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CITYBUILDING
GUOPERTONNO CONTRACTOR INFORMATION:
PERMIT
8� DING
sON LN L 3 PERMIT1030029
9'r"Ad'E,VELOPMENT CORP. 03LM/2001
PHONE: ` t� SANITARY NO. CONTROLNO.
ARCHITEC (ENGINEER: a'J BUILDING PERMIT INFO
n �&6vl BLDG [CECT PLUM ME 1
�'!1J[� LICENSED CO,Yr�RACfTOR'S DECLARATION Job Desch t On
Ih,mhyaffm,lhat l am licensed underpmemonsaf Chapter 9(commencing 3172 SQ.FT. CONDITIONED SPACE.
w action 7M) of Division 3 at the Business and Pmm%sars Code. and my license
in full farce and effect. ( INCLUDE 741 SQ . FT . BASEMT . )
License C�la`,, Lic.,
1401
at. cartmictar 432 SQ . FT . GARAGE.
ARCHITECT'S DECLARAT N
I undermine my,tars shall be u,ed us public records ,}
Licensed Pmmssional
OWNER -BUILDER DECLARATION a l/
1 M1erca affirm ma, 11. amain Busin from ,ha Conaucmrs Licence Low for the
following reason. fest t 7031.5. Business oad Profmsloa Cade: Any city or county
which require apennh ns comma, applicant
impmsu demolish, ore par any romance
that heor sdocrits uodpummre to thers, meappinso the Com Permian Bleos Lw(chned amem -- —
(coma imaing wit, Section tome, f Divinsnf3.1 he Bo m,LiaT Law (chapter Code)
Sq. Ft. Floor Area $38882�1uation
or that he ing with t thcmf in add t e basis or t the legedea, and exemption.
vi CnJe) ,
or that h.. is 31.5 b tnercfrom and the basis for the alleged ppl term It) Any violation
of Section ]oils v anydred dollfornPermit subjects the aFlPlicam ,nacivil penalty
of not more man five wgdrte aaRan rsstwl 3 6 215'ViFll`1u[t�' t�w e
D h as owner of the property, or my cmployces with wage%as their wile compensation,
will Jo the work. -and the structure is not intended m offeree for sue (Sae. 70,14. 101 - FOUNDAT I,p
Bpiimcxs and Professions Cade: The Contractors License Law does not apply to an `4(�uired Inspectio G 1
nwnc
r of property Who builds or improves the... and who dues such work himself 102 — PIERS 6 2002
or through for
sa employees provided hat or
such improvements t intended or .. _ . - ..._ .._ .. ._.
offeredr .1 Ifh m building t p cmc Ia m 'rear or 103 — LIFER- •'.
completion, theo n null II haveth huN fp Sthat hdid Ibuild or
improver lip try%. r: I ). 104 - REBAR BUILpIG
❑1.a%,wn.racmePon, ." ode.ew..elycommangw,lnbanodrnohomo,to 105 — ANCHOR' BOLTS -_ .
rant
ra., the part (See Tw+. Bu,ine,, read for(coinns code:) Thi, Contractor, 106 - SEWER & WATER
Lieu... Law does not apply to an owner of PmpcnY who Haim, or impmve, memon.
..and who contract, for such projects with a contmrtons).li eased pursuant to he _ 202 - UNDERFLOOR PLUMBING _...... _.
El
Commerce,
an,,m pit under 5m.' :B&PCf In,, mr.og 203 — UNDERFLOORS MECHANICAL
Owner.' Data 204 — UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
1 hereby affirm under penahy of perjury no .1 the following devlarmions: 3 01 ROUGH PLUMBING
D 1 have and will mammig a C=nuirate of Consent to oar-Im,u a for Workers 302 - TUB & OR SHOWER
Comprnvtion, as Provided for by section 37W of the Lowe Code. for the 303 - ROUGH MECHANICAL
perfmmance ofthe work hn which this Permit is i ... ad,
D 1 have and will inainmin Worker's Compcn,atinn Insamnce, as requited by Section 3 04- — ROUGH ELECTRICAL
n of me Labor Code fid: ma pedismoma or me work tar which this Nrout is 3 05 - FRAME
I : My Workers Compensation Insurance rank and Policy number ate:
f. '.. 3 06 — t OWNS._._.-
g�.1._R»�.' _ ww HOLD
Ott'' CERTIFICATION OF EXEMPTION FROM WORKER -RS" 307 - INSULATIONS
OMPENSATION INSURANCE ". ._ 308 ..—.-SHEETROCK. ..._ - .�.. .. .._. _.. ..... ._. .. ..
(Thkwetion need not be6nmplered if the permit is far one hundred dollar, 309 — EXTERIOR LATH t
rslw)mle.,.)- 310 — INTERIOR LATH - •-. - -
` i cenJy mai in the performance of me work B. which this p=that i; iauua. I 311 - SCRATCH COAT
shall not employ my pery r in any manner w as to become subject m the Workers
Compensation Laws ofcarlm;,ia.Date 3.13 — ROOF. NAIL .... ._. -
Applicant .. _ _ ..
NOTICE TO APPLICANT: It. ammn,akinglhis Cemee,t=nlEseu,p, a,you ,houm 501 - FINAL ELECTRICAL ENERGY
Z
O
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p
Z
F.r
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became mbjea to the Workers Compegsaadn provisions of me labor Corm.... must
fnnhwilhcmnplywimsuch provisions orthis permit shall hedeemed revoked ,
502
—FINAL PLUMBING_ ENERGY
CONSTRUCTIONLENDINGAGENCY
503
— FINAL MECHANICAL ENERGY
I hereby anion ilia, them i.mean.wnlon lending agency for perfomwnce
504
— FINAL BUILDING ENERGY
at the work 1'or which this Permit is issued (Sec. 309], Civ. C.)
UndersNama -
505
-
— FINAL ELECTRICAL.
Lzmha's Addmss
506
..
— GAS TEST
I amen toocomp,e retie this application ndconty ordietnmmeabove maws nalan"
rorrht. 1 agree m comply wish all city and county ordinances and store toes rtlaing
507
- FINAL PLUMBING
ms building con.strueIion,and hereby authorize rcprescnta oev Ithis oty aenter upon
508
— FINAL MECHANI
the oW,c raemmncd pmPeny, lar inspecdun pogwses.
imariniry and keharmles, the city of Cep=niho ugalno
(We) agree m keep ti
509
- FINAL GRADE
liabilities. juJgments, mot, and e�penms xnich may in any way acerae egain,t said
,it, m con,equege of me gra„Img r i<Parma.
510
- F AL NG
APPLICANT 'N oRSTAN 15A ILL OMPLY WITH ALL NON -POINT
Issuetk�l3yq
_
ata
SO CE IL TI 11 V
Re-ro
- PLYWOOD N IL
ig t.m.fA ,aan nutwmr' _tie.
. Hr7.ARDOUs. T. IALSDISCLOSURF,
33511 tb applinm m.fumre din8a<uWm shim or handle hazalloua macn:J
.T e Ol
YP
t� ROOF BATTENS •. .. .,.,. ,.., .. .. _...
us Lefned by the Cupertino Municipal Code. Chapter 9.12: and the Health and Safety
— ROOF;IN—PROGRESS
Code, section 25532(a)'
.. DYe, ., ON. ” "
All roofs shall be.inspected prior.to any. roofing. material being installed. -
W,11theapplc future h'IJng occupant q i t d m.wnelt
_
If a roof is installed
'without first obtaining an'inspecttori; I a'diee to remove
e n J M1 -amnanninalov a% dtfired by the Bay Area Air Quality M nagcment
District
all new materials
for inspection. Applicant understands and will comply with
0 Yes DN
all non -point
.
source regulations.
I have read the W ardau, mammals mparemem, ander Chapter 6.93 0l the
C iknola Health& Sal'ny Coda Sections 25505.25533 and 255311 nndermaod,hat
e building des not currently have a mount, that it is my responsibility to notify the
%,Pam id the r=gniamem, whic st be m prior m „ua re of a Cemf¢am of
`ups{
Signatme.of
Applicant Date
-nh—
All roof coverings to be Class "B" or, better
Owneror age
author
,r
'OFFICE