00090001 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING IA 0-'—: � O Ik- 1 0 — PERMIT NO. Q
OW NISRR`'3 NA APPLICATION SUI{UN'I
3 C a\)
I'IIONE: LOWS - SANITARY NO, CON'IROI.NO.
0C>- ARCHITECDIiNGINIirH: BUILDING PERMIT INFO
-100 T/ RLIX' ELECT PLUMB MECH
NE 3 -1 IJ L=
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LICENSED
LU CONQR•S DECLARATION
Job DesCF
I hereby aion that I un, I nood amder pawiansChu m(armmcndng
wihlinoIJI)nflivl,onJul lieuProcxiuns Code,anA mylccn,tt
1p ❑
n tall
li,rrc and cfI'mt.j�
z Lice,se I✓ Lia k
xoa D,te' � Cm,Imano VOLUNTARY SEISMIC UPDATE
m3" AHCl DECLARAIION h%,SIN
I unJcmand my plans shahaW used he useed ac public ncuNs 4
f�Y
LiccnncJ Pmleuinnul
fS that
I am exempti from
the ontraRAI ON
>, I hereby Nfirm mat 11. exempt mon the Cnmruem's :Any c Law o for the
F 7 M whi g (Section]Ilam S 11 . r. J Pr f h Ic Any city Linty
4 ❑ whit q permiu t t h f demolish. p any stuure
a. prod t 'LI y dapplicantf M1pc ', II 'g a rt mem 11000.0
partl 1 rh , tt d 1 rte crmm,ide, s,Law t..I,Co e) Sq. Ft. Floor Area Valuation
(mhatheis with therein
7I: dtreb mo, hin.ln, a,uxuu'A illi I
mnn u
of thin he is 31.5 b ,day ail t unJ 0e boars to, lt, he exemption.Any I penann
of Sceinn e than le ha handled
dollars
a prrtni,,uhJec,s thuippllc;nu n,a civil penalty
mn,m rm,rethan Rvenundrvd aNm,a(s500p. APN Number Occupalc YP
❑I,ti-owner at me prapeny or my empinyce,with wage,as their.a,le compensation.
will do the work.and the structure is not intended or ofmrW for same(Sec.okW, -,�
Business and Profession,Code;The Conttaaar,License Law does Bat apply m w 'R wired Inspections
r of property Who builds or improve,thereon,and who encs such%ark himself
orthroughhis awn employers.provided that such improvements are not intended or
offered for sale.If,however,the Waiting or improvement is sold within„rte year of 101 — FOUNDATION
contortion,the owner-baileer ,dl have me Wrica ofpmving than he did not Wild at 102 — PIERS
�,tpmvr rte pmpa a nf,:ae.), ,
171,a of the properly,a exclusively connecting will Fence od,eclo,m 103 — UFE R
cnn,ovciwtha project tree.7044.itu,mcx,and Prvfc,ma,C(xlc:)The Candace tnr, 104 — REBR R
License Law does not apply loan owner of property who bullas or intpmres thereon,
and who contracts for,urn Po,Jee,with a contmen x)licensed par uant m the 105 — ANCHOR BOLTS
Contmcmrs Liccnu Lm,%
❑lam exempt.Wer See. ,R B P C tar his.-a 106 — SEWER & WATER
Owner
WORKER'S COMIIIHNsnnoNDECLARAr[ON 202 — UNDERFLOOR PLUMBING
I herby affirmI I,pnall,oI parp,ane of the following dmlaal a, 203 — UNDERFLOOR MECHANICAL_.
❑ I have and will mninmht a Ceaioate of Caaam,t m,chin:ate far worker. 204 — UNDERFLOOR FRAME
Ca pea,adan. a, ......Well lam
I... by Seam 3700 of the Labor Cade. far he 205 — UNDERFLOOR INSULATION
pedannmme of the walk far"hien this prrmit is ismal.
❑l nave and will maintain Worker's Compensation Insurance,as required by Section 301 — ROUGH PLUMBING
3700 or he Labor Code,for the perrrvaaoce of the work for which his pemtit is 302 — TUB R• OR SHOWER
ix,tw&My Worker,Cmnpensation Imamate carrier and Policy number arc:
carrier�T
Pals,,III uy3-73� — 303 — ROUGH MECHANICAL
CERTIrICAI ION Op EXEMpiON FROM WORKERS304 ROUGH ELECTRICAL
COMPENSATION INSURANCE
305 —FRAME
ITh.,sodionm,Ihe I dd,m,Iifbepram,i,rorannhunamdollars 306 — HOEDOWNS
(Mtro)nnesw)
1 certify that in the lead rntorte of the said lin which his permit is issued.1 307 — INSULATION
,hill at employ any Ircnna in any naanmr-a,m Ixeome xabhet in the Workers
b0 B _ SHEET R O CK
Compcnsatinn Irwwf CaliE,mia.Doc -
Applicant
NO]10E TO APPLiCANr:If.after looking his CnnPaeme of E,empacm yau,hould 309 — EXTERIOR LATH
Become subjectto the Anker',Comprnxation pro %iris of the Labor Code.
you must ?10 — INTERIOR LATH
Q O buthwuh comply who such provivinm nr alit,permit,hall be deemed revoked.
311 — SCRATCH COAT
Vyl
CONS dar,is c d,u iiaING AOIeg,"NCY 3
C he by n m,,h:t dere i,a con,nan on Ienab,g agrmy for ion herr Miocene° 31.3 —' ROOF NAIL
ol'the work tar which lair Innmit is iswred(sec.3097.Civ.C.)
,7 Lender's Name 501 — FINAL ELECTRICAL ENERGY
V Q Lender,Address
I coal` thmlm,ema thi.npphraeam ana>tate mat me ala,vr inronna,;on is 502 — FINAL PLUMBING ENERGY
L.
fz corren.I.gree aIlcity u ad county ordilardesaadxlate Raw,reading — IFIELECTRICAL
MECHANICAL ENERGY
Q U mM1,i unstrvction,um hem,auiho6tempresentativesofthisciiyp,enterupon
th,above-memmned pmpc y farin.pectionpaga„cv. 50 — BUILDING ENERGY
HL lit agree msave.' unify and keep harmless the City of Cupertino againz
Z imndhie,, a,am circuses which may in an %.r teem e agam,t.aN ` /Q/1Clay in corse -ofthe m....ig of mix pelma / (/t/AP TUND.RST AND WILL COMPLY WI�{ALL NON-POINT ISSkICd by: ST D:1[C
CE REG . TION s ✓1 —
sig„amrrnfnpprcanvconvanor !! Date Re-roofs
Will,nc ppIIAn DOIJsdare Wilding LS[ISCLOSIanJlc LvuNnus,rvateaal Type of of 508 — FINAL MECHANICAL_
as defined by the CaRcrara Municipal CWC Chapror9.12.and the[health and Soley 509 — FINAL GRADE
CWC Section 25532(.)"
❑Ye, 0 N All ro fs shall ba`{11.slected�ille�t�-an��'c�h Ii�t2rial being installed.
wiBmeapprc.ntmhourehaudi.,weupant.,amlmpmentorde,wi,,which If a roof is instal lR1k4ithoutRVdGl1aaiPh�InlApfld(1B{�(� gree to remove
out haandous air or
ns defined by the Buy Area Air Quality Manag Iran,
mnric,7 all new materials for inspection. Applicant understands and will,contply with
rlrew 7Na all non-point source regulations.
S.f'h'
a hamolom,mntarid,mquirancnm under Chapmr 6.95 of the
afar,C,ale.Section,25505,25533 and 25534.I addcrnand the,
nrremly haceatanunt.that it is my re,pmsibiliplm a...drthe
rtmemx which most In met pact u,i....re,of a Cenircam of/ Signature of Applicant Date
ag Data
All roof coverings to be Class "B"or better
OFFICE