00080006 crry oF'CUPECONTRACTOR INFORMATION:
BUILDING DIVISION
su)` PERMIT
RUILDING ADDRESS: PERMIT NO.
00060006
OWNER'S NAME: • AI'I'LICA1 ION till if )XI IT
EE _ 06/01/2000
NoPHONE: SANITARY NO. CON-FooL bO.
Mari, ARCHI I'FTC 1 ENGINEER BUILDING PERNII'I'INFO
wOOF RLDG HIAIC'I' PLUMY MI?CII
EQ� I_1 1_I 1-1 f'-I
God
To
LICENSED CON'I'RAMOR'S DECLARATION Job Description
0O S or 1 hereby allim:that 1 am licenved under provisions of Chapter (commencing
E-`=hto with Sectian]INXIIof Divisionlallhc Ruxinexsand Ii csdan.Code.and my license
¢ jW. isinfull Tri it erred.
W.z a< ILcnnse Class ie « REMODEL OF 20 SEI. FT.
U Dom Carnrue,
el 3 u ARCH I'ITIM S:)ECLARA1]ON
1 understand my plans shall he used as public records _
T4Nay_
T4ea-8o oLicensed Pmfesslor.I
OWNERBUILDER DECLARATION
1 hereby alRrm that I am escmpt from the Cantnctnr's Licenw Law lin Ne
FT fgls g (Section]031,59 ens IP I' . eCd p AY . tUwnly
SS0 hlh e1 r — I mill m l ,],, p Inlldt any trrutr,
wCer
po, I I ,I. q :ti IIIc, tI ,,all Ill II.it,,,pred,nuent,al
but he is licensed .,rII the a ,n 1 he Contractor's Lla (Chapter9 Sq. Ft. Floor Area Valuation
(commencing is all Section Mid)of Division 3 of the Business and Professions Codd
or that he is escrept therefrom and the basis lot the alle,ad exemption.Any violation
of Section 7031.5 by any applicant For a penult subjects the applicant to a civil penalty
of..,.,,an man five hundred dollars l$SWI. APN Number Occupancy Type
O 1,ns owner of t It,property, amy ctnl9uyttx with wagon as their solo cnmperuado i, 2 Me
will do the work.Ind the xlNfl:or Is silt hal ndcd nr allemd lo,Sala(See.7044, '
Rusine.s and pmlessioni Code:'nm Co c raaorN Liceluc Law dews not apply a,all Required Inspections
r of property Who builds or ho,invei thereon,and who does such work himself
orvthndgh his own employee..provided that..urn n
impro. nr.enare not intended or 101 — FOUNDATION
offered for sale.If,hawescr,the(wilding ar imVmvemenl is sold within ane year of
completion.the asm,hadder will have the harden of proving tied he did not mild or 102 — PIERS
improve rarpar,o,ccf.ale.). 103 — LIFER
tµ of the Pmp,nv.unr enulu.ivcly mnrcaall,with a,rind contrumors to
u{,ani�,r'i necerpn,jeet(Sec,T94.Ra. red Prafex.tana C,.Ie:)'rbe Cama+:,r. 1.04 — REBAR
Littmsc Law docs ant apply a,an nwnc�o("",cy who build,at impmms thereon.
and who recall lot such project,with a cortmeams)licensed pursuant to the 105 — ANCHOR BOLTS
Contncr iti L,,unde Law. 106 — SEWER 8' WATER
❑1amcle,Liundersec_ .1+x Pcrrr this reav,r
own _Date /`ZOCy 202 — UNDERFLOOR PLUMBING
R R'S COM PIINSATIONDIiCLARATION 203 — UNDERFLOOR MECHANICAL.
Ibelch,alran antler peaahyrf pe,myam,onb,Imlawlrg decmrad6n.: 204 — UNDERFLOOR FRAME
C3I have and will maintain a Centi cue of Consent to self-mmon for workers
Comam,aion, as Ino.ided for by Seniun 4100 of the Labor Code, for the 205 UNDERFLOOR INSULATION
perfaro,rnecoftheworkrorwhiehthis .it is issued. 301 — ROUGH PLUMBING
1 have and will m:dnl,m work,,.Comp[nxrdnr In..mde.Ti,cNiand by Seed a 1 302 — TLIB R• OR SHOWER
3700 of Ilio I.uhm Cade I'or Elm perl'mmanee of the work Iia which this pmtnll is
issral 303 — ROUGH MECHANICAL
Carrier:
[,They No 304 — ROUGH ELECTRICAL
CERTII9CATION OI:1 XrI IPT1ON FROM WORKERS'
COMPENSATION INSURANCE 305 — FRAME
(11:1,mnion nen]ant be completed If the permil is for are haadred daunt. 306 — HOLDOWNS
($1W)nr1111)
I unify that in the performance of lire work for which this permit is ismcd. 307 — INSULATION
,
shall nor crudity any prrson in any manner s,as a became subject to the Workers; 308 — SHEETROCK
Compensation laws of Calirr air.Date
Ali cant 309 — EXTERIOR LATH
NOTICH TO APPLICANT:If.art,,making his CerriRcde of Escraprom,you should 310 — INTERIOR LATH
become subject h+the makee,Cotnpco-ol r provisions of the Lahr Com
Code.you ust
O f.mhwhb..,mply wallubt provision,nr this p,rail shoo an deemed revoked. 311 — SCRATCH COAT
z
Vim) CONSI'RHCfI ON I,BNOING AC IT NCV
� > I hereby mend hal There is a coastaction lcrdia,agcnry for he wrom,nmx 31.3 — ROOF NAIL
ul The work for which this permit is issued(Sec.3M7.Civ.C.)
a $ Lende,sName 501 — FINRL ELECTRICAL ENERGY
= 7 Leader Address 502 — FINAL PLUMBING ENERGY
U O I ceniry that l have read tbi.apphe:etinn and slam rhaphe aFove lnR,rmmlon l.. 50, — FINAL MECHANICAL ENERGY
La �. anrtem.1 ogre,to IT'y
with all city and county ordin:nmev xnJ amu lows rotating
O v tamdmingean.m:eral 'it"Lc byoae,ori,erapr,sct:tarv,.aftnis,ilyme:a,rey,an 504 — FINAL BUILDING ENERGY
W the aMrvntnentinnell
ptopeny fur acite ion pugmscs.
E^ a
agree at ave.md,mm'yawkcepnarn,le..merlyarca cnmaag:tin" 505 — FINAL ELECTRICAL
p) liuhilid,..ludgntems,cost,'and esl,en.ws which:buy in unY way accrue against snit
Uz Citrin,anserpm.Ia thegandallor 506 — TEST �/ J O
APPLICANT UNDERSTAND$AND WILL COMPLY WITH ALL NON-PoINT Issued by: Date_ O —I�
SOURCE RF,OULATIONS. —
sisnamm of nppucaNcantmetnr Dam Re-roofs 506 — FINAL MECHANICAL
HAZARDOUS NIAFERIALS DISCLOSURE
Will tire illiberal rofinalachurlding occupant somill handirba'aidou'acilerall Type ofRoof 509 — FINAL GRADE
as defined by the Cupertino Municipal Code.Chapter 9.12,laid the Health and Safety
Code.Section 25532m)? 510 — FINAL PLANPING
Oyes ON. All roofs shall �n,(ti, cele (]j-f�Npt[-t(to tp. n clog installed.
Will thea applicant or future building occupant use eeuiacnan,or devices which a 't]W th W 1 t', OD�I�• :1Ai pest e
nn s van I I If a roof is instalte rthot[ l tarot n inspect n, agree to remove
•slit haea dons air contaminants ax ddined by the Bay Arca Air Quality Management
• M,rcl? all new materials for inspection. Applicant understands and will comply with
❑Yes C1No all non-point source regulations.
1 have read the hanardous materials requirements under Chapter 6.95 of the
Culdra a Ilrehn h Safety Cude.Sections 25505.25533 and 25534.1 undersand that
if the building does not currently have a tenant.that it iv my resptmsibility In notify the
Oce..nt of the requirements which ren.% the amt prior m issuance of a Cell of '
°ctupu^..y' •yw
7/(y�,(/�// � Sig nature ofApplicant Date
%nia-dariaedme Dale All roof coverings to be Class`B•s or better