00120095-
CITY OF CUPERTIN0 - ,
I BUILDING DIVISION pE 11� ' ' CONTRACTOR INFORMATION:
f'. H tit,
Rl11LDINGADDIII.SS y, PERMI'1'NO a
,OWNER'S NAME: — _ _ - EAHE - APPLICATIO t;IA' , r
PHONE: - 377 8186 SANITARY NO. CONTROL: No.
ARC IIIHICT,1ENGINFER: , - -r BUILDING PERMIT INFO
R' --d ❑- RI.DG• . FI.ECI. PLUMB I MECH
Z LICENSED CONTRACTOR'S DECLARATION i --
oF�°• z'� u,
I hereby al maiIamylicensed u
icensednond amuprovisions ofCnpr 9 (COHnineral
INTERIOR RERLQ��r,ptlp°1,.1. "CHEN/BA`r,
HS9 RENO.
V
7Wn)n)„on3none Rr n .. Code,Iy rte ae
i 1 ul re, .,NEW WALL A/C WASHER/DRYER UMTS NEW
1 ice CI:e,win's"”,
in st
3o nam
uy ARCHITECI'S
DECLARATION
O [.ad ... M: umd m public rtmNe
I.iccn,sd Fullcasi0all -.
Joy 'OWNER-RL1II.DIiR DI;CLARAl'ION-
❑❑ L hereby d1lun mm 1 am sgmtpt from the Convertor', Luanne Law for roe- y '
t ? follnwiny reawa (Section 7031,5, Buri.„ and Professions Codc: Any city or coumy _ • -
f € O which requires a permit a) coTvam, aIle, improve, demolish, or repair any stmcmn•
i5 prior to itsalso mi the apliliciatf such prf to file y d statement
m,rh : cep, ort mep nn c t t L 1 (cl pt ,,. ., Sq. Ft. Floor Area - Valuation '
f..b al S a 7W0) I O" 30 ItoII: II .` : C I1 $34350
or that he I, r,rlmv,tmn and It, h:,s for Our, degid e,emui I.Aty volatiou
of SG[linn 7031.5 by any applicant for a permit nuc,, the lip,hcan to o civil penalty
nr nm mnR than five nandredollars ($5W). APN Number Occupancy Type
°1: YX none, of III,,pmpt,rty, army employ,,, with ways, a, 'heir snit, annpen,minn,
3690300a 00
Bal dLI u, wurk. Inal yhotot Iol I, not ItIal off,ed ol :all 111c. nu4. .. Required Inspections
Ba, dP f clb I c t tr Lad 2olrkhi lf 101 —• FOUNDATION
Oilntl Rrh.. proyi... Who buce, orhpr rvc,h navdwhtotl ,such, intended
ntehimself
Ar through hie awn hosAver, t pmvided that such call nememm within
nut one year o,
,Rapt lio..eale. R, however, the building , improrcnenr i, mold within one year of 1.1712 — PIERS
anplt tat 'n h II Iltr tl bN 11 gnarl II th Il tr - � .
rep I p: , rDNDERFLOOR
ER
1. as ollrurr nn p pry I: Ir oa t s ml t -BAR
I s m p j 2 IS 704-1 Bu:2 t d CoJ ,,
nee 1 d ply, xdn 5CHOR BOLTS
ata h r t for hp 1 Nwth n If .,ant"i -
Ol o,, r or ( -R11l f,ER WATER
°1`�"L F'LUMEiIIVGOw WORK:l COMPHISSATIONDECL.ARAII)N � 7DERFI_OOR' MECHANICAL
ntrt,b,ITIrm rmae, ,mallynrperm,, non of mg l'nu�wrmb drela,al1,: i°04 — UNDERFLOOR FRAME
❑ 1 bare aw m ntmmain a cerdlr:ne aren:t,Fnt tn',nlr-i sure n,r worker, r 2 .05 UNDERFLOOR INSULATION
Compen,mion„a, provided IF.. by Scc2inn'37IB nr the. Labs CMc, for ore 30`1 - ROUGH_ PLUMBING '
. pvrli mtaric. ohne wad for x hick Ili, Noun, is issued.
°I noand n wdI ntammin Wmkef, cmnpenmtlnn ln,tuance, as rc,aird by sectinni - 30d.' TUB & OR SHOWER ,
37(m of Labor Coul , Ih, ate Imr1'mnuave at Jul wank Int whim Illi, pernR It, �r03 '— ROUGH MECHANICAL
issued. My Wmkef, Compematinn Inommec Owner and Policy nunb,,mv: '
Calumet:' V IlNn.: . - ' ' 304 — ROUGH ELECTRICAL_'
- CERTIFICATION Oil EXEMPTION FROM WORKERS' 305„— FRAME '
COMPENFAIION INStTRANCE, -
IT ' his eoction ured not lw nintplemd it ' Ince llennit iv Our one lmad.1 dollen "05 HDI_DOWhdS
alnnnrle,,.l . . 307 — INSULATION
I certify mat in the Nuromut or ate xnrk at, worm dis pern6 i, ie,mm. 1 . - .308 — SHEETROCK
hall nnI etnpiny any croon in nay mnnnm so am m becmne pamI, to the, Workers 309' —t' EXTER I 0 R LATH -
Con..., L mol C I,f H'a .
Appl °
NOTICH1 0 APPLICAN r If. n kin, his c n'r Iro an ml m
' 10 — INTERIOR LATH
pnen ry,,theW,ker.emorn pmnohne Labor Cilt,, ynyrnw
Ornrtnwith comply wim,enprovisions
tmimpemtir,hanbyeare,u
;
37.1 — SCRATCH COAT
n nvs'rRuri'IONL.IaNDINGACI:Ncv': . 313 ROOF NAIL
ay hkForarhmtntatmerek,neouN(See.3097.tgagcnryror,hepudr^u"`c 501 — FINAL ELECTRICAL ENERGY
W of the workd'or xhich 2h1, Penni,is coast (Ser_JIndi Cil. _
zd`re"'" 50'r• FINRL PLUMBING EI'aIERGY
Lender's Address
U O Ie,oily thnllha,aondrm,upltliwtic.nmal mmemattheA...cinr,,,,fi;n„L, 503 FINAL_ MECHANICAL. ENERGY
k err t 1 s r plr 'e II ty d ry d t r2 s 504 FINAL BUILD ENERGY,
O U 2 n Id s e alaih ni n p t r .re, '2y2 enter pan 505 — FINAL ELEC
he
nm e , e p Rnr r pert perp, ,
Imbi re r. case, incharrinnify and
�k , launds, he Cry 1 Cu,nino
P ag'
1, ,,,mIl t t n n n y..yyr,.g,: id
GqqA��S F��rCity ,,ac"e . L -S
APPLICAN WILLCOMPLY WITH ALL NON -POINT
SOURCE REGULATIONS. Issued by. G—n��”tt
y�.atC/INL.Date 12
,
Y-.1.
Si,mltueof A,,IiI.IYCnulme,m Dam Re -roofs — )
. HAZARDOUS MAI ERIALS DISCLOSURE 1 509 — FINAL GRADE.
Will d,cappnrammrn2nronralabty,nenpnrn,mmn,haitmehn.mdnn,mm"cI Type of Roof+ac= - _
Rnea by meenprmnn Manmipaenapmr 9.Iz,ntta ole ucalm mm saretr 570 — FIhIAL 1='I_AhIIVING
Cole, Section 25532(a)! -
❑Ye, ON. , All roofs shalAr ihspecEdlliRf-toFa6yilo(Tlf'rgliQt"S}ah being installed.
6 . Wil I the appican, or far.,, l Icing n.- pare,w equip 2 r ,which If a roof is installed without first obtaining an inspection, I agree to remove
mitt : 'rep r,asbaum rhoB,yAc, Ai, Q It)M pe
alct
Fill t ;all new materials for i6pecfion, Applicant understands and will comply with
°Ye" I - all nodi -point source regulations.
I have read ,he hazardous material, under Chapter 6.95 of ,he ,
California Health& Safety Code, Sections 25505, 25533 and 25534. 1 undwmmnd that
if ll gt ¢,m.Wy havc. cnaml,thtt tymsp bit, tirynu
'cup h I amwl ,b l n tri,,, I ( Itw1 '1 -
OCe1” ) 1 Signature of Applicant Date.
owner .nnmr. r [)are All roof coverings to be Class "1,3" or better ._
2
OFFICE '