00090011 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ONTRACTOR INFORMATION:
BUIty;NG ADDRESS: PERMIT NO.
I PC V eNt C� �u C.-1-10 V
OWNER'S NAME: Imo,` �` /I n/, C ^t ( APPLICAI'[ON SUB DAfIi
C�07 MYRTI El-100D DR
PHONE: I,d� 0 Ls C-( (v J-0 7 SANITAR1'N0. CONI'Hc11,N0.
II1l l„F' {{11 r� r .'
G ec'. , tCHIT[CI'II?NGINHHR: BUILDING]'hlt 89l
FOO BLDG ULIiCT I'LII.MB M[Cfl
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LICENSED COcensdCIder, O[CLd RATION
Job Description
F=ti7 1 hen8y nrtirm mat[.at licensed ander pervisinm of Chapter ,9 nd ni,li,c w,
Pi, w ith Sen inn 7txxp ofDivi,inn3ufmc Buviness and l'n,ru.vinnsCode.ural myliccn,c .
ate n
is in full Le"and cl'Ikd.
C ce2 Levine,Claw, I,ic.N
O�"u Dmc Contractor
3 e.y ARCHITECT"S DECLARATION
food r I yph 11 he fossil.,pbl N:
f r l . REMODEL_ /
i 6 p 0
Licensed d 1 fc'.
sr'
OWNER-BUILDER xr DECI ARAI I(1N /
W= a, by sell ,e 70 11 treat 0 C I' I I' rine
15110 6 [e tit ]Ill l S 11 J I iun Code A y an ' um e I^
sF wnmh rtquite.a permit ro comtrua,uhcr.improve,Jc n J'nh,or repo r mty atruamc y
.a3�
that
is,uunee.alto wrryuirc,me rpp)icam lot such pemnir to file a signed statement
at he i,licensedpeafl
a, Sq. Ft. Floor Area Valuation
(midmorning with Nation 701 of Division 3 of the Businc.,and professions Cade)
or ilia(he is exempt therefrom and the bands for the alleged exemption.Any violation
of Section 703 I..S by any applicant fora proton subjects the app)lcart n)a civil penalty
,it dm mometaalive hundred dollars($5q)). APN Number Occupancy Type
01.a,owner of rhe pntiv ny,or my employees with wages as their sole romper,"amt,
will do the work,and the structure is not intended or Nfured for sale(Sec.71Y14.
Business and thofe,%imss Cole:The Commaor',License Law does net apply to an Required Inspections
owner of property Who Wild,or improve,thereon,and who doe.such work himself
or through his own employees.provided that such improvements are not intended or 3691.7006. 00
offered lit,.aide.If,however the hmiding n,impmvcmmet 1,sold within one year or
Lm,plction,Ibe owmrhudder w111 h:rve the harden o1'proving the he did net build of
npmvc I'nr ampmc of rule.). .
E)T. m
I.a,..act of rapany,am exclusively contracting with licensed cmmn"r,to 1.01 — FOUNDATION
consumer the project(Sec.7044,Business and Pmfc,sians code:)The Comraeou's 1.02 — PIERS
License law due,,nm apply or an frame,of pmpenY who build,or improve,theme.
van who ummns en such projects.with a commctods)licensee pursuant to the 103 — UFER
Contractor',License law.
Cl l am exc,nln ander Sec. .E At a c lar this reason 1,04 — REBAR .
owner Da(r 105 — ANCHOR BOLTS
WORKERS COMPENSATION DECLARATION 106 — SEVIER & WATER
I hereby affirm under penalty of perjury one of the following decimations:
202 — UNDERFLOOR PLUMBING
race and will provided
a Cby Se ti of Con3700 (i m mLulioure lin Worker's
e
toprn,anan, n, pruvitlm-fur by secran 3nxl ser line Ianar coast. fur me 20.13 — UNDERFLOOR MECHANICAL_
oro,aneeaflhcwutk1111.1iehnJwperotitiaisa=`` 204 — UNDERFLOOR FRAME
0l hmetmJwill maineia Workers Conipenerion lr%rencpenrequiredhysection 205 — I.INDERFI_OOR INSULATION
37(:(1 of the Luton Code.far the perlonnance of the work far which this permit in
M,My Workers c/urm`rn.a/amnm.urancecarrier and Ponc,number am: 301 — ROUGH PLUMBING
erSr h_/'wrsl—policySm.: 302 — TUB (X• OR SHOWER
CEIC IFICATION(1F EXEMPTION PROM WORKERS'
COMPENSATION INSURANCE 303 .— ROUGH MECHANICAL
('I his veclin i need not be eoindeed ifthe permit is lin at hundred dollar., 304 — ROUGH F_I_ECTRICAL
IS I W)or len,.)
1 certify that in the performance of the work for which this permit i,i„seed.1 305 — FRAME
,hall not employ any person in any manner sa as to become subject to the Workmr, 306 — HOLDOWNS
Compensation Laws of Culd"I'da.Due
A,hcma 307 — -INSULATION
NGIICE'I'OAI'pLICAN'1:I!,;flier nekup this Cenilwar,a1 Exanryont,you should
become sobject inthe Warker,cu”tpenarrtonpmvisimn,onhelahorCrde.I'm am" 308 — SHEETROCK
Q O forthwith count),with ch trmmen,ser this permit,hall be deemed revoked
309 — EXTERIOR LATH
su
Z ^ CONSTRUCTION LENDING AGENCY '
I hent affirm that then i,a construction lending ugracy for the paffornence 310 — INTERIOR L ATH -
W
aide work for which this permit is is,ned(Sec.3097,Civ.C.) —
L a„',n,i;i<n, 311 SCRATCH COAT
z 313 — ROOF NAIL
U O I cited,dim I have read this updicu km and vee Into the above infornetion is
❑. F. 'mmO.I agree its comply with all city and county ordinances and state mw.miming 501 — FINAL ELECTRICAL ENERGY
O Id to building construction.and hereby iuthariunpm,cmmive,othis city it)came upon 502 — FINAL PLUMBING ENERGY
the alt d property for Inspection purpose,.
t},r a c)agree o save,indeamily and keep hmm)o.the City of Cupertino against —
tn 1 Ides.ening. rax.cats and r.l,ntne,which may m Imy way acerae rgain”,aid 503 FINAL MECHAN I CAI_ ENERGY
U "L AYPLIC,Its Ri"rIRthc granas this pcmnil.
once RSTANDS WILL COMPLY WITH LI ON OINT Issued by. 504 FINAL_ BLIII_DING F 4Fe RGY
URC'REGULATIONS. �� .
Sign pPhcur ant,,.,t Dare
Reroofs506 — GAS TEST
HA]ARDOUS MATERIALS DISCLOSURE
Will me applicant or fear.buildr,occusum,arm or handle lecamau,mmmim 'hype of Roof 507 — FINAL PLUMBING
as defined by doe Calvin....Murearlpal Code,Chuper 9,12,and the Health one Seery
Code.Seen 125532(a)l �1-)V �Of
❑Ye, 0 N All roofs shall �I,t�508pecteFlr ArAr 10 an] tb7o�flp{)g Tt5 L lul being installed.
Will the applicant or future nalldimg,ceup"nt",e ewipeart or deviees which Ifo roof lS insti111 Ap i d l 01 t IUbtt. IfigI 1'inspection. I agree to remove
emit harardous sur ronmminums as defined by the Bay Area Air Quality Mamaginem H 61x1pIEp1T^
Districrt,vita ❑No all new material5i• J(P inspLEt�i�d9)1p�fi v n1 W, AeiStands and will comply with
all non-point source regulations.
I h, the hamrduus ntemrirl,octal rcnen1,under Chapter fi 95 nt the
ctdifn nllaullh ' lidel,Code.
Su' 25585 m
,25513uo 125534.1 unJemndmu1
ire oildin, snotcu�nllylr use nrnt.the ifin my respnnxihil by to mnifyrhe
upa Lf r requiemems w hI ,t be mm prior h,issuanceMe n,of
cu
"` f' 03 Signature of Applicant Date
net aamudnedagen, / Dmc All roof coverings to be Class "13" or better