01040140CITY OF CUPERTINO
CONTRACTOR INFORMATION:
RUILDING DIVISION PERMIT
31-JILDING ADDRESS:
PERMIT NO
20298 NW SO
01040140
OWNER'S NAME:
APPLICA'T'ION SUIT DATE.
04/25/2001,
PHONE.
SANITARY NO. CON TROLNO.
ARCHnrcL7&NGINEER:
BUILDINGPERMIT INTO
•
HLOG ELECT PLUM M111iC11
L I _
LICENSED CONTRACT( WS IIECLARAIION
Job Description
1 hemby, anion Inas 1 am 1wea ed under pm....mrs f Chapter 9 m, acing
with semina 7000)nypi inn Jnf theHuincsv Pyj sy��j livens
umrn`°�ci ".°°479` r k Det/ J
KITCHEN
REMODEL AND PANEL
Dale='7��=T�o�_ Couranr.ARUIIIIECI"SDECLAR
t1obi
endmy plan, shall he u,ed a, public reenncA
6ELECRICAL
Liansel Fit uional
OWNER-RUILDER DECLARATION
1 hereby aSv,l ten, 11. exen'pt Rein the Gonion, rix Law for ,he
Any
mn, mal n i c
Cw,, Any city or coat re
9t1.t.r
follwhich a, rcn,on. ISnoul
I. t,"Itainm
which rnp'Irrs a I,crmit to umnuvc,, ul'cr, ingnovc, dcnu,linh, nr rcpvir any ammturc
d. al
/
insissuance,aha hyo inlfireachpa'nnilmlite..signednwwnmm
Sy. Ft. Floor Area
Valuation
thethe .,na
mat.ei,d.,wJwcedon7mI)ofDiran.a3.1thetacmr,.l.irr
dialre
ad Profe,Icnapter9
(c Seminaananof Division3of theleg id Cede)
is
ewith
exemption. vi
or that Ihcrt,rom and ,or burn for the exemption. Any violation
7
2 0000
for a Permit snbj,et. the applicant n, v civil pennhy
of neriine 31.5 b ct%the
io by any ilmd
APN Number
Occupancy 'type
dell
nrna, m'or'e t,Im,r„numlred nnnar, ($$nm.
a lain
❑1.a r of the proprrty,o my employee with wage., as their sol, coalearoahon.
�the`work.
Required Inspections
will do and the .trucaum is nm intended or offered far ,ale (Sec. 7044.
Fast., and I'muessin., Code: The Contractor', Liana low does not apply to an
owner of property Who buids or Improves thereon, and who does such work himself
or'hlnuxh his own employees. iced that .such improvements are not attended or
101 —
FOUNDATION
thio ne yea, of
otre,ed an, v:de. It. how'eve4 the huilding n, i...pn vo nmol in ,old iso
epletioa. the ownet-baEner will have ma burden or proving Trial rte aid not build tar
102 —
PIERS
,,up m c. bar poq,na of xulc.l.
103 —
UFER
Cmmet,o
❑1.asowner ofthe property.am Businlssad Promnxwithr That mr,
Armee.. Ctde9 The
1.04 —
P.EBAR
Liceas et the awi m apply 7044. and property whio ht improves he
I.imnaLaw,co docs nm amply m vn owner of it contr who hn11CUild� o, improv„ Ihas he
and who rnmmen, tor ante prniadn win, n .nmmrtm(,) rennwa pnnaa'h' la Ih,
105 —
ANCHOR BOLTS -
CIImneamplonda see'. •.Be:PCfor this reason
1.06 —
SEWER & WATER
202 —
UNDERFLOOR PLUMBING
0, net Date
WORKER'S COM"ENsvION DECLARATION
203 -
UNDERFLOOR MECHANICAL
Ih ash, alarm anna,prm,ly of p,rlwy or,e of r,unw ing dr, lanai...
204 —
UNDERFLOOR FRAME
❑ 1 nave and will maintain .a Certificate rel Cnocnl to sell-in um for Worker's
205 —
UNDERFLOOR INSULATION
Compensation, m provided fur by Section 37110 of the Labor Code, lir the
peAommncc oflh —al, erwhich this permi, is issued.
301 —
ROUGH PLUMBING
❑ I have and will niaimadn Workers Conalre sa ton bsurame a arpr'red by Sodi'm
- . 302 —
TUB & OR SHOWER
3700 o! Ih, Labor Coale, rnr the putbnnana of the wore lot which 'his pcmal is
I,sam.M, nil ,C.... 'nnmsummeeanln in)L<yl, n, 0� —
C��
A 303 —
ROUGH MECHANICAL
rimer: I�� "n'i=y” `
304 —
ROUGH ELECTRICAL
CERTIFICATION (IF FXEMITI( FROM WORKERS'
com"ENsnnoNINSURANCE
305 —
FRAME
cod,ser.... need ,at h,rmaldeledit Icsweat is fin nhnn• Sam trd dopa,
306 —
HOI_DOWNS
($100) nil less.)
307 —
INSULATION
I certify that in the performance of the work for which this pcomit is issued. 1
,ball on, nnpby aa, per,nn in any amoner.n a, In became w river m the Warken
308 —
SHEET ROCK
Comfe.o.niom Law, of C:aN,mia. Date
Al,kara
309 —
EXTERIOR LATH
Nuricif 10 APPLICANT': II; alta nmklnx This Camli"'w of 1!aemption, you should
Workc''s it, Labor Code
310 —
INTERIOR LATH
berm.. subject In the Cnmpansmion frovskinnnul ynunnM
forthwith comply with .such provisions or this permit shuts he deemwl revoked.
311 —
SCRATCH COAT
Chin herein ado L,fion cr AGENCY'
lending agency for nm p,rrnrman,e
1 n,mby afr'nn this thea ass limned
313 —
- ROOF NAIL
(See
deC,hNi wmenthis pemniti rete Ilsu,,3n97.cm.c.)
501. —
FINAL ELECTRICAL ENERGY
Leaders Address
502 —
FINAL PLUMBING ENERGY
I ecnlfy that l have mad this application and state that he above inrammron is
503 —
FINAL MECHANICAL ENERGY
correct. 1 agree ,o comply with all city and county ordinance and slate laws relating
mildmit cnnaracti r, and hemby authoriec reptewn,advicear this city In caner apse
504 —
FINAL BUILDING ENERGY
the unnva.mcmnan,J Foo,ny lir in recluou pnrponen.
(Niel ague Io,:or. iadenInify and seal, h:hmnlesn the C I I y or CupertiIit ngai no
liabilities. iudgm ,. liner, aad es este which may in any way aeeme agaiaal ,aid
at thege I. flhi,perand.
505 —
FINAL ELECTRICAL
, C9
que
506 —
GAS TEST I�
Nl'U ERSTA SAND WILLCUMP.Y WITHALLNON-POINT
Issuedb y'
ate
R[GU ATIDNs.
*W11
—
Re-roofs 508 —
508
_
FINAL hIECHRh1ICRl_
all,of"Ii=ams nus 1yLle
'IiRIALS
IIA IOUS MAI DISCLOSURE
,Lc applicant or more building ncupvn, oto¢ or handle havmdoas'iturra1
Type of Roof 509 —
FINAL GRADE
as defined by the Cupertino Municipal Code. Chalde, 9.12, and ,he Hcdlh uad Safety
Cade. St mitre 255321.1!
54.0
I
FI AL PLANNING
❑Ye, ❑No,
All roofs shall be i��FF;;ej I
r�1 ftp r,Q(r ejr installed.
will be appfim,"or came bar dar,o,emaul use erltdpaanl ret dc,ic„ whirb
Ifaroof is installed`ZvS tltou[PIF�c
ACiPARSn.�CeIY�OVa ee to remove
coil Imnrdnus air coney irmas as defined by the Bay Ave. Air Quality Management
District?
all new materials for inspection.
Applicant understands and will comply with
0Yes 0N
all non-point source regulations.
I have read the hairtal materials reyuimmcm, under Chapter 6.95 of the
Cldirnnia Ileal A' Safety Code, Srclinns255115, 25533 and 25534. 1 unde'xtuM,hat
' hUlldingc nal carom ly last,, c'n'nr flea it k ni, re n ponsi hitly Ina Aify the
u 1 rel Ia, , Iai'cns' n when ,nuns be mors prim or issuance rela Gnl,irne o[
`r Toney' Y
Signature of Applicant
Date
All roof coverings to be Class "B" or better
bate _
aamni.=t
OFFICE