00100192CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
EUILONG ADDRESS:
PERMH NO. -
7
OWNER'S NAME:
APPLICATION SUB DNIT _
IONIi'
-
$ANI'IARYN C It I. 'O.
C
ARCIII'rF.Cr/CNGINEER:
y
BUILDING
ILUM'E INPO
h1N
BLDG ELECT PLUME MECH
CI l_I I� I_1
LICENSEDCON RACfOR'S DECLARATION
Job Description
1 hefchy allinn Lha )alt, Iiccn,d under pro,va o.s tl Chapter 9lnanmcnoing
with Section Mint Division J of the Buxine,s and P4rofessions Code, and any license
is I.
's In full force anaYed'o ,� , > [ 4
C.•'"' �' Lie.. J`_ �f
/
)are Cn','C.nf _
GAS TO OVEN
ARC IITIC .S UIiCLAO 10
—.and-r�.O—Q�
I undcnunJ n,y place xhull he hent us Public nvvNs
/
Licensed Pmf ..i... I
OWNER-BUILDERDECLARATION
1 hereby affirm that I am exempt front O,c Contractors License Ialw for the
/
c,
o,c amnn, (Section 70.11.5, lin,incm and Professions Code: Any city or county
which requlrc, n permit ahce approve. repay any arucmre
which Jrnnnit
/
n, signw amemem
path., re quires the l file
alsrsa requires the, an lot such
Sq. FL Floor Area
luation
that s l licensed saun the Cch iculta ice s
p mine time hvisi nr me
of Division 3 of M1c and Rofcssi
nancolnmsetlpmetio the Bussines anenselnwon% Code)
witM1 Section Onion
1,,cd cit
vi
orI, rent and the basis lits the allege) exemption. Any violation
or that a
or Shut he is exempt Iany
l
of Sof ion 7031 applicant $permit nuhjceas the apPlirmetacivil penalty
anyydred oll
APN Number
Occup n� ype
v rs
ornol moa tnaa five hundred dollars ls5rol.
union,
01. nto. her of the progeny. or my employee., with wages as their site compensation,
J f f
Inspections
will do the work, and alie structure i, not intended or offered for sale (Sec. 7814,
Business and professions Code One Conlracanr's License Lrw does an, apply ser un
Kequired
n1 properly Who builds or Fall c, Ihorenn, send who Joos such work himwlf
or through his own employees, Pmrlded that such improve n enl, are not intended or
202 — UNDERFLOOR PLUMBING
nnence for ..ale. If, how' ever. the building or impmvnnml is sold within one year at
complepau,dou,.erbuilder will have the bund,. of pfovingtlut he dud not build or
301. — ROUGH PLUMBING
m,rose fa,urpon ofwle.).
502 — FINAL PLUMBING ENERGY
❑I,as..sums of ahe pmpeny,lameeels.i,nlyeontrarling nim licensed cnmmcmn,
.
on%lmct the project (See. 7144. Business and Professions Cotle:)'the Conlmctor's
506 — GAS PEST
License Low docs tun appm un builds or improve, thereon.
ly owner or property who M
and who contract. for such project, with a crainactons) rcenwd pursuant m the
507 — F I NAL PLUMBING
Commntors Li....0 La'01
am exempt under Seo . B & P C far this reason
.
Owner Dore
WOR KHK'S Cf1M PI7NS ADON DECLARATION
I hereby at bran under penally of perjury one of the following declarations:
,
a I nave and will n amain a Certilienc of Coman n, w1Gir,. Lire lir Worker',
onra'a
utio.. m provided far by Sectio 3700 of IM1c IrMr Code, far the
peronfulacc of the work for which ahin penuil Is.......I.
have and will ansinluin Worker', Cannpensotion In,urmca, its required by Section
17 1 .1 IM1c Lahr C(Ac, for the performm�ce of the work for which this penuil i,
issued. NY W^rkcd/C�nanpc( lionlnv.arunce carrier n'nJgPolifcyu(n�the, u�rc'j
r7�
cannier: M c�•- � NfT��'leralwy ls, )lio w`RIceR—
i s'
COSI I'ENSAI'[ON INSURANCE
(I In, ouninn need not b, enmplesed it pca'ntil 1, for one hundred dollars
DIED) no lees.)
I ccnify that in the perfomunce of the work for which this remit i, issued. I
.
shall nm employ any tier....:, in any nan.ue, so is to nr<n:,:n .ubjeca u, hie Work,,,
C.,,,,n,minn Laws of Cnlifomia. Date
Applicmu
NOTICE To APPLICANT: If, after making hi, Cei ifieme of Exemption. You should
them 'object an the Woder:, C'ntnpcta,Witn faol,iorl it NC Lal, rCode. You RUN
fnnhw ilh comply wish such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby union that there is a cunarectitu lending agency for ahe perou ananee
of the work far which This permit i. i.... J (See 3097. Ci, C.)
Leaser', N.a e
Lender's Address
I certify thus 1 have read this application and state that the above information is
sea. 1 agree h, toorl, with all city and hammy ordinances unit late low, hAating
to building ar,lm,ii 1, and hereby:authmiee rcpmsenrativee of,hi, city a enter upon
,
the flowe-namioned propany fir inspection purpose,.
(We) agree u, ,ave, indenanify and keep harmless the City of CurveJino against
liabilities. judgnnmu, teas and expenses which may in any way accrue xgaina ,aid
City in cart egnnac of the pranging of his (N:moil.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: �� Date lU �3U —Gy
y'
SOURCE REGULATIONS.
Re-roofs
Sulu, of nppB,antccmnm,lor Ula
HA7ARU0IIS NIX] 17RIAM DISCLOSURE
Wil he ggrIiI of future building occupant sabre nr handle hamN.us anterial
Type of Roof
as defined by the Carona., Municipal Code Charter 9.12, and the Bettina and Safety
Ct,ucSecd i255)4(a)' -
0ve, 0N
All roofs shall be inspected prior to any roofing material being installed.
Will the.pplicant nr Insure l,uilding occupant use equiunan, or device, svhlch
If a roof is installed without first obtaining an inspection, 1 agree to remove
`TEI hu,adou, air ounniinunu as defined by the Bey Area Aar Quality M.,i,anem
iadcrr
all new materials for inspection. Applicant understands and will comply with
11 yes 0N .
all non-point source regulations.
I h.,v read the b:vunb... mate6aa.. req.incment, under Chapter 6115 of the
California Health & Safety Code, genions 255)5, 25531 and 2S!534.1 understand that
it the builAing )nos urn canicatly lana feram, ahal it is my nspo oihilay h, notify the
,..pan, of them lire ¢ata xhic iter Prior In i„seance of a Ccnilicate of
Signature of Applicant Date
All roof coverings to be Class "B” or better
O.lag nr.e'n mI DLG—
V OFFICE