00080189 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
RUHAUNG ADDRESS: PERMIT No
OWNERS N,$10540 RANDY LR APPLICAIO S IMP
PHONE;: LIM UOOON—.TRE SANIFARY.n. , b.
µl OO ARCHHECIIENGINHER: BUILOING PERMIT INI7O
Fl _ BLDG IiLEC'r PLUMB MECH
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noj IJ 1 J IJ LJ
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trNZ LIIn"al I i CONnsed under nDECLAR ATIapt Job DCSCrIpllOn
zO O y I Immby nl'llrm Ih:u 1 am licensed
under Provirionv..f Chapter 9 fcmnnsneing
Pte wlln Sctlion]LA0)n1 Division 3 of Iw butane,and limb,....nn Calc,and nhy license
z m ln C is in full farce and effect.
c < Liaaw Clan Lie.x
OWU ante Cimmcmr EXT LATH/WINDOWS, PLBG
ARCHId'TM S DECLAR.4'i'[ON
t_g 0 st I onl—land it,lairs d,:dl he vwW m public enORN
a
C Licensed Professional
a
a �
OWNER-BUILDER m anion comm from'
tKil /
'g_'—' 1 hereby n that I am cfmmthe Contractor's License c Law far Inc O
C Z r following re n.(titian,I 703 L0.number nA liafcniali Calc Any city or county
C wd' l 1e bill brcn.phcr for
d lint 'i ywntnm
3= put t t la y e t pylic such hit I I signed Culp teem
mole h beersed nth p oo nn Clinometer,oc : � (chmrcry Sy. F[. Floor Area al t
(commercial tot thi oma fU ,. t fth l Ravines, tedPof sCudel
or that he N exempt Ilmmirom and me beers for Inc alleged cxcmpbnn.Any violation
of Scotian 7031-1 by any applicant ban pnanit subjecd the upplicmn Ina civil penalty
of no,lnd,m than nw lundmddom,rs(ggo0). APN Number OccutllAEIe
❑Las owner m the pmpeny.or my employees with wages as their sole compenunion.
will do the work,and the arucmre i,not intended or oRemd for.ale(Sec.7004+. 31.602059. 0
uuanc.a:,ted Pmfmsiona Code The Conrado'.License Low does not apply ,,an Ulred I nspect ions
r of pmpcny W tea beim,ter Ilnprocc,thcrmn,and woo d..n ouch work hi own
or Ili h hisown rar,Iayee_........idled that each inpmvenwms ce not Interdcd or
ntITmd for,ale.II:hnwmen the building or inyrmvcmenl is wild within one year of 101 — FOUNDATION
Completion.the ow'nonMtilder will have the burden of proving that he did nor wild or
improve for parryrw of.alt,). 102 — PIERS
❑I.aw owns,or me Inopeny.,tm cadasvnly cmtlaedng with IlannW camomors to 103 — LIFER
n...urtan Ie Wol'ect(Sec.7041 trusion,and Prorenwiar,Cndc:)'I he Comate.:.
Licen.e Law does lot apply o an owner of property who build,or hnpmves thereon. 104 — REBA R
and who contracts for such pnjale with a commool(y licensed pursan
ut pr the
Contractor'sLicenseLaw. 105 — ANCHOR BOLTS
❑I altexemt under Seen&P c far Chia onron
-� $ 7 -00 ]OF., — SEWER d WATER
0.11, amp
R's compENSA'noN UltcLnenldoN 202 — UNDERFLOOR PLUMBING
oi�4l hereby office under penalty of pequr,one of the following declaration 203 — UNDERFLOOR MECHRNICAL
❑ nae Ind wIE cumlalt a cerntireb,at Conwnt m wellbinsure fur worker. 204 — UNDERFLOOR .FRRME
coohp.....nnn. ., Provided for by Seceon 17W of kc Lima, Code, for Its, 205 — UNDERFLOOR INSULATION
performance of the work for which this pemnil is issued.
❑1 have and will maintain Worker's Compenwllon mourn I cc,u,"mooll by Section 301 — ROUGH PLUMBING
3710 ohne Labor Codefar he nefformnove of he work for which his permit i, 302 — TUB R'" OR SHOWER
Issued.My Worka'I C'on,pcnwtlal Insurance c.,tar and Policy mnnher ire
Cartier: Policy Il 303 — ROUGH MECHANICAL -
CERI'IFICATION OI,EXEMPTION FROM WORKERS' 304 — ROUGH ELECTRTCAI_
COMPENSAr1ON INSURANCE.
IPm...no..ncedmal beno0nidcedllhefar...tisforonel,00dreddawn, 305 — FRAME
($100)orass.) 306 — HOLDOWNS
1 ccniry that in the performance of the work for which this prono in issued,I 307 — INSULATION
.shall not employ why person in any manner so as n,become subject to the Workers
Conmcnsxtion La"of Cxllfom'm,Date 308 — SHEETROCK
Applcal,t s t Id 309 — EXTERIOR LATH
NOI'Ici?TO APPLICANT:If.nl'¢r makin this Ccnilicvm nl'13ac(nption,you shoo
hcome subject to the Worker a Compcnwtion provia on,of Inc Labor Cade.You coma
O Q raahwhlt comply with sum pm.d,ionx or lair perm..what be deemed resealed. 310 — INTERIOR LATH ..
Z
CONS'FROC'1'IONLENDING AG17NCY - 31.1 — SCRATCH COAT
C > I Itcmby arnnn tint them is a coagrndtmh ieoodng non,In than p form°"i° ^] 6^ — ROOF NAIL
of the work for which Obis recant is issued(Sec'.310)].Co.C.) 3
,y Q Lender',Name
D z I,ender'sAddren 501 — FINAL ELECTRICAL ENERGY
U O 1certify thalINon read thlisapplication and.statethat the aM,vemformationis 502 — FINAL PLUMSTNG ENERGY
w F correct.I agree to comply with all city and county ordinaneev call state law,olatng 503 — FINAL MECHANICAL ENERGY
O V m building coNwclion,and hereby,wthorve prescumble,tel mi,city m en ret upon
y W meal,,, memionedp.Kny("Iinnpccdonpnrrnws. 504 — FINAL_ BUILDING ENERGY
tiy Otte)agree mmvc.indemnify and keep noble,the city of Cupcnino against
(O liubililies,Iodb mints,costs and expense,which,nay in any way acerae u,nist said 505 — F L ELECT R I CAI_
V z Cily in eonwycal ,I he grand og 0 I ii v lxnni', r�I��J T
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: -1 506 — G r•'ILS-1 Date 's/V
SOURCE REGULATIONS. --
SignatureofApplicartlConuactor Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE 508 — FINAL_ MECHANICAL_
Will the appllcan or butorc nodding oavp:ml Com or handle h1undlns ntmaal Type of Roof
a,ddlned by the Cupertino Mu hal cone.Chaeta 9.12.and me Hnalth and Sufclr 509 — FINAL GRADE
Cone.Section 25532(.)?
0Yes o '^ All roofs shall FaligpeetelF{SMAlo.lr7 _PJ ihjMCatcrial being installed.
Will theappncanlorra rzen,ildingocca.pan,use cywp(oemo.devices which If a roof is insuC4LIc vithooTriipultbtiMiiWAa6Ehs -.IZM9 agree to remove
ud,hawndon,ail I cols naan,�irnmd by the Hay Arca All Qullity Managmnc n w
nnhicrt all new materials for inspection. Applicant understands,and will comply with �.
❑Ye, all non-point source regulations.
1 have real the hazandou,material.reyuiremcms arms Chapter fi95 of the
it inamin Heahh&Nbr y Code.Section,25505,25533;ird 25534 I undo slaud tial
it Ihu building ill cur,mnlY hoe a intact,thw i0 Is Illy rurrymslb City a,ratify the
scup rl tel the reyaionoul which must be mel prior to'inema¢c of a Certilicul,of
°"ap°n`° 4;7-2,;-- Signature of Applicant 1 Dale
owns aalho,i. 'no
'all O All roof coverings to be Class`B'p or better