00060132Vrr1YG
CITY
UauONO
CONTRACTOR INFORMATION:
BUILDINGviNPERMIT
HUI LDING ADDRESS:
PGRh11 f Nf
1'110060132
10240 PHAR LAP DR
OWNER'S NAME:
AI'PLICAI'I(1N S11H DcTH
06/20/2000
RUBIN RAMI D AND NANCY
ZONE
SANITARY NO. CONTROL NO.
ARCI 111EC'PENGINEER:
BUILDING I'Ii OdI'I' INTO
O C
w—
ITLDG ELECT I'hUMBI_1 MUCH
I_I 1=] L1
y j
LICENSED coNTRACIOR'S DECLARAI ION
Description
I hereby trimmed I um Iicca,d under..,,loom of Online, 9 (Iotnmencing
.1017
I—n'r4
with Scctinn703))of Division 3of the Hn,inew.and Pude...... Code. undmy license
is in full force and effect.
REPLACE RAILINGS OVER GARAGE, INSTALL TI
u
d�
1-ocn,c Clan,
Date Connote
REPLACE VANITY SINK/FAUCETS
O
ARCH I'I ECI'S DI!CLARA'I'ION
I tWdcca:m.. ory plans shoal he Dwell a, public rccnN,
pLiocr�al
y
/
Prnlcvxional
OWNER -BUILDER Il[CLARATION
I hcrcsY alfno am ramp, ,roan ate G,mmN,re Licema: Law for Inc
Z, a
,cram. ... 703"5. Business and Cade: Any city it county
cwhich)lo,ks,ne.also
whichtoll.i.,
vc,demolish, nrrspan r any tarectae
nantt 1 Improve, dcikdi
IncnnWmcfidler,nt
3w
for
'hat he isscentmccasrm lione.stothe previsions applicant the quch Corinnniunicemsle ae gneesmpteem
epit DivN.anl thelracmr,Llcen,el.aw(ClCode)
it,opwitPwwion
Sq, I+I.I �OOr Area
lUtl
he
7000)3 of leged „and v, Code)
(comment, log with Section 7,nl) of
0.'
ionfAny
li and the nasi. for the alleged exemption. Any viNmin,
on thin e basis
that he is encmp, any
/101
of Section]031.5iv as applicantlinapertni,,unjemx We aDTlleunf0,acivil penally
ar applicant
APN Number
OCCUITApe
„fni,mnmenanfvenanareaennrna(s5(n).
[11. un owner of the pnnperty, o, my W np^o,r, wish wage, m mcir,ile compensmion.
n
3e639026- Inspections
will do the work, and the amcmm is of immadeal or ofIDred for sale (Sec. 70,14,
lfusine,s and Prol'cxwToo, Code: The Clrllnl'mmrs Liccnm Luw docs nal apply I" nn
quired
owns r of property Who builds or improves thereon, and who Jar Inch Work himself
o foreign arc nil ine dedyear or
pnmWcd ,hut suint coorat
Won croploychowever.
,
is sol
for sal the saki amnio one year nr
compicton,we.B',enbuildroemavetet'Impmva
101 — FOUNDATION
provit
Wsn have one nurden of proving mm he nm.o, n,:Ed i,
in,nWeion,menwnecb 1..).
n,:pnove lar purwa,e of ,rut').
102 — PIF_RS
❑ 1. as caner of hep-,.y.ren e,el.limly enmmarial will, hecn.ed cm,h ,too, to
103 — UFER
nnsnuel the project (See. 7014, Ib si.c,I and Pore simu Code)'IW Contractor 's
Licence Law aces nor apply to an owner or property Who Wilds orimproves thereon.
104 — REBAR
mdq licensed pinworm to the
and will cmmecrs for Inch projeeu wilt u comcm
105 — ANCHOR BOLTS
n,LianveLaw.
Cnntmctr
❑ 1 am e,emp, ander Sce. , H k P C for in, I'enxen
ref WORKER'S COMPENSKI ION DECLARATION
106 — SEWER & WATER
202 — UNDERFLOOR PLUMBING
I hereby.mmt ander lx7nafy of peijrry nuc none fiEnwing dcemmamns:
203 — UNDERFLOOR MECHANICAL, .
❑ 1 have and wilt naintam a Cerriaeate of Con,cm to welt -Holme for Workers
204 — UNDERFLOOR FRAME
Cu111pcnxatiWI. us nmvidcd par ny Section 370() of the IAeror, Cade, for the
205 — UNDERFLOOR INSULATION
perform,acenfine work for Which his Non,,iwiswed,
0 have and Will otaintainWorker ,Compen,aaonInsurance. asrequired bySection
301. — ROUGH PLUMBING
3700 of the Iamm Codefor the ped"In encc of The work I'll wlnidn this permit is
302 — TUB & OR SHOWER
clued. My Worker', Con,cosanion Insurance currier and Policy number am:
Car ....AVQi 5TE11945oµcyNo, �G3lQf%/
CERTIFICATION OI' E%EMI'I'ION FROM WORKERS'
303 — ROUGH MECHANICAL
— ROUGH ELECTRICAL
COMPENSATION INSURANCE:
304
305 — FRAME
rlti, section need not be completed if ore permit is for one hundred dour,„
-
306 — HOLDOWNS
I amy inn m he peos,mmnen of me Wink fit which this Iventlil i, i„aha. 1
307 — INSULATION
,hull not c�rru��yy���.....y�.yk)' c • - unncr> u. berome Nabjeet a, the worker,
Comp n r . Ibr :. >a e
308 — SHEETROCK
Applmum
NOTICE TO APTLIG\wr: . Her making, his Cemfcme of Eaemplion,yiu should
309 — EXTERIOR LATH
became object Ionic, W..kcl', C an, InalinI provixion, if the Lallor Code, you IT
fnnhwIda conad,.imsuch pre�6inn,.1 his pcmot hall Wdeemedremked.
310 — INTERIOR LATH
CONSTRUCTION LENDING AGENCY
311 — SCRATCH COAT
452
I hereby of irm that them is a constriction lending agency for the pnlbnnance
Civ. C.1
313 — ROOF NAIL
in pen^ i, issnesl (Sec. 3197.
01 the work B,r which per
G
Le her Name.,
501 — FINAL ELECTRICAL ENERGY
5z
O
IIagmethaOhave rciththlcityrofcoats.mmencesthe d%lateiii
502 — FINAL PLUMBING ENERGY
w Femreel.
lawsatiamh
I to comity With ill nNmanees and ,cite mss ,cluing
503 — FINAL MECHRNICAL ENERGY
> [)
con all�mt e repo
mnrildingrontionednmand auction
. i
tyfori aI)oWmmive,unni,dtvmenlenupolt
merve.oagreeensave,indemnfypedkepmpnsc,.
504 — FINAL BUILDING ENERGY
� y
IA
(Wal agree in save, indemnify loll keep hrnnlc, the City of Cupertino ,grana
liuhiliries. prairie.,.. art and experts, which only is way it, nccrue atpain,I ,aid
505 — FINAL ELECT L�
z
any nn eW1y,W� sec a l nuc gr:nnm,g nolo;, r
APPLICAfVTyM1 ERS' \ WILLC Mnt. WITH ALLNONd'OINT
Issued by: — dlC
souacli_E[ n T
Re -roofs 507 — FINAL PL I G
�+r
Signaurclnl ApplicanlA.'an an Dam
lI"A"DO11S MATIi11 DISCLOSURE
SQ1g —FINAL MECHANICAL
Will the applicant or future Wilding occupant stone or handle hamrdou,m teriat
Type of Roof
a, dented by he Caperdne Municiwl Code, Co,11, 9.12, amt he Ueahn lad Safety
509 — FINAL G RADE
Code, Section 25532(aU
ores Nn
All roofs shall%d OspecIF4ZINiALtoPh)11alIWii IChaterial being installed.
Will the applicant or future lwildmg iceupan, use equipnwnt or devices which
If a roof IS InsMIjk4 w.uhpal fqpLobpOl Bllg J(CinWi k(5 I agree to remove
ni, carantnu, au' cimm�ninunN a, dcfmad by the Bay Arca Air Qaalhy Manrgemem
all new materials for inspection. Applicant undershmds and will comply with
i,mct7
0 YO` �a"^
all non -point Source regUlat ions
I have read me hamNia, nest rcadren enns under Chapter 0.95 of be
Culilorma Berth A, S, I cry Cndc, Sol'-, 25505, 25533 and 25533. 1 understand What
if the building Joos not carren)y huts v mnnm. that it is any responsibility ,, nmily The
.
Ithe rcyvinn,i.eJ7genf I, W nigh 1- w m 'nr W Imuunee of a Cc^ifcwc of
'^°ra"°' ' 0
b sane
Signature of Applicant Date
`•B"
All roof coverings to be Class or better
OW,mrn Ihu
Vrr1YG