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00090116 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PFRMI'INO. OWNllt'SNAMIIMINLK APPLICANON SIM DATE ONE NISSEN PE&SY H SANIIARY NO. CONTROL NO. BUILDING FERMIT INFO C ARCHITECT'/fiNGINGEH: BLDG ELECT PLUMB MECH a�u �I I_I 1=1 1a G¢? LICENSEDthata CONTHunder iiC ns of Chat Jot) Description I hcrchy ofhrm that I ata obelicensed under pro,ntP nle of GM1opmr 9 r dnnmencing �rmCw wlin5«lion 7000B of Div lxion3nf me business anti l'rnl�ssinns Ctvtq vnJ my liccme _ ar—� in in toll n,mayf�t�Lee'. >.,L3S �x6a Id<en,e cm1,s 5{��_ Lic.B�_ REMODEL BATHROOM AHCHITECu e DECConamLs I nnderhnuml my p1:,nh,nau he nt«I as ponroe reenret �} 3/ a p c Licenced hereby offial pre_ fIWNHR-ftU11AER DECLARATION 1 hcrchy u(TSect that I am exempt from the Cammmor's License Law liar the C?} which renu n.tendon 71131$B. der, nJ Pn,fc, ns Gnle:Attycityn lcoumy Sxp which 4 s ' P thio .t tder, p I link I Y.t-cmrcar O C= pr ort t Inn I stn poli, If r. eM1 pe iu IIbn J:f m.ncm 5'O that he teemed promen to the provisions ofthec nlI 's Lictarse La (Churver9 Sq. Ft. Floor Area Valua OIl (nimntencrag with Section 7VXy of Division 3 of the Business and Profession.CWc) or that ne In exempt thelehont and 111t basis for Inc alleged s,roonin I.Any violation of Section 7031.5 by city^m,lieam rural hcnnd alhjeuls the applicant 70:1 civil penally of not snore than lot hundred dollar.($500). 'APN NUmber Occupancy Type O I.:..owner of fhe property.nr my employee,with xagcn ax their sale com,en.mi m, will do the wvn'k,and the,Imclure In nm Intended or interest tar,sale(Sec,7144, �a _ Haim,,and Pmfc"ions Code.The Contractor',License Law docs ran upply It,an C Lllred Inspections owner of pmpeny Who builds or improves thereon.and who Joe,such work himself or through his own employees.provided that such improvemenu am not intended ar r indicted rat side.1f,bosses,the nundirs or in, semen,is sold within one rear of 101 — FOUNDATION nnplenI.Om owner-Wollner wdlI meh. filen of pn.ving mat ne did bol buildor — innmPIERS ❑I.as owner of the propcoy,am exclusively contracting with licensed contractors to 103 — UFER Lnaruct the paste,,1Sev.71,14.Business and Pemi:n,iom code:)The Couriwoa`n ]04 — REPR R ice e Low doe rat ep,ly it an owner^f Pmper1,woo build,nr imp,, 'n thereon. and Taco eomraens rat non,protect,wilt a anmmetoas)licensed nor m the 1.05 — ANCHOR DOLTS 01 ma License law. ❑lam eamttptuwer see. .R.@PC for this reason 106 — SEWER & WATER a""^r D'^` 202 — UNDERFLOOR PLUMPING WORKE'R'S COMPENSATION DECLARA'T'ION Ihereby amnnander penalty of[eriuryone ofthe following declaration 203 — UNDERFLOOR MECHANICAL I hnvo,nI] win muinlait u Cerhfiente of Consent m nell:ir,um mo Worker's 204 — UNDERFLOOR FRAME Ctal,...lion. us pro,idcd for by Set 3701 it ere I.,m Cost,. for the 205 — UNDERFLOOR INSULATION performance of the work for which this permit is issued. 301 — ROUGH PLUMPING ❑I have oust will lntthnaio Woke„Conipen,alion m,mume,a,lectured by Section 3700 or me Labor code for be pmdnnnuull of the won;ror wmml his permil is 302 — TUB 8• OR SHOWER issued.MyW'adv-C.nt1a1alion Insurance eanierond Polm,nmaderum; 303 — ROUGH MECHANICRL c refer CHRTIBICAI ION OF INIMPTION paOM WORKERS' 304 — ROUGH ELECTRICAL_ COMPliN56r1aN INSURANCE 305 — FRAME .,'his tenlon need of be amn,lemcl if the Permit is for o ,hundred do[]... 306 — HOEDOWNS o Da)or less) I ready mal in he rermnnuu,s of work ma whist Ill,permit'.,issued.1 307 — INSULATION smm not employ an>'psrsnn in an>'rrlangy{,=nLWbeung subject to me workers 308 — SHEETROCK enmrensafI -m imer, Dane��Z5— Na.ICE Ito ne Laslf. thinto110111.0cme of Hacntpfion•you,Would 309 —EXTERIOR LATH ncnnweh sonapin mew..It p,.vi,i isorthisK....itha.,fete lemorcodn.lou thus) 310 — INTERIOR LATH Q O Innhwilh�omply'with mch proviainns.,osis l,crmit,hall lac deemed revoked. . z _ 311 — SCRATCH COAT (~ Vj CONSem fin olu,ON LmIy.NGAGENCY — z > hk ny radon duo mere o eonu (See.moving agancr for he perrormo`'e 313 ROOF NAIL m the work lie which Ihix Inrmit is Issued)secs 3007.civ.Cd y o IsnJcr'sNamc 01 — FINAL ELECTRICRL ENERGY 7 z Lender's Address U O 1cw'illy lnatILive read this app,„olmound uuedull'bit above Into()a,imst 2 — FINAL PLUMPING ENERGY Ia. [— comm.I ogre,to comply with 701 shy bud county omuance,and site now1� 03 — FINAL MECHANICAL ENERGY O f, mWilding construction.and hems,anllimee mprcsentmives of this city it)c' W he above.7070tHonm pn,peny fur inspection pwtpo,en. 04 — FINAL BUILDING ENERGY EyL 1Welnyrec In save,lndemnityanl keep harndcs the City of Cupenit — rn h:dmilien,jlidgtontn,coal,a,m espnlnos wldeh may in any way accrue ng505 FINRL ELECTRICAL C,,inconsequnce of the grmeng ooh,Peron .. 506 — GRS 1-F_STAPPLICANT UNDERSTANDS AND WILL COMPLY WIT11 ALL IN N-PDate SOU n iG'. IONSNG S,rrammot AppGclm/Co- in D—.teRe-roofs UA' tDOUSMKIERIAISDISCLOSURE 508 — FINAL MECHANICAL_ Will the applicamor future tuildi.,t ,to,cm swam or handle hvafdnus material Type of Roof 509 — FINAL GRADE u,defined by the Cnry:nino Municipal Code.Chapter 9.13,and the Health and Safety Gala Seen355331b7 �FF48L ¢'hd?Md�4 • Cl Y,4 . ❑No All roofs shall he t`—ila ,ted n y an 1 )a real bei, installed. Will the applicant or future lmlWing occupant use equipment or device,which Ifa roof is install©U Mthfmt fir1M1ainRV1M-i •PcNflcklfklree to remove ,in hvallou.a air confuntinanta as defined byline Bay Area Air Qualify Management n,'lrimr all new materials for inspection. Applicant understands and will comply with 0 Yes 0N all non-point source regulations. . 1 have read the hamrdou,matenals requirement,under Chapter 6.95 of the Cu`ifomiu Heahh k Safety Cale.Se"ions 255(15.25533and 25531 I undenunJ fM1m it mo btwding des,no,enrenlly nave a term,mat it fa uty rwpou"hility w aofiry 0te upnnt of me"eminent,.1, . n.,l be uta Poor to is,om,c of a Cedlnnne 0 , "nof� Signature of Applicant Date ro-lntnorieed 0 1e All roof coverings to be Class .'B"or better