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CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
1,9900 PRICE AV
AMERICAN BRANDS CON
IERI&ION000a0101
OWNER'S NAME:
1145 HAWKS HILL RD
APPLICNI'10 ti 11) l'
N16�%3�r/2000
K.WOK
ZONE: -
SANITARY NII, CONIBUL NO,
(408)265-8000
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F ARCHITECUENGINEER:
NUILDING PIiRAIrI'INPO
RLDG ELEcr PLUMB MECH
LL
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IJ 1" 71 1_1 L.J
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LICENSIiU CUMI'11ACode, rDICLARA CION
Job Description
)I.encing
n,nmby ntEnn m:ul:nn renn.ed nmlcr Prcrvlx'nrnr or Chnpmr�nnin
_tM
wahSesti„nnkrolerpoi,i.n,3nnheBusiness am]11I.ninn.C,rlo.nndmrlmen.e
PATIO ENCLOSURE
m —
atte U
full haxa and )O.
Liceme Cl r _ Lic, a_ 'L o
.
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ARCHITECT DECLARA IUV
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1 nndcmannJ n,y plans shall he used an puM1llc records
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hicenwA 1'ndmist onnl
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OWNER -BUILDER DECLARATION
License Law for the
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$ S se
1 nosy afhrm thin 1 am chimp( rmm the mW... Cod
ad mprose. dendi Cwlc:Anycity or comity
improse. do f structure
Q/
t: se
whichingrcmnn(Sermon]IUIS,Buaino,
which 1 b,rrhu construct. p .h p Y
prion t y 0 rpt: it .0 s 'rhat
,, fl bawdsomen(
(hath sip u p P t th C t J t 1 Law (Chapter,Cody)
Sq, Ft. Floor Arca
YaIuJ,( 1�
(wntheiseemtIn Scott( 7000),a U v'ko,3.r Lc R.�d h.: n. -Code)
7x14 uJ0
exempt
I), thatheis exempt th the M1asis fm the alleged exemption. Any vialmion
of stenion 7071.5 by y appl+and
applicant d ll fm a pcm,it mhjcns the applieum to a civil Penalty
APN Number
Occupancy Type
nr net marc mace Eve hundred aouars tssfal.
hu
36904029.00
El 1, rP MnY Y PIY withE. theirI pc. rim
1
RC litre {I :`ypCGtlODs
will I the work, 1 tht( t t d 1 IT e t (S . ]o a
I- f n. il I'I roe t I' I J 1'rply t, n
rufrngrconcon builds (or cstindhwho Jou work ti nxlf
owner h
101 — FO AT ld14
prvPre,
that mpr improvnneol arc hint intendedcar m
orimpugn his ewn soli m
, the building g or i, sold within one year of
howe'ecet. budded
alined rot sale IC howeve,
1 02 — PIERS
hard,. of pew
ompleibo the owner -Wilder will have the Burden of proving thin he did not build nr
imbrove
103 — UFER
lint porpore or nale.l.
❑ 1, a,owner of in, property, on exdndvely contracting with ocnt,cd volaranor, to
1.04 — REBR R
(Sec ]In , buxinco .1111 or 91m tor',
mea,' ia,
uceanel.aw
1.05 — ANCHOR BOLTS
a who hold, ve, he
does hint apply mun nwnernrpmpeny who naudn n. hnrrn.e. mercon.
1 w oe, n
and who emuan, for such project, with a commonrlsr licensed pursuant to the
1 0E — SEWER & WATER
Conuacter'x License Wu.
❑ I am exempt under Sec. . B x p C for this reason
2202 — UNDERFLOOR PLUMBING
owmee Dane
203 — UNDERFLOOR MECHANICAL
WORKHR'S CONIPHNSA9lON DECLARATION
204 — UNDERFLOOR FRAME
Ihereby alrm, under penalty ofNTjuryone III the following declaration,
205 — UNDERFLOOR INSULATION
I Wom, and will maintain a CenlOente of Coesrnt on selein,ute for worker.
mpco,ation, as providid or by Section 37al of the lahor Code. for the
301 — ROUGH PLUMBING
formance of the work for which this permii is issued.
302 — TUB & 0 R SHOWER
1C.
Imv. I will maintain wmkerx cam eodm, In,umnee, nn re qu ren by Section
10 of the Ishnr Code, for the Inr1'ormance of the work far which this permit i.
,?41D3 — ROUGH MECHANICAL
W'..ker, Compennaion Ia,tinece carrier and Policy nmhr arc:rries
304 — ROUGH ELECTRICAL
—c�-��veucyw.a�7371S--
-
CERTIFICATION OP ENEMPf10N FROM WORK1iRS'
305 — FRAME
COMI9iNSATION INSURANCE
306 — HOI_DOWNS
n'ni, xtlnn need nm necmnlunea if (rte nennh ix hit one nnnd.wl damrs
307 — INSULATION
Isualonew,,l
I cenify rho in the pe,to nae sec of the work for which this permit is i ... ed. 1
308 — SHEET ROCK
,half not employ no, pcnnn to any maaam nn .,,o leeomd,object m, he worker:
309 — EXTERIOR LATH
Cma,ri,nion Laws or Caldornin. Date
310 — INTERIOR LATH
NOIIL tC this Canihcoc you mind
NOI I`E
Labor
v
7
iper,ing
the Cod a
become,ahjectmtee wmkern em+n+en,adon ern rix none Labor Code. you avast
ct no the W o
subject
311 — SCRATCH COAT .
O O
fonhwi0 comply with such provision, or this peanit shut] he deemed revoked.
31.3 — ROOF NAIL
CONSI'RUM [ON LENDING AGENCY
hereby affirin that them is a construction leading agency for the performar.
501 — FINAL ELECTRICAL ENERGY
>I
face E
rrr which this permit i, isnucJ (See. 3m)7. Co. C.)
of she wok Il
Leader',N„ore
502 — FINAL PLUMBING ENERGY
a
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Lender's Address
503 — FINAL MECHANICAL ENERGY
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1eerdfytha,Ina,ere.d,m,application and %mmthat hethieve abstraction is
owneev 1 agree to comply with all city and county ordinance., and state lawn echoing
504 — FINAL BUILDING ENERGY
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hili 1J g annstraction. andhereby andhorim reprowittatives ofth: cityt t abort
the M erten( dproperty f pch n p
505 — FINAL ELECTRICAL
F2W..
(Wtgreo to save, intlernoily andkeep l I.: (heft} ofC P t again
liabilities, Pdy,el, unu end ext any I olon, agvns, It
,
506 GAS TEST
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City in con,r4mncc of the gtaming ol'this permit.
APU
ULATIONSaSANDWII P/LYSWITHALLNOfI�
Issued by; 507 — FINAL PLUMBING Date
RCh.N
rd Gpp
Re -roofs
509 — FINAL GRADE
kt�
Signonr PPhcanJCnmrannr D'allnc
H,vneuaus MArERInls Dlscl.osuRl:
Will rop nPplic nt er tonne lauding isvvpmt nom nr I, ffle hwardona,aamdol
Type of Roof
510 — FINAL PLANNING
r 9.12. and the eaden aad Safety
as delmod by she Ce,at MotruipA Code. CInf,teD
Calle. Section ❑Yen 25532(.)? 1:1 Nu
All roofs shall I)j1iApei:teffW1,9 aii�QWIg ni' PW$eing installed.
Will the applicant or future building occupant use eyuipmem m devices which
If a root' is installed without first obtaining an inspection. I agree to remove
emit nwardon, air conuminam, m dcrned by the pay Arca Air Quality blan.gcmcm
<ona
all new materials for inspection. Applicant Understands and will comply with
[I yes 0 N
all non -point source regulations.
1 have read the Witudoun materials requirements under Chapter 6,95 of the
California Hcahh Rr Safety Cale, Sections 25505. 25533 and 25534. 1 understand that
if the building docs not currently have a tenant, that it in my re,par,dality to notify the
cupant of t requirements whim mint be tact prior nr issuance of a Conifemc of
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Signature of Applicant Date
"B”
All roof coverings to be Class or better
)wrier Jmnn.lied agent Dale
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