00120071 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: t.
BUILDING ADDRESS: PERM I No.
21905 SAN FERNANDO AVEN E 00120071
OW'N17R'S NANIH APPLICATION SUB DATE
GU 12/12/2000
'PHO 1 SANITARY NO. CONTROL NO,
p6Z ARCHI'I'ECDENGINEER: BUILDING PERMIT INFO
CW
C ` O NLD IiLIiCf j'11UMB MECH
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I.ICENSEIIC(INTRACI(lk'SDECLARATION Job Description
z S= hcmny nf0r,Ilan I unlicensed un ill provision,or Chup¢r 9 Umnmcncing P
with Section 7000)of Divisionlof the Uusinasandprol...ian,C,de,andmy license
a Lin full fact and effect.BQ/w�f `2Dp pe
ice I I.icen,C Cms, 6 / isle. J _ SFDWL: LIVING 2747 S0. FT. /GARAGE 4�.
au nine/ T�O_ Com.m>
5 a��.,
ARC I IITECrS DECLARATION
C 'V 0 I undeawnA Illy pins,shall n,'used n,Pnblie reuaa,
w 6 p 0 hiccnmJ Pm4xional 1 v V`�� S F�w`
�f a Oat[ann excion R DECLARATION
W I m 1 hereby aso,l.bon 1:u.exempt lion,Inc Contractor C s Ali,e ... far 1M
C'Z< following comm.,ftimtiut 711a ld,lt.qu r,.ud Prot urine C°Je'.AnY cen ar county
5 z—� which rquisu u permit to cam,t eL alter,applicant
for such
h probit I m rcptig any structure
c c 'bathet to slits ceused purm,cquime pro,idocaot the Cordanniunfile ices Law hapterm
,nmini,lice.IedpSammmep,fDiinn.n3oftheBusinessandn�hwlur,Codv Sq. Ft. Floor Area Valuation
(cammcit I,ew'nh I'tha Section no and
he hall, 3 of the Business and onfA.,vi Cede)
nr Ihut hit I,c,mnpt thorc0om cul the hmis falls,allogeJ exmnp,ian.Any violation
of 5ectinn 7031.5 ny any uppruuu,far a penny.objects lite nppli,unt bI a civil ptnally
.r not own,roan live htntdred dollar.($501). APN Number Occupancy Type
01,asovoerofthepmpxry.ormyeohployeeswith wages as their.aleeompemation, 3571_5046, 00
will do the work,and he gnnmrc i,no,Intended or o0kmd far sale(See.7044,
Bu,int,s and Prore,,,ion,code:The Conlmelm',License Law docs,of apply l..a. Required Inspections
awar,of,,,,pony Who builds o....q,ravc.thereon,and who docs such work dirwif
rnthough his own employees.provided that such improvements arc not intended or 101 — FOUNDATION
offered for,ale,If.however,the building or in,pnwm,rtm is sale.;min one year of 102 — PIERS
c,nnpletion,the owner-Wilder will have the burden of proving that he did not build or
po,efarvw
ro ,enfxals.). 103 — UFER
yn.°,owner of the properly,an,esClind,ely c000uc,in,wim licensed c.nnmar,1. 104 — REBAR
,earum the project(Sec.7(W1.Business and Profession,Code:)The mm,
Cau,r i
�i«nseL.awa.m.not apply ma.owner of property who Hund.or..proves memos. 105 — ANCHOR BOLTS
and who contracts for such projects with n contmcmlfy licensed pursuant to the
C....IaaoL,I-kel,111)nw Law. t 1.06 — SEWER &: WATER
❑i n.,c,cml�`" , � Ir lRls moxa
Dwain. Dan, 202 — UNDERFLOOR PLUMBING
WORK- )MPENSATION E LARA ION 20,3 — UNDERFLOOR, MECHANICAL
Inecchyttfli.nunder,anidly orNrjnty....a m'nit wuowingdecwm,ions: 204 ..— UNDERFLOOR FRAME_
0 1 have and.rill den.said a Cenircme of Carl m self-insure for Worker. 205 — UNDERFLOOR T hISUI_AT T ON
Cmnpemalion, as provided art by Section 1700 of the Labor Code for the
perr°rl.crrent the led,forwhiclhthl, nallisiswed, 301 — ROUGH PLUMBING
Ilovea„d will lmdmm�a W..se's Cm„lwns:pian lnsu—nae.as re.luired by Sell 302 — TUB 8 OR, SHOWER
3700(If,he Labor Coda lot the performance of the work no which this permit i,
issued.nfy Worker's compensation Insurance carom and Porey.amber am: 303 — ROUGH MECHANICAL
arricr:54Rfe 'C. 11P Policy No.: 9—/6 9-00 304 — ROUGH ELECTRICAL
CIRI'IIICA'1'ION OF EXFMPrION FROM WORKERS' 705 — FRAME
COMPENSATION INSURANCE
(This snnia.most no,Wcompleted if,hep—it is for one hundred doll., 306 — HOLDOWNS
S rX)lorlts'') 307 — INSULATION
I Cenily m:e'tu the pcdlnnounce elIt,xork Fa which hi,s perl,Iil 1,issued,1 308 — SHEETROCK
,hall no,a.ploy any NI,on in any manner sa as to become subject to the Worked
Compensation Laws oCalifornia.Date 309 — EXTERIOR LATH
Applicant
NOTICE TO APPLICAN"I':ll:after making this Ceniremc of Exemption.you should 310 — TNTERTOR LATH
bclau.0 wryjm I.ant 11..l r:s Cotm,un,°non.....vols.,ul't he Labor Codc,you must
O p tormwim,...oil,with ad,prsvi.h,a-add.pero,it a,:dl be dretned,tvoked, 311. — SCRATCH COAT
EZ^` CON,SrRUCIONLENDINGAGENCY 31.3 — ROOF NATL
1 hereby aftim,that there is a con,vumton lending agency for the perhmnarec
^p it11h-orkfor wlrtcnthypa, �isuc a1�97
�.Civ,C� 501, — FI'NAL ELECTRICAL ENERGY
z 1,ender',Address �J� ZJ1.fQF� ,°-1 �g90 502 — FINAL PLUMBING ENERGY
U O 1r�y eA.).4 ,di 1 T'a. tt� ,�tI aho,�e ifarma"anis 503 — FINAL MECHANICAL ENERGY
iL F... c rt t l n,me t co ply II it II ty J county J btu d o t s rclat ng
O r, I,n 'If g uo alyaam p tniv fah: 'Ill cmerup.n 504 — FINAL BUILDING E R G Y
In n t ,ear e jot ,peal 1 505 — FINAL ELECTRIC°(,)
F a Ica ) gruff I 'fY and k cPl I ._:,h City fC p,ri no a%a ns,
'J] City in co sequence roar and granting
of t i which may m any xvy acme°gains wIJ
U Z All I inconsequence ofthegranting 1)tits 1.CO
N'1 RCE RT UNIIERSTAN1l5 AND w'ILI.COMPLY WITH AL1.NON POINT Issued by: 6 — G T T ptue
SOURCE k1iGf11,ATIONS.
Si...tureofnppncandeonnac,m Date Re-roofs 508 — FINAL MECHANICAL_
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or mture Wildinglasupon store or handle hazardous nmtmial Type of Roof 509 — FINAL GRADE
;Is frilled bydI0Cupc.im,Manietpal It.Chirac,9.I2.tmd the Health and Safety 51.0 — FINAL F'I_AfINThIG
Cada Sermon 25512w1�
❑Ye< Na All roofs shall bgptttspcctel�±❑�?-04grLt)Vkjgofll6 LV ft'�sbeing installed.
Will the applicant or routm Wilding occupant use equipment or devices which If a roof is inst.•g'I wi[hoFfU�J oT'S tw �[ism n, 1 agree to remove
nim haznNous air contaminant,ue ddiry,d by the Ray Area Air Quality hfanagCmcm t�`r p dd�-
u'Ixt,,et" E'�/ all new materia s1��toi ins qn ��LRRC�lerstan sand will comply with
❑Yus all nun-point sc C regal F BYNb P Y
I have mad the ha.;,N.ms material,requirement,under Charter 6.95 of the 604 ROOF IN—PROGRESS
Culifomia Health A Safety Cola Section,25505.25511 and 25534.1 understand that
if the hullding a.so,not currently have a tenant,that it is my responsibility ,I fully the
«ccupaf of the "tianncuts which fun,Is,°act poor m Ismno,e of a Ceniliw,e ill- _
r Signature of Applicant Date
�U_ All roof coverings to be Class •B'• or better
OFFICE