00020153COMPENSATION INSURANCE
(This seniors Red n« be complucd if the permit is Imam hundred dotlara ($100)
or War.)
I unify, that in he perfomtamc of the work forwhich Nisperrut is issued, I shall
not employ any redoubt any manner a -11- become .him, to Ne Worsen' Compen-
atiou laws of California. Data
Applicant
NOTICE TO APPLICANT: IL afar making this Certificate of Exemption, you should
become rubjmI. Rha Workers Compensation provisions of the Labor Code, you Run
forthwith comply with such provisions in this permit Mill W demand evoked.
CONSTRUCTION LENDING AGENCY
0 Q 1 hereby eRon that Nem is a construction leading agency f« 'be performance of
Z yNe work fm which this permit is issurA (Sec. 3097. Civ, CJ
Leaders Name
7 Lender '• Address
W 1 certify that 1 have read this appllcmSn and stn¢ that the above infatuation is
C. comm'. I a ams to comply with all city aad county ordinances and sera laws relating to
building cndsvuction, dad tummy suthonce repreanwives of this city in emerald dm
U ahovc-mentioned property for inspection purposes,
;a. (We) (We) agree to.. itdcmnify end kap healea the City of Cuanino agalat
0 U limilmics,judgments, costa and expenses which may in any way acne against said City
'fix ❑i in maamuedoe a the grand, of this permit.,
p. aAPPLICANTU '.RSI'ANDS AND WILL COMPLY WI IIT ALI, NONd411NT
rex SOURCE RF. IONS. �a�
Sl�tum Of Aliplicmdtm
UCoctor - Ir Drs[
HAMRDOUS MATERIALS DISCLOSURE
Will da, applium m fu'um Wilding neupann apes or handle hasudous mammal
ax defind by the Cupertino Municipal Cade, Chahar 9.12, and the Hwhh nd Safety
Code, Smion 25532(.)7 1
❑ yes Na
Will the applicant or fumm Wilding occupan, use equipment or devices which
mit haudems air carounia n s as defined by one Bay Arca Ar Quality Managaden,
Disuict7
Yes
I havethe hi urdwd muerials anme
ion ns utap
nder CTter 695 M me Cali -
few Healed ey Cade. Sections 25505, 25533 and 25536. I understand that if the
Wilding currently have a errs'. this it is my responsibility to May the me, Pa.,
of the ext which must hemet priorm asuome of a Catify<-gRy ency.
Dwric'mandlauninadtiffent /OData
Re -roofs
Type of Roof
shall be inspected prior to an
If a roof is Installed without Irs
remove all new materials for in
�nd will comply with all non
Signature of Applicant
OFFICE
All roof
FEB 18 2000
ofing material being
L'taming an inspection
spec Applicant
point so ce regulations.
Date
to be Class "B" or better
BUILDING DIVISION PERMIT
CONTRACTON INYORMAHUN:
„000j01,53
BUILDING ADDRESS:
l
903 DL9T0wN Cowj��
cep/���0��
fry
ANITARY NO
APPLICATION SUBI
M
p
�H DEL.iroE S�e •
/�a4�G ��/i.�[�,
A
OWNFur 4 /�/�/vR. Je/�/•/l/.ri
NO
Or C(yNT OLb
_
°`ON`: oP) g 96 PG .aG
BULDING PERMIT INFO
ARCHITEUPENGINI?F:R
gµ��
V
Z O w —
LICENSED C'ONTRACTOR'S DECLARATION
1 hereby afrnn Nu 1 am liccnaed under provisions Of Chapter 9 (commencing
Job Description
_F-ai
Y z j
ti to w U
3- N
wish Section 7=)ofDi'im Sof ball ns andfoofwgio ode.anderty,fig"
in full force aha cRcn GG 7 33
Limnm Cl Loc.
Dsm Cmuamr
C LL u g
I undemmad my plans E shall W used in public records
S.Eo a
Licensed Prefessiowl
Y T G•/V {e
u _
OWNER -BUR -DER DECLARATION
f Z O
I busby aRrm caul I Am exempt from the Convectors License Law for the
Ptofcniom Cade: Any «Runty
5
following mason. (Section 703 L5, Buniness and city
which imports a permit m comVuct, alter, improve, demolish, or repair any swctare
S Ft. F
9'
Valuation
n3_
prior to its imuance. also mmdoes tWawEca.I f« such permit to Elea sigpedadeam,
9
that he is licensed pursuant in the provisions of the Contractors License Law(Cbapom
(consummating with Sectm7000)ofDivision 3oftheBusiness endPrmeaiomeodmor
APN Number
Occupancy Type
the, he is exempt,Naefrom aha Use basis for Ne alkgsd emmpuoa. Any via
Section 7031.3 by any applicat fm a permit mbjecu Ne epplicnnt toe c al of
' C)30,
d mom Nan five hundred dollars 15300).
I,uownaoftlepropeny.«mycmplayaswiNwagnunc�rmlccompewu
Reyuir spections
will Ne wark.0 d ont is oanschal 7066, Business
Unease La dosed
e: no not apply
and I' Code: the Unease taw does not apply toowergh
...
stheiContractor's
my who ueon, and solo dna such wok of through
ny who Wilda or improve
edohimself
his awn employaae provided them such improvements art not intended offered for
his o t
�i
/
of a
ale. If. howesel. car Wilding or improvement is sold within On year Ol camplcuon, the
owmr-0 ildcr will have to burden of proving that W did not build in improve for tor-
`z
pose role.).
V /
I, u ..of the property. em exclusively confessions, wimh licensed contranun to
a
construct Ne project Sm. and Profeuiom Code:) Tau Cmamom. nd
1. n wner of who builds or improves Norton, and
cense Law cams ens apply jo an ower of
apply
ssuchodimpe-Y
who far such prolecta with acmtratortal licensed wrsuenttocar Contractors
La.
License Cirlaw.
0 I dm exempt under ga. P C for this maum
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby aRra ander ratably Of perjury ons of the fallowing dmhostio Cir
] 1 naiveand will maintain a Certificate of Consento elf-insum for WorkersComped-
aum, as provided for by Section 37W of the Labor Code, for the performance of the
as=h Nis permit is isssed.
maintain Workers Compensation Insurance, as repired by Section
3 e tabor Code, for the peAormame ofthe woes for which this permit is issued.
My WortofilCm�pSpilY!'n liy'wnttc�aM Poliry�uiil%�/kM �A
COMPENSATION INSURANCE
(This seniors Red n« be complucd if the permit is Imam hundred dotlara ($100)
or War.)
I unify, that in he perfomtamc of the work forwhich Nisperrut is issued, I shall
not employ any redoubt any manner a -11- become .him, to Ne Worsen' Compen-
atiou laws of California. Data
Applicant
NOTICE TO APPLICANT: IL afar making this Certificate of Exemption, you should
become rubjmI. Rha Workers Compensation provisions of the Labor Code, you Run
forthwith comply with such provisions in this permit Mill W demand evoked.
CONSTRUCTION LENDING AGENCY
0 Q 1 hereby eRon that Nem is a construction leading agency f« 'be performance of
Z yNe work fm which this permit is issurA (Sec. 3097. Civ, CJ
Leaders Name
7 Lender '• Address
W 1 certify that 1 have read this appllcmSn and stn¢ that the above infatuation is
C. comm'. I a ams to comply with all city aad county ordinances and sera laws relating to
building cndsvuction, dad tummy suthonce repreanwives of this city in emerald dm
U ahovc-mentioned property for inspection purposes,
;a. (We) (We) agree to.. itdcmnify end kap healea the City of Cuanino agalat
0 U limilmics,judgments, costa and expenses which may in any way acne against said City
'fix ❑i in maamuedoe a the grand, of this permit.,
p. aAPPLICANTU '.RSI'ANDS AND WILL COMPLY WI IIT ALI, NONd411NT
rex SOURCE RF. IONS. �a�
Sl�tum Of Aliplicmdtm
UCoctor - Ir Drs[
HAMRDOUS MATERIALS DISCLOSURE
Will da, applium m fu'um Wilding neupann apes or handle hasudous mammal
ax defind by the Cupertino Municipal Cade, Chahar 9.12, and the Hwhh nd Safety
Code, Smion 25532(.)7 1
❑ yes Na
Will the applicant or fumm Wilding occupan, use equipment or devices which
mit haudems air carounia n s as defined by one Bay Arca Ar Quality Managaden,
Disuict7
Yes
I havethe hi urdwd muerials anme
ion ns utap
nder CTter 695 M me Cali -
few Healed ey Cade. Sections 25505, 25533 and 25536. I understand that if the
Wilding currently have a errs'. this it is my responsibility to May the me, Pa.,
of the ext which must hemet priorm asuome of a Catify<-gRy ency.
Dwric'mandlauninadtiffent /OData
Re -roofs
Type of Roof
shall be inspected prior to an
If a roof is Installed without Irs
remove all new materials for in
�nd will comply with all non
Signature of Applicant
OFFICE
All roof
FEB 18 2000
ofing material being
L'taming an inspection
spec Applicant
point so ce regulations.
Date
to be Class "B" or better