00060004 CITY OF CUPERTINO00060004
11utL?95J5vt#rl"DGE VIERERMIT CONT — O ATION:
BUILDING ADDRESS: - 1'IiRMIT
COMPAQ COMPUTER
OWiNER'S NAME. APPLICATION SUB DAT[
PHONE: (650) 335-1990 SANITARY NO. CONTROLNO,
M ca Z ARCHITIiCUENGIN?ER: BUILDING PERMITINFO
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x w_ 81.MELECT PLUMB .MCCII
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�� LICP.NSEIICOMRAMOR'S DECLARATION Job Description
E5 11 byfl ni ih tl, duJ p f Chapter 91c�n muJu, P
r� w ithS t 17000)of 1 of the N , dP f Cule tel tl'ume
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AyCHH U(.T S DLC(A (1N
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AaiYtu¢nI ✓�a1Lhe aced m n
Vuhlic cnnL
la (/I INTERIOR TENANT IMPROVEMENT
vi c4 p I em d 11il'c{Fpmul g
e. OWNCR-IIUILDL'R DECLARATION
I hcrcFy allinn Ota um exempt from the Contractor'.,License Law for the
Z a Ill mason.(Section 7031.5.Business and Professions Code:Any city Or count
f'z a which require,a pennit m compact.after.Improve.demolish,or repair any amcture $125000
ae 3g prior u,its is,tzmce.also requires the applicant for such Permit m file a signed suttement
— that he is licensed personal mthe pars,oisasofthe Contractors laccawLa.(Chap,ery Sq. Ft. Floor Area Valuation
(commencing with ScOinn 7010)Of Division 3 of the Bovines,and Pm&s,inn,Code,
or that he is exempt headman and the Nasi,for the alleged exemption.Any violation 31606048. 00
of Section 7031.5 by any applicant far a .it subjects the applicant to a ci tea ly
of not mom than five hundred dollars($500). APN Number Occupancy Type
❑[,a%owner of the pm,crl,or my employees with wages as their sale comps —
will do the wad.,and the,vucmre is not intended or offered far sale(Ser
Business and Pmfe„,ion,Cade:The Coulost Idaase Law doe.1 oat a r 102 — P I ERSequired Inspections
owner of pm,ay Who build,or imp.twes thereon,and xbo dots web ala bin
through his nwa cmplayrrs,provided that.such impmvrmern am nn lion 1 n 103 — UFE R
nllcred lira,xlc.IL h,wevcg the din6 ter improvement is,.IJ w'nhin one Ycm
n...ploom,the oworr-bnilJcr wi the bunlen of pmvlog that M1e did not build ter 104' — REBRR
improve 0u purpose of s;dr.j. 1.05 — ANCHOR BOLTS -
❑Lasoweotthepn,pr r,an,vel minc,i% ,Ithren,adeorlaoors�t, 1.06 — SEWER & WATER
n,Vu”Iberprojcct(S II Praha ,CurlcO'rhe Convaca,r',
lila c Law doer u." � y w un War of ,pen' 'ha build,t ;npn e,lhemon. n — -
ror w
;amd who e„muauts lar �n n„r'1ect,w1i ,tial reanrd phvw;w "s, c02 UNDERFLOOR PLUMBING
NG
RaloLlnr,licrnae La 203 — UNDERFLOOR MECHANICAL_
❑1 a..n cx mpl under sea. I m r e roc this r
Owne7 , 204 — UNDERFLOOR FRAME
WORRCR' OHPn- T 205 — UNDERFLOOR INSULATION
I mael":erm oder lmnelt ad toneofther in 'vas: 301 — ROUGH PLUMBING
❑ 1 have sadnal nai narrate of cause sum far aim,, 302 — TIJB & OR SHOWER
Con"twation, a, me 1 v S,I1. 37 ill Ct 4,
performance of the work for son I ' rernif is is, e. 303 — ROUGH MECHANICAL I -
have n.uma]asuranre.aas tee `man 304 — ROUGH ELECTRICAL
fi of the Luton Code.lot the)edam f the mock forrah lis
i,med.Idppp Worter'%C in,crosationhim - p�dPo�lic a 305 — FRAME
Carrier: Parc'No.: .. 16aL- 306 — HOLDOWNS
CBRTII'ICAHUN t IF EXEM PTION )M WOR ERS -
CObIPENSAIIDNINSURA 307 — INSULATION
IThl,section need not be completed ifnte permit is for he hundred dol h308 — SHEETROCK
$101pir1cn” 309 — EXTERIOR LATH
I tend,hat In mm pedonnume anhe work ror whleh his n;it I,mood.I
.,hall tea rn,loy my n,r,mt int;.ay.manner ,,as ,,beromc snhjea n the w.,.kens 310 — INTERIOR LATH
C(an,rn,ada Lnw,AC:dln,mia.D,ar
Applcmn 31.1 — SCRATCH COAT
NOI'ICH 90 APPLICAN'1:It.ager making his crrireate o Elle rfflan.y".Illnnm 31.3 — ROOF NAIL
her d;ne.subject n, it,Wacker',Crn,tpm...11 Prnvi,inn,of the Ulthor Code,you molt
Zn,nhx;ln ramtply w'itlt such nros,inns ror this permit.ban be deems mvnk`d' 501 — FINAL ELECTRICAL ENERGY
FCONSTRUCT r[ON LENDING AGENCY 502 — FINAL PLUMBING ENERGY
> 1 hereby affirm that there is a comlonom.lending agency for the performance
of the work for which this pemit is issued(See.3097.Civ.C.) 503 — FINAL MECHANICAL ENERGY
a c
Leader',Name
.L lender's Name 51214 — FINAL BUILDING ENERGY
U O 1 tariff that I have mad this application and%late that the above information is 505 — FINAL ELECTRICAL
Gss F, mama.I agree at comply with all city and county ordinance,and one law,relating
O U mMaildingcomwction,andherebyamhorieerepresentative%ofthiscityinenterupon 506 — GAS TEST
r (zjthe alnwomen Toned property for inspection purposes,y Oitc)agme m,uve.indemnify and keep harmless he Cit Of Cupertino sgnin"t 507 — FINAL PLUMBING
V1 liabilities,judgments,ensu and capenxs which may in any way aerac a,hOl slid
Z Cdyin'tume mofthegn ungOfflu" ft. 508 — FINAL MECHANICAL
AOL CA ON IERSTAN S ND WILL COMPLY WITH ALL�O d'OIN'f Issued by: Date
SO Raj (/p/AI �ij(7/1
. gmh cOf Ap mhmvcnm tenor �)atr Re-roofs 510 — FINAL PLANNING
HAZAR000S SIM RUALS D
ill the'Pplicaat;it foram naiwmg arcunnrl,o,,cn handle lha,amoa,anatniad Type of Roo:51.4 — FINAL PUBLIC WORKS ,
M by the Cnperrlan Mmilelpal Code,Chapter 9.12.and the ILAth and Safety .
Cavla.Rnnlon 2%?210'1
❑Yes a All roofs shall be inspected prior to any rooting material being installed.
Will licapprimntorlia cbn'Idingamnmanluseequipnhrntardeviceswltirh If it roof is installed without first obtaining an inspection, 1 agree to remove
twit nnrurdous air cununninnm,a,defined by the Bay Area Air Qu thly Managcmmni
D11111"? all new materials for inspection. Applicant understands and will comply with
aYc' a all non-point source regulations.
I ham read the harardou,mamnal,re,immem,under Chapter 695 of the
Cullman in He lth k Sne,CcAC.Sections 25505.25533 and 3534.I understand that '
if the bulding Jams not currently have a mrmnt.that it i,illy m,toodbility h,notify the
occupant of the n'qu t¢m,which a st be met prior m issuance of a Cenifcma of
Use `y' Signature of Applicant Date
ow r out avice, ca Dam All roof coverings to be Class "B"or better