00090139 CITY OF CUPERTINO
.BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PHRMnNO.
OWNER'S NAM121.700 OLIVE AVE APPLICATIONS I -33
PHONE: TREVINO 17 W 4151 HIVE SANITARYNO. G lA
C o ARCHGJ!CI'7UNCINEER: (65@ 1 341-62@ BUILDING PERMITINI'O
BLDG r:LECr PLUMB SUCH
m u IJ I- 1 l_I LJ
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,S?yI.ICENED CONTRACTOR'S DECLARATION Job Description
"here"
ft nth tl a 9 R, two's,
FZ'G{n uh Sedhor,70()fl1 lU 5 Athe It rc,,and1 I ..11 Code.rod It,,license
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T�/ 138. 75 SG. FT.
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I de"tand ro"AaHol 11hUllheuscd alliablW lelmd'
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w a Liaamal ProfessiomJ
OWNER-BUILDER JUL 1 6 2001
1 herby.(Lent ohm 111. exempt from the Contractor's C I.iccma Law... ohc
Z a fol ch rx roman.per
mlon construct.It,,s and pr Professions Cade:Any city it mra,mrc
III C O which rey i...o Iwr ...m construct.alter.improve.ll .,it I file
repair an,d,odemum
prat he its ceased p al.x,pursuant
to the the applicant for such mune,o Ilea signed su,teman
a. do,he is punavonothepmvivisinr me the Business
slnd Pm.,w(,.%Car9 Sy. FL Floo Valuation
(commencing with Section n,an of he basis
eof thelegede xandionfAnyvnL-Exec)
or Shoo be is exempt tat,,.,n,and,he basic for the alleged exemption.Any viaemion
of not mo 7131.5 iv any hundred
doll for a permit subjec¢the applicant w u civil penalty
nrnotmonthan rvennndmddonnr>(ssool. APN Number _ _ Occup'and)6"C3+piti)
0 I,as owner of the property.or my employees with wage,as their%ole compensation,
will do the work,and the structure is not intended or offered far sale(Sec.7144.
moors,and rrom,,mns Code:The Conmim ,,Liccmc Law does not apply to an 35721001 Rfquired Inspections
oner of proprm'
property Who builds or impes thereon,and who d« ms
n such work hielf
or through his own nnployceaprovided that such improvements are on intended or
ouered for sale 4 however,the building or improvement i,void within one year or 101 - FOUNDATION
completion,the owner-builder will have the burden of proving that he did not huild or
improve I... mp-enfoid..) 1.02 PIERS
O 1.a-avurr of lcpmpe,ty-nocaduoivdy contracting with hecnsed oomrac III, 103 - UFER
maathe project(See.7W L Basins and Prnfe,owns Galc:)'I'he Cn itu"o", ,
ums.nse
Law doe mora,"lyloan ownerofproperlywhobails,ormoluovc.ametcon. 104 - REBAR
nd who..,..undo or void, pmjcata vim u vomrnemr(s) limned patxtttt I to the
acontmcmt',Licco,eLaw, 1.05 — ANCHOR BOLTS
O I an,exempt ander Sec. .B&P C li,r thio nmsnn
105 — SEWER A WATER
owner Dam
WORKER'S comPlaNsn'noN DECLARAt7DN 202 — UNDERFLOOR PLUMBING
I hereby aW....under penalty of perjury ane of the following dedam,ione 203 — UNDERFLOOR MECHANICAL_
0 1 have and will maintain a Ccmraam of Consent m,aR-insmre for Work,,% 204 — UNDERFLOOR FRAME
Camper-ion, as provided for by Section 3700 of the LaMa CNa, for the
prfoorrtan«nrmcworkforxmchhisp.itisi„Coed. , UNDERFL_OOR INSULATION
t\.fhaveand will maimaitiWorke,,Compen,aannlnsnancea.required hyS«mm 301 — ROUGH PLUMBING
3701 of the Lelun Code.for the Performance of the work for which this perms is
issued.ofyWorker's Comp�enxaa�o�nInsurance carrier�andIP_oli(cyyn�mm�e 302 - TUB d� OR SHOWER.
Crrie _�_yI_ ,IcYNa.:{Oy-}LI Y 303 — ROUGH MECHANICAL
Cli TIIyCA'IONOF iXEMPI'I SURA h WORXIiRS 3@4 - ROUGH ELECTRICAL
COMPL'NSA'fION INSURANCE - �
('rhia,ection med not he completed it the Permit is lot one hontired dollar% 305 - FRAME
Islt(norle,s.) 306 - HOL_DOWNS
I eerary nom in the pomrloance Ot dw work far which 11.......,it is'tvould.1 307 - INSULATION
0'01nm employ any pason io any tmnonar,so a,to 1,s, is suhjcn m it,,worker'
Conl3moannn Laws of California.Duty — l
Applia:mt 308 SHEETROCI
NDn(l Tonl u.lcnNl It, n kinym c hr:ne olL n' r:a,hotad 309 - EXTERIOR LATH
Z bec n) a n,aw k c , neat p - ,old
LaborCN you otos
C O Tarn n rely ;m rnpn - . arm n ,:hnubeJ a kd' 310 - INTERIOR LATH
F y
CONS FRUCI'[ON LENDING AGENCY 311 — SCRATCH COAT
' I hemhy alRnm that there is a ennmuctlon lending agency for the terformanta —
y
onhe work for which this permit is o,md(See 3097.Civ.C.) 313 ROOF NAIL
Le`p nde`sAam501 — FINAL ELECTRICAL ENERGY
Address Name
= Z, ULender's N
U C) IeerifythmIhave mad,hisapPlicmiona.it I.m bar he a Kim information is 502 — FINAL PLUMBING ENERGY
:r. t..
come[.I agree u,comply with all city and county ordinances and state laws renting
o v to Wilding constivaction.and hereby atimorim repic,culadoes of this city to creel up . 503 — FINAL MECHANICAL ENERGY
Y Ga: the.1ove.rrtoni,mad pmNrty for no,mlion pmr,,o,ev — .
Ea a (We)ugmctosave.indemnify and keep harmlessthe City ofCuPeninoagainst 504 FINAL BUILDING ENERGY
tT liabilities,judgments,costs and c,tcamm which may in any way acerae against said
V Z City in consequence of the grunting of this permit. 5L F�h1AII ELECTRICAL y���
APPLICANT
UN ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 5@-a„@5_ {�SSyF9T Date
signammnf npldie:ontrc„mmcmr Due Re-roofs I ENS.
507 - FINAL PLUMBING
HAZARDOUS MATERIALS DISCLOSURE 5@B — FINAL MECHANICAL
Will the appltcam or coos,Wiw'ttng occupant store m handle haamdouamatarial Type of Roof .
dean 1 by it,C,tPcomn Monidp:d Code.chapter 9.12,and be Health and Safety 509 - FINAL G RADE
Code.SlcuL
0 ye, CD
❑Nn
All roofs shall being installed.
Will menppue:noCor lknum buddingocv„pam use cymptnent ordcvlcex which Ifo roof is install'd)yitryyu f 1'041 naf[H, %LL p,Ltilsree to remove
nthhavaNaos air c,ttannllmn,t,detmed bydW Hay Ama Air QUall"Mana"o'co, +'1' 1",'L(` 0MeTt+p W`-"x„+ I'
nistriar all new materials for Inspection. Applicant understands and will comply with
oil 0 Ye. ON. all non-point ,aurce re vulations.
I have mad the hamrJnus n,a¢riv1,reyuimmems under Chapter 6,95 of the
cli ifirmiu Health&Safe,,Code.Sections 25505.25533 and 25534 I understand that
if the building dwz nm cutremly umnanL,hm it is my respmsibili,y mnmify the
,ceu v m or era a rant met ram m i„nanae o m cm Coate Cor
i3ccapan ��J7�//p �/)� Signature o A plicant Date
Ux�ert,r a,nGrt—Fut -/- S�t�` All roof coverings to be Class"B” or better
r'