00080045 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNIiR'S NAME: APPLICATION SUB DATE
PHONE: 10093 PHAR IZAP IDR SANITARY NO. CONTROL No.
cWZ ARC]111 ECi , _ BUILDING PERMIT'INE'O
_ Ii1.IH'i IiLEC'I' PLIIMN M1IECII
c U
n
Nj LICENSER CONTRACTm,cmam, D,lor,l Churn[ON Job Descring p 'on
y0Z; Ilion 70onion In:n1nn,limnedsinesp rad Prosof Chaplce9ndmylea'nse
FyFw with Scclion]flgllufDivisionnof me Businosand Pmfcsninm Code.and my license
w z z LIn Intl lmW effc.
ce Cass
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o a.u C;u
ter
3 u AHCNS DECLARATION
C 1 underatlnd my Plans shall O used as Public recdN
cel'^s 2 NEW WINDOWS AND DOOR
s=o sensed rroresdonal
w
OWNER-BUILDER ATION
I hemby affirm that I.. ocluld for.'be Co
e : n Low me
follow ins,masoa(Scain ] nS, and Pmfsions C,dcAnY city or county
hallrqu r:' tx la consumer.
os, ,.fiber. P doilih.or repair any: sueto
,, m prop t Ir 9 -m PPI tf D such perm, flsigned:nment
,Hall 1 dp -.o It e r- n1 c I , r l n L ICl pter9 Sq. Ft. Floor Area aOi n
Icomnwrrl ng with Seuion 900(h of Dh9s nn lot he Busnes and I rolesdom Card ��
If Ihat he I%exempt themfnnn and the n:ois for the alleged exemption.Any violation
orSmion 7031.5 by any applicant for a permit subject,meapplictmrto a.itilpenaay .
of.mo
mine than etc hundred delta.(s500). APN Number - Occupancy Type
O 1.as ow act of the property,or my employees with wages as their stile compensation.
will dm ate work,;and the,Irumure is no,intended or offered for sale(Sea]Wd.
Bminu,s and Pmreseinn,Cade:'i he Connacnn',uteric Law docs nu,apply h,an Required Inspections
owner of prupeny Who Wilds or improver lacteal,and who docs such..,it himself
nr Ibrough his own cmpinyma.prav'Idcd mal I,,h inlprovclncmr arc nn,Interned or x"'61.8040. 00
offered for sale If.however.the building or improvement is scold within one year of 32
nnpletion,the owns-hullder will have the burden of proving that he did no,build or
Impmrc for propose ul'sale.Y _
e1.asnwn,rofthe psopeny.aire.crosively colmacting with seemed coutmaoran -. 101 — FOUNDATION
Iinstruct doe project(sec.7(4,postal and Aokosions Cede:)The Contractors 1 02 — PIERS
Ieellso Low doe,not apply turn owner of properly who builds or imoomis mcrc m.
and who contracts for such projects with a contmcua(s)licensed pursurnl a,the 103 — LIFER
Con too, s Lo,cme Law.
❑font cIrmpl under See .BR PC hit,Mum,w 1.04 — REBAR
owner Dan, 1.05 — ANCHOR BOLTS
WORKER'S COMPENSATION DECLARATION _
Intrtny tirr
[ n„anatpe,aly err Peta
perjury .,e onbe following dtnrm
tlitii,a: 1.06 — SEWER & WATER
❑ 202 — UNDERFLOOR PLUMBING
1 have and will Inaim:dn a CeNr,aLL of Covent Io relf.inrurteIIIe, r
• Compensation. .a provided far by Seaihn 370(l of the Lana, C,tle ter he 203 — UNDERFLOOR MECHANICAL
rerl'om,u occ or me wink it,,which the perms Ir is..acd.
❑I have and will r maintain Worker,Compensation I a,work fill
as re width
chi by Seaton
204 — UNDERFLOOR FRAME
3]1x1 or me wear calq ter he p.,n,rolan,a of cot wog for wltitn ted.Pe,mi,'Is 205 — UNDERFLOOR I NSLII_AT I ON
issued.M1Iy Ar'ers Compensation surarace carrier aanu7mMr' c _
� _ap 301 ROUGH PLUMBING
Curricc_ Policy No.: _
CLRTIPICA'1'ION(IPESIisIprR IrH WORKERS' 302 TUB & OR SHOWER
CONIPENSn1'ION INSURANCE 303 — ROUGH MECHANICAL_
(SI W)('I'hl,stovistt iced not bit....noced if lstrroh is Corinne nandred doll.,. 304 ROUGH ELECTRICALRELECTRICAL .
ns ltm'.1
I ccrody ma,in Inc POil innrancc mf tic w,,,it h r which this per it is lx>ucd,1 305 FRAME
shah not employ any pertain in any manner tat ar m become subject m me Worker 305 — HOLDOWNS
C..... n Min.1,awr of Ctdimrair.Milo,
Applicant '07 — INSULATION
NOTICE TO APPLICAN'Cif. far,making,his Certificate of Esemp,iun,you should �+
Z accome,ahjectlo icwoncrrrcit,rill,1,prwi,inn,ofn,al.lhmC...i.yoniou'r 306 — SHEETROCK
Q forthwith comply with such provisions or this permit shall he deemed revoked.
fin CONS TRUCTION LINDINGAGENCY 309 _ EXTERIOR LATH
m etcmbyalBrn,halthem isaeonstmcaonlending agency mrthe performance 310 INTERIOR LATH
of the nmk far which this Limit is is,amd(Sec.3097.Cin..C)
`a Lend=,•Nam= 311 — SCRATCH COAT
7Lenders Add,s,s —
U O 1 e=ntry mat I hate read this xpprcaann and„me mat me afore mfnmtaaon is 313 ROOF NAIL
too. correct.I agree to wnnp]y with ill city and tnuny m,dm roar,Intd Gum lawn chin, 501 — F I NAL ELEC I CRL ENERGY
O V to nndding 'onstmea„n,and hereby outhimrc mpmsemadvesofthis thy to enterupon
roe nota- Iemonc p,opnnyririospemionpmosx. 50^ FINAL PLUM IG ENERGY
rFi 0. ( -Ode nee.mdenmiry.i. ham the City of Capri.,.last —
to nnnilina. inn, qtr. 'wt%an .pen 5 Ice may In any way ansae against said 03 L MECH I CAL ENERG �.}/�
U Z Cit'in-in. rate, the gr ting( I nail
APPILK iG NO STA n .LC YWITH pAALL5,--Op
N-I�� Issued by: - 4 L HI_I ENG k�Fe.RGY �`/ -VCJ
sibs T- ,p . n�m Re-roofs _.
lossI .ARDOUSMA'I'MALSDISCLOSURII S - GAS TEST
Will the anAiaant or future hulldi g nnipen time or handle hxaardws mmorCd Type of Roof 7 _ FINAL PLUMBING
shied by ate Curri iso Muni,pal Calc.Capt,,9.12,roan the lbiLi r told Sir”'
C e,Section 255n2(o)" _ p
ossa ❑No All roofs shall b 2 ectec� ��o a) i �nitehal being installed.
Will the alplicaut or future building occupant use=nuil!men,or de;ccs which If a roof is install itfiol�NF(4bta , L"gwins ection, I agree to remove
thin hamrdousid,cnmaminamr its dulinW by otic flay Ara,Air Quditr Mam,xcmcm XAS((K�I p
Iva,'ct'r all new materialFi&irk-incpeEtibMFl4pp�i�d141�1❑dcR4Pands and will comply with
rlYe. DNo all non-point SOuSTegegula0g1%AL PUBLIC WORKS
I base tea IM hazardous momrial.s requirements under Chapter 6,95 0l,he
California Health Safety eine.Sectloos25505.25533 and 255311 understood I all
irlhehuiliingdr s not re y limeotenaaL)hol if my re. mibili,y,omin the
crum of me .....i t fish m be me ted r. . 9 a C.,ni tuts or
ixsc aSignature of Applicant Date
- - - -� 5� All roof coverings to be Class "B" or better
Or 1age. nee