabilities,judgmemn,costs and expenses which they in any way ruca a agaiast%aid wafOS — fF1h(I51fll._ CTRICRL
U 'z C con,,q. ¢-lir the grading of the permit 50G — G,AL, I )I /, V
'A ,.R. ON AN II.LC(��`))))))```1PI.YWITIIAI.I.NONN IN Issuedb _ ate /
.'t CI:1•:('11 ) .. / �V 7f - ..: ..
tgtmt�it Applicant mbacha ,�)ve Data Re-roofs 508 - F.IW.U_ 1•IEf 44,11TY-L..
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant ar fmure bmlde,gocco,cn,orcor handle ha.ard„ns manedal Type of Roof 509 — FINAL MADE
Its defined by the Cupemno Municipal Code.Chapter 9.12.and the Health and Safety _
cod,,.Sttdon 25532(x)7 J 0 — 1.-]:W-)L I .BNNING
O Ye, 0 N All roofs shall be insfi prior ro to g installed.
Wil the applicant or future buil ding accurate,a,,canipn,ent lir device,which 11'a roof is installed willig airs[ a t c(S gree to remove
ens na,atdaa,art coramma..isaw defined by he Hay Arca A;,peon,,Manageme"' d,will comply with
D;.,,ie,7 all new materials for ins ori, cal " a
OVcx ❑No all non-point source reguli(Pris:• fT. .F WITTUE,
I bare read he hamaddonv onaurnal,row;rnmlotx,ander Chapter 6.95 if the 604 -- FMOF :1:15F'-G'f2f:1(nIT1_TEES
Culuomla I Icanh A,Safety Codc Staniar,25,5115.25533 aul 25534.1 unde,,,m,d than
;I,hc building Joos not cumcally have,,,meat that it is my responsibility to utility the
at at of the haler ,s which matt be tact prior m rs,nence o,a Certificate of
Signature of Applicant Date
- to,Linn re sen, Dam All roof coverings to be Class "B” or"better
! OFFICE