00050106 CITYOFUPERTINO CONTRACTOR INFORMATION:
E IT 00050106
BUILDING A[)DBMS: r PERMIT NO,
(�. 05/16/2000
OWNER'S NAME: ANPLICAI'ION SUR PATI.
30L,1 , u�,aa,r . lls•. �� Z�e�vd1 012
q{ONE: � SANI9Y\RY NO. CON'fNUL NO.
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BUILDING PERMIT INFO
O AIICHITIiCI'IENGINEIiN: BLDG IiI.ECl 1•I-1LD411 MECII
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>5„z ucI:NSEDcaurencH,R'Srnscl. ATION 1 STORY ADDJo�iri�i�icmSIDE F
o z—o I hcmhY alfirn,that[.,,I Manned undo provision. dChelncr 9(cmmnencing
Fy`j wish seclinn](Xlolaf Divi.vionJof the Bosinea,ondl•ml•.sa,lu Cale dray license /
G m In In full force and CRT
ae s < License Clus Lic.as 6
u�” )am_ Cnnmmmr �
ARCHIMC DRCLARn
t— 1 understand my plans shall be used as public records .
I,ianaal Pruresxinnld
OW NEIL BUILDER DECLARATION /
,i,-- 1 reason,
,(Gen,hid 11. Tnosin Iran the Contractor License city
o For the
h z a following reason.(Section]ourtr It.area, and Aafeaions Cade:Any city or county
EFo which requires" p ,in I Ih clrp cd list p ),Imuurc $5�101]J0
atpr'Irr Ins I II ppl'c I M1I in 11 m I:Iltencal
dam t mato licensedp ,tallothprovisionvomn c t rsL 1 tchaper9 Sq. Ft. Floor Area Valuation
(commencing with Section 7100)of Diviounin lofthe Broincosand Parlessions Code)
I),that he I,cmund momnom and the naik for he abege.eaeropbon.Any violation 33932009. 00
III Soon 7031.5 by any applicant to or Fomit,t,bjc,1,the applicum a,o coil...malty
at not more Ran five bmmdrod dollar,($5Bo), APN Number Occupancy Type
01.a,owner of the property,or my employee,with wages as their sole compenamion. 1 VA 1 —
will do the wostructure
rk,and the is nut intended or offered for sale(Sec.]AL
na,;nesx alnd los, ro
s Code:The Donmaemrx L'menm Law door'nlay m Int or,aO 1.02 — P I E FMquired Inspections
orvthr of propcny who builds or inghves thereon.and who dans such work hlmadf
rough his own employ ns.provided that such ImPrrlvemem,am not intended or 103 — UFER
offered far.vale.IL however,the building fir improvcamm is old within one year err
'O'doue,the owror.mlBdo,will havT tlm unroll ofpnlvif,,me o
m he an mlild or 1.04 - REBAR
improve for purpose of sale.). 1.05 — ANCHOR BOLTS
❑I,a,nwae,miproperty.amcaaa,kc],iontmcnngw;thlicensed eoatuxos10106 — SEWER B WATER
m,mot t[no p,o)oc,(Sre.7(N4.Bu,ineu:old Proreexion.,Code:)'rhe Coremlor'x
1106
Low doe,nal apply ul am owner or propcny u bo buddo or imps—,dmnon,
and who eontroct,for such projects with a eommotons)fiansed pursuant in the 202 — UNDERFLOOR PLUMBING
olmerev License Law. .B&Pr.for lids mason 203 — UNDERFLOOR MECHANICAL
Owner Date 204 — UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION
IIIeKpyarnnnm,dmPenellyofperimyone ofinefollowing ducmnllia1,, 301 — ROUGH PLUMBING
0 1 have send will maintain a Certificate of Consent to sell al for Workers
302 — TUB 8 OR SHOWER
Compensation, u, provided for by section 3700 of the LaMar Cale. for the
priom,amc afore work rrwhieh this Ill i\issnc,t 303 — ROUGH MECHANICAL
❑I base and will maintain Workers Cormeavation m,or:mee.as required ny Scehon 304 — ROUGH ELECTRICAL
37011 of the Labor Code,for the perornunce.1'he work for which this permil is
issued.My Worker',Comets-run Insaaneeeairm,aadTommynumberare: 305 — FRAME
crier: _ s t w aa�dfisyNo.: z�tfIf� 306 — HOLDOWNS
CERTIFICATION OF EKEMPI'ION F OM WORKERS' ,
COMPENSATION INSURANCE 307 — INSULATION
ei��m„ion,llea
('Flmebeeo�l,pmlwam aa
mep ,nnisrorohorl"ddollmx 308 — SHEETROCK
(ala)orle") 309 — EXTERIOR LATH
I certify than in the performance of the work for which this permit is issued.I
%hull not employ any proton in any manse,so as or become sabjce,to the worker. 31.0 — INTERIOR LATH
Aprica^amon Lawsm cmB,nbnt.Done 311 — SCRATCH COAT
NOTICE 10 APPLICANDE If.after making finis Cenalcde of honamma.You sham.
Z become onjomm nae workers Co,mmn,almn provisions onhe Labor code,yon must 313 — ROOF NAIL
O ., mmhwith`amply wilh saw,provl,iono or nhl. ,erten slhadl he demote revokm. 501 — FINAL ELECTRICAL ENERGY
O 1
Z 'A
CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY
ti
I hereby m@n,tha,them is a couvroc,ion lending agency for the perlimmunce
� > ofmoworkfo,whi,llmispe,miIisi....dSee.3agzci,C.) 503 — FINAL MECHANICAL ENERGY
a. c
Lender, ddre
z LenderAddress 504 — FINAL BUILDING ENERGY
U O 1 comity that I Irv`mad this application and state that the above inforanioa is 505 — FINAL ELECTRICAL
IL P tarsal.1 agree to comply whh all oily and ammy ordinances and ,are laws mlalm,
O V lohoddingconstruction.and hereby sumariaercpresentativesofthiscity Inmmrtrust 506 — GAS TEST
a. the abovpro,.,nenlioned prony for inspection lrurpoux.
(We)agree monce,indentnifyandkecPInuorksmeCity sitCupenlnoagalnst 507 — FINAL PLUMBING
m mmintex,judgmcmts ands until aapm,sex which Isar in any way acerae age I,aid e
vz City in conagaence'If finning of this pante. — INAL MECHANICAL / /J
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issnedb Date
SOURCE REGULATIONS. y'
Signature of APPllesllnConlraenn Dare Re-roofs 51.0 — FINAL- PLANNING
HAZARDOUS MATERIALS DISCLOSURE
Will the applicumor future buildingter
mcupant se a,handle havau
udsmaedal Type of Roof 514 — FINAL PUBLIC WORKS
us defined by the Cupertino htomcipal Code.Charter 9.12,orad the Realm and Safety
Code,sm,lon 25532(01
C Ye, El No All roofs shall be inspected prior to any Fooling material being installed.
Will the im,licitm fir room buildingumircmsea oquipnmmor dm'iccs such If a roof is installed without first obtaining an inspection, I agree to remove
Unlit hour I.....dr ulnwminan%a,defined by the nay Area Air Quality Mwulgunmm
Disarm? all new materials for inspection. Applicant understands and will comply with
Cl Y., IDNo all non-point source regulations.
I have read the hasanmus na crialx requirancros under Chapter 6,95 of,he
California
Realm&Sri cry Cale,Secl In ;1 un
n,155)5,2553it 25534,1 undms,lud(hot
if the build ing dote not currently have a wan nl. h a it i nn,respm,ibi lily to notify the
occupant of the Kqui,cmentx which must he met prior ill issuance of a Cenificam of
rx`a"ancy. Signature of Applicant Date
owmforaamodaad erg Date All roof coverings to be Class `B"or better
OFFICE