00090173 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDR&S51�: 47^ D 0
VFRMI'I'NO, ,T,T
10332 NORWICH 0009017373
OWNER'S NAME. APPLI IV
KAMORAMICANDATLI ICATION M`1��1/c7/2000
4 PHONE: SANITARY NO. CONI Rol.NO.
O z>. ARCHIt'IiC'7ENGINEER: BUILDING 1'ERMI'IINFO
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hICPNSIiU COh'TNACfOR'S DECLARATION
O 4 O 1 hereby and, ,M1m into licensed under Fmvisums of Chnp¢r 4(commencing
�Fa wanSmtor7annoiOmiamiinnnvllnSinn»nndPrnr..lnenne.nndn,yliren.e 1500 SG.. FT. REMODEL 691 NEW/ADDTN SW
a,Y^J is in lull lore[and[treat. )
z
a:,., Lice,w Class -
ii O Dum Cuntmaer
5 a NARCIII'I'ECI"S DECLARATION
01 1 undammrd my,lans.hnll he used as Fuhlic records
ip o Lianad I'n,lcsniunal /
OWNERtIIUrtion front
nt the
Contractor's
S
I hereby notion o that 1 1. canine frnn,the cesions Cel
Any c latw for thefullo
FZ� whichrquing tsnn.(ScetionColusl,Busina000nnar.d and Professions Carr:AnY city orcounty
addr❑ which or as ,asaIr.also a,connlrun,,Iter,improve,denadis b,ores ssirany talstmaurc
e3� that heslcense caabnresryircs,hcup..).,ouen the Carl penmanlian.Tnit,(Chcmcm
thateaoneing.sedpnzctiono00)orOivkin 3 o Celmrachrs Liamm L,w(Cbap101Y Sy. FL Flour Area Val ti
anmmend,g co, Section urn and
s.hall'
3 of the evade.,sena ion,Anb,n.ender ��.1°®282
or 16th to is 31.5 b tha,clmn a,J the brats it object,
ct, he
ppli"oion.Any vinlution
of Sraal 7181 S by mty dreg doll tin a pcanit enhjmn the applicunl h„civil penalty
of nm marc man bre M1,nared throb tsswl. A PN Number Occupancy Type
❑I,as witue,ntlh,atTr ly,or a,y aaplo,,a,,with waea.,as mair.nla aanpe'n,aium 31629094. 00
will do tire wink.and the I,u,,mr is nn intandcl o,libelee tear snie(Sac 9044.
business and Professions O,dr.The Cmmn,clor'a License law does not apply m an Re Ulred Insppection,
o,IM1rof bruised,Who builds or impmva,heaven.and who dues Saab work himself 101 - FOUNDATION
nntgh his own cntployaas.pmvided Mar such inq,rn.emcm,are nut intruded or
uttered lot sale.If.however,nae habdiab m impmeantent is wail wiln'm era rural 102 - PIERS
-
ialudedon,the owner"Mrader will have the burden of proving that he did not build or
mpr ero'purp,„ear,ala.). 103 — UFER
r of ilia pmpery a„exclusively c„mracting with licensed caalocu)s m 104 - REBAR
conaimui the project(see.70,14.badness,and pnaec,ion,code:)The Contractor's
License Law does notapplym an owner of prose y who builds or raptures thereela. - 105 - ANCHOR BOLTS
and w r Jaata with a contractors)nranttYd rarstual, to he[antra I,aw 106 — SEWER R WATER
❑la .x ever r.. �B/&rcru,mixreaann 202 — UNDERFLOOR PLUMBING
ow — 'DRFTR.Scomplcusnrl-(iNe�c-Ln'rFn{ION 203 - UNDERFLOOR MECHANICAL
Inaahyanion under penahynf ,ary one nothe following decmratians: 204 - UNDERFLOOR FRAME
• ❑ , have and will manta,in a ccrtnca, nI Chuan Ise sidi:imuaa for Workers 205 _ UNDERFLOOR INSULATION
compensation. a, pmvided for by Seaa,n 37CM of the I,anan Cara. for the 301 ROUGH PLUMBING
pn
erfon:nce of the work for which this Fenner i,issued.
❑)base rad will n arnain Worker,Cn,npa,Seim Founurea,a,teyuircJ by Scali o 1 302 — TUB R OR SHOWER
3741 lir he Iola„care,far he perrn,manca lir he work fell which his ptarmic i. 303 - ROUGH MECHANICAL
isaved,My Worker's Campcnsu,ion Insurance[:ante and Ibo icy number one:
canian Policy No.: 304 — ROUGH ELECTRICAL
C,iRrnlCAT1DN OI:FxFMl'I'[ON FROM WORKERS' 305 - FRAME
COMPENSATION INSURANCE
('1'hls lemon need not M coaapletm If he pennil i,for ane hundred dollars 306 — HOLDOWNS
(SI(Xborlea°.1 307 — INSULATION
I acrd,total is the part!.... ca of ma work Fur whim n,I,Fermi,is issued.. 308 - SHEETROCK
shall not employ any Fraser in any,canna sr as to Facials,subject to the wodsrs'
Cnpa
mr,atanLaw,noC,bramia.Date 309 — EXTERIOR LATH
Applin nt
Nn'Ice'10 APPI.ICAN'1:It,after anaking his Caniraae antrcnption,you shOuld 310 - INTERIOR LATH
becomesubject or the Workers Co al ensation provision,ul,he LUMr Codc,you trustO z0 renhwimrumplywith such oakionaorhi,Fam,ilshaln.daaaredre-ked. 311 - SCRATCH COAT
CONS I'RUC'1'ION LENDING AGENCY 313 - ROOF NAIL
I I hereby alien that tion,is a cnna.train learn,agency for thel,cd oorraarce
m n the work for which n%rest is issued(See.301 Cie+C.) 501 FINAL ELECTRICAL ENERGY
[� Lender's Nnnte '
7 z Landrr,Address 502 — FINAL PLUMBING ENERGY
U O ,ccnily,hat l have read this upplica,inn and alae that the uNon infer nniun i, 50' NAL ME ANI CAL ENERGY
[,meal.I agree a,rurally with all city and cunnty ordinances and stem laws relating
O U ,eFallen”cor"o'cnon.andIsaiah,:.ahseri,a ap,wnuai,a,of hi,cilyhnmaernpna 04 — INAL BU LDING ENERGY
�] he adwr.memiured pituitary for impa6.a Purposes.
F a
(We)agrm m save,indemnify and keep hamdes, he City of Cupeninn against 505 — FINAL ECT R I CRL
UV) liahilitie,,jud,asa ..c...Ix and espensa,which may in nay way acerae nguinst sued
Z City iaaat„ebnesouonccgauingordr,bem,1. 506 S T �O i�
r AT C`RF INDERSTANDS AND WILL COMPI.Y WITH Aid.NON-POINT Issued by: N(Pate
'igna I at mon D:Xc Re-roofs 8 — F I NAL MECHANICAL
HAZARDOUS MATERIAIS DISCLOSURE
509 — FINAL GRADE
Will me:q,plicantm future,lvai.dirgmcepar,uarcor handle h:vardou,ntaen.) Type of Roof
,sdalinad by me t,krtimi Mmticipal Code.chaFm,9.12.andha Health and Suety 510 - FINAL PLANNING
Code.Code.Section 2553200!
Oves 0Nt' All rooks s I be i5pttFtod pIT(rt4 nypW3l'm'Iimtg46ft0g installed.
Will maaFpnc,m or Itch.Fallen,Isc,part ,,a la,upoenn,daci,'a,which If a roof is Installed without first obtaining an inspection, 1 agree to remove
emit land I,air coraanninunt,u,declined by the Buy Arca Air Quality slnagcnanl
. Distract all new materials for inspection. Applicant understands and will comply with
❑Ye, 0 N all non-point source regulations.
1 rare a,,l the navurdona nracrlal,rabmcn¢nt,under Chapter b!15 m Ibc
California Health&Safe,y Care.Section,25505.25533 and 255)4.I undeotend the,
iI the huilding doss not contently base a tenth,hat itNmy re,rymsibi III,I amify he
' raw—
I.
'Ihh,rare.r I,,,wIlsh�u rah he er prior ,,kouuca of u Cun.ncaa of
Signature of Applicant Date
a,,n Dale All roof coverings to be Class "B” or better
OFFICE