00080070 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILI lIN(I ADDRESS: PERMIT NO.
"'A7 ��I/?1t7OM 17IM17190070
OWNHR'S AAI.. `) AVEAPPLICATION SUIT DATE
06 osvE— Hi<t
/ Il,
PHO '
NE. f. H K1
- ,41 SANITARY NO, /CONTIROI.NO.
❑C ZO ARCIII'I HC'I'iTiNI',INFER: BUILDING PERn11'1'INFO
IB.DG EI.Ecr PLUMB MECH
F e C >i �9 c�LrS rC✓ I� (J 1—l I_I
Z b�� LfCrrvsnU C(IN9'RACmR'S UECI.ARA'f1ON Job Description
O,_G I hereby n�ir'rhm I rm recnue under provision,of Chaffer 9 Rommcncing
w with Section 7IXXryof Division A nl the Business and Pmrc,.ion,Code,and my lice'e
a s 5 is in full insetted ef�s /I(
z ¢ Liceme Clas, Lie.p
KKpa0 ])air a /ova C„'m� _ �✓e _&lc SFDWI_. 3930 LIVING SPACE,, 461 GARAGE
W a N / ARCIII'I1C1"S D1iCLARATI
cw�g de dayplanttl,ullhuscemPunlicrcmnl° FI1�1�►LED
�}
ca sc sc Liccnad Panessimtal
f! OWNER.BUILDERDECLARA'HON
e DEC 0 4 2001
W I hanky aflirn drat I am es,marLunLaf
ut rano,the Cmclora Luno"[.:as fin"In,
C Zhollowing rcmon.sermon 7031.5.Bue
wins and prof..ion,Crate:Any lily or county
S
a,F-O which oa mal,a Innnk m construct,ale,triturate,demolish.in repair any crucfare
ca prim m ifs is....cr.alsa mqul"the applicant for,ach prmrino file m,ignedamemem
that he is firemca pursuant to the provisions at the Contractor's License law(Chaprer 9 Sq. FL Floor AreaBUILD Valuation
(con ung win Sectio.7000)of Division3of the lia,i e,sand Pnd...ion.Code)
te
(a n he i,uman mercfrmn i i the hc,is lar rhe alle,,d lice priori Any vi,Ininn
or Section 7031.5 by any applicant for a pemal subjects the applicant n)a civil penalty -.
rk
orma more dean five hundred dollars fssan. APN Number Occupancy Type
❑1,a%owner of the protucry,or my entployae.,with wises as their sale c ta"FIVnti,n. -
will do the work,and the.mremrc is aa,Incudal a, ,tiered fur.ala(See.7044. ,s, . ..
business anal Pmfrw,mt„Coe:urn Cmmnem,',Lisema[,aw mart not apply m air - Required Inspections
mine,of property Who build,err improve,meson,and who docs will,work himself
or through his own employees,provided than such impmtenents arc n'imendeJ or
offered for,ale.If.however,the budding or improvement is sale within ane year of 101 — FOUNDATION
nnplait)t,the owner-hold,,.111 have be harden of pnrvin,that he die pmt build or
i�,tpante nu Papua,,of.:de.>.
102 '— PIERS ..
1,as owner niche rroperY.amexclusively contracting with licensee conmemn to 103 — UFER
Laacr the project(see]INA,Int. ,and Note..ia lir Cad,:)The CmmmcturC, 1 04 — REBAR
ia e Law(lass tint apply a rof profeny who build,or imp'ct[heretic,
as wea sonnet,far,n,[, per iia owner
a Lannsans) hcen.al an cam r,mer 1 0`r — ANCHOR BOLTS
Can rales,Licence Law.
❑lames d B&PCI;,rthis reason 106 — SEWER R WATER
ER" U[CLARAI'Il1N i_02 — UNDERFLOOR PLUMBING
CaM1PEN5ATl(IN
lnercny anima ander penally arperiury an of billowing aeemr:faun.: 203 — UNDERFLOOR MECHANICAL
o I have and will r,ainmin a Cerifieme of Convert rt)self-insure for Worker's 204 — UNDERFLOOR FRAME
C...a,vm ear. :,s untitled far by Secfinn 3700 or the Lobar Cndq for tee 205 — UNDERFLOOR INSIIL ATI ON
Oda.mance of[he work fur wnlch[hi,pinuii i,Ism W.
have and will alumina Wnrkcr',Compensation Insurance.atrequimd by Section 301 — ROUGH PLUMBING _
3700 if the"fan,Cade.for he perrrrmarre of the wore far which his parch i, 302 — TUB R' OR SHOWER
issued,My Worker'.Compemmion Insurance carrier and Policy number are:
Carrier: Puli.yNo.: 3'0h3 — ROUGH. MECHANICAL
CHRILgCAI'ION OI;E%CMPnON FROM WORKERS' 304 — ROUGH ELECTRICAL �''/'��✓��(��� /p�,�
Cot he completed
INSURmit is _'✓ Y
(phis srrm,n need not he carr„In[w irntr permit i,II„ono numaa dt)llma 305 — FRAME
S100)"11111) 306 '— HOL.DOWNS I
I Wo ry that in the I,srformance lir the wars:tar which this pemdf is issued.1 307 — INSULATION /
,hall not employ any person in any trimer to as to beca'e subject a the Worker`
CuVf R — SHEE T RO C K
mpen,anam Lawsl CaliforniaCaliL,
it .Dae _
AI'plira"' auld 709 — EXTERIOR LATH �
NO ICE'r0 APr1.ICANT:II,arra making Chia Cenifirmc,f I?scmud,n.you s
0 O hccmec snnirrur ere Wink,es Con"nodam rrovi,iortar me 1,1m,Code.yen moa 10 — 'I NTERTOR LATH
forthwith coply mwith such urothion,or this lmmril shall be deemed misused. 310
z .^�. CONSTRUCIION LFNUING AGENCY 311. — SCRATCH COAT
14 I hcrrny:miat feat mere b a ran.rmaia::Iam'mg:tgeny Par do.lve,mraar,e ,,1,3 — ROOF NAIl_
677 of the work far whlcl,[Iris,Penni,is I med(See.3097.Civ.C.1
a c unlef'`Name 501 — FINAL ELECTRICAL ENERGY
D z 1<nJer'.AJJa.s
vO Irenifymatlhntereaddt,apphraaanftntonne that 0a,,avainannaaanis 502 — FINAL PLUMBING ENERGY
❑. F corals.lagrretoa..only with all city mod roany ordiranrwand ,all facts rrlatmg 503 — FINAL MECHANICAL ENERGY
C V mbuildingcrn.nceion,and hereby u'hofi,empm-araim,at[hi,city In ruler opo,.
y m the alave-m,nnmedpro,mytarimpesionpurposes 504 — FINAL BUILDING ENERGY
j. 96 (We)race a...W.'mrnnify and keel)hmmle,s the City of Cupertino against
Ulin nanihrr,.jrdgncrin..rasp,and asperse,whim gray in any way airline a,a n,r,aid 505 — F NRI_ ELECTRICAL
7 City In consequence of the gnuuingofmis.LCO '
p E t
APPLICANT U AND' Nn WAR COMPLY Issued by: 506 — 'ff Sl Dale
SOURCE RE( LAT /Q t —
, nnvarmr Dwe J •^ r
o Apt Re-roofs
1 31101 MAI'Iikl .S DISCLOSURE 508 — FINAL MECHANICAL -
wdlmeupper„dmf ern',twin alnn.'o,arnanleha.,rdonsanterial Type of Roof
m reduce by the C'u,wrinab ode.Chapter 9.1 2.audme Health and safety 509 — FINAL GRADE
Coda Section 255320'
ore, III No 1' p c�hl I kin P�`d}�ITNiri b
All roofs shall � 1h'l' ected nb�to nyy rf ,( naterial being installed.
wulmerppficana,hnttrcwddingarrufaafno,rgrdrvncnordevire,which If a roof is instgflbdtwitho6tTlt1Q. )bt9iihl�-aj7Lit7sKtrb'n,31agreetoremove
emir hazardous air c5mmntimint,u,defined by the Bay Area Air Quality Mawpemenf
District! all new materials(Mir inspdZlibhF Ar0blichi ttlMeMaa)llls and will comply with
°Yet ID No all non-point sque58regul1,bE BATTENS
I have rend tel hwarluun mrmnul.rap.irmncn..un.Ic,Chapter 695 of the .
Cddar,i4 Health&Safety cast..Secdan,25505.25533 and 45534,l uadeamramaf 6314 — ROOF IN—PROGRESS
if fhe building does hot cmrcnlly have a remain,that it fins,rctlwmibilirY in notify he
occupant of the requirements which must be tire[prior to issuance of a Cerllicam at
Oc,apiri rr3Signature of Applicant Dale
o . 1
erarmithIre m l All roof coverings to be Class rB” or better
OFFICE