01040056 CITY OF CUPERTINO
[BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING A"T0037 SCENIC BLVD p. ill"°. 01.040056
OWNER rvnerr lcnl'IG"s011h/1
"DAVID NILSSON Uj 2/2001
PHONE, XANI'I'ARY NO CONTROL NO,
GmZ ARCHITEC171: GINBEIR [WILDING PERMIT INFO
it,0O I BLDG ELECT' I'IDh11i M[f:II
fa. Est— L�/^
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F N 7 LICENS171)C PsH RACI'OR'S DECLAkNI'ION Job Description
OG=O I hereby allino[hut I ait licensed under provisinnx of Chapter I(eonm,emcing
_ - with Section nno)ofDwi.iansnf the Holmes,and Pmfe.annsCode,add myecens CONVERT LOFT INTO ROOM
Y E J ,s in full force and effect.
a,wu Lme",eG1°`° teas« REMOVE NOBEARING WALL.
x P Uwe Cm+
Oy ARCHI'I'IiCI"$DECLARATION
t-— ; I uMcmm�d nny plem shml be used a,pubic retard,
5.nor
Liren.eill nefcsslonul
ace�o
oat OWNER t esculaI t DECe RNI ION
Counlon
W='m 1 naso alien Ihm 11. cBusin faun Inc QOIrno Cox License Law fnr the
which roc masa Section 710 L5. t.afte¢and improve.
d moll h,or Any city sir ceunre
`2 O which ill reclaims n pemtil it)ec cansaue,lila impnn'e,h istesh,or retain any structure
c. 'finthn,licca;meq nlnu m I,,resthe he,q,eroof,hc Cormi,unt lnu,a,ele Law(Chapteni
omremucing itpSectio t"meprfCivili n3rtetheBusines and
essimsa odd)er 9 Sq. Ft. Floor Area Valuation
or that he is a with Section7000)a ofhe basis
3 of the Amine,.,and ian.Any vii Calc)
of that io i,excmpr[tiny ap li mut the ba,i>fur the alleged exemption.Any violation
III Section 7031.5 by any applicant tor n pcmhit%nhjed.the applicant m u civil pcnnhy
II mn,etm thio Pae l,o„a rdnnll,oa lsxkn. APN Number Occupy
m owner of fle property.a,my cmpluyce,with wage,as Ihci,sole omnanemoon.
II do the work,and the xwcmm is nm intended nr offered far sale(Sec 7114. GrJ
Bninex,+,ml pr�msdnt,s Code 'I Counaeloi,License[.few does not apply to nn R y� ,red Inspections
o.oc,ol Pn.peny WI builtb or improves thereon,and who dna%nuv'1,w'ark himvelt'
or through his own employees.provided[hat such improvenams arc nal intended or
effmca ler sale.If.however.the building or imporminem i,sold oimm one year of 101. — FOUNDATION
mnfut e ,the ownerhuilder will have the humen of proving that he did not build or
%atpm%for.... ,,,of,be.). 102 — PIERS
01.mewRe,Iftire propert,and esea,ively cot I.Oirg wire licensed summer...1. 103 — UFER
cenarect he project(See.7BW.Business and Profession,Cade:)The contractor•% 1 04 — REHA R
Li'atm Lew doe,all apply a,on owner of propcny who build%or improves Ihemon.
aId who ttmeada 1'w steel, pr ill',,with a cnm...e l)licanecd I urea In the r• —
commc I.man,I"we 1.0,3 ANCHOR BOLTS
❑fa.nh.�jc��,Ina. lis/¢{. R&PCn"'Ifi, amt 106 — SEIJF_R & WATER
uwncr_(/�W t/'L{*� Dam S S/al 202 — UNDERFLOOR PLUMBING
WORKEWS COMI'CNSAI ION DECLARn'1'ION
Ihereby afrner under penahyofperjuryone ofthe rnReeingdeclaration% 203 — UNDERFLOOR MECHANICAL
0 I has hod will dnwla a emtbcam or consent ,elf-intoIL
e r Worker', 204 _ UNDERFLOOR FRAME
Compenunoa. as pavided b„ m„
by seet 3704) or tire Lal e, Code. for the 205 UNDERFLOOR INSULATION
Performance of the work for which this lem,it is issued.
01 haze amt will mane%ie Worker's con
. pen,l,on m..i
. re.as relented by section 301 — ROUGH PLUMBING
3700 or me Labor care.for tin se, al or the work for which this pe.....l is 302 — TUB & 0R SHOWER
issued.My Worker,cootpensmio,Insurance carter and Policy numbs,are
303 — ROUGH MECHANICAL
CaricY. CEKIUNCAI'[ON 01;EXEMPTION FROM WORKERS 304 — ROUGH ELECTRICAL
CGMPENSAIION INSURANCE 305. — FRAME
(Ibis section need non be,r INcled ifthc permit is for one hundred dollar 306 — HOI_DOIJNS
1S 10(d nr Ie".)
I certify that in the Redlmnamez of the work lie which this Ixrtnil is i%sacd.1 307 — INSULATION
.hall not colder anyperominanynmanm.oasmtexame,object ,,meWorkers' 308 — SHEETROCK
Compensation Laws of California.Date
A,T)C""
NO309-- EXTERIOR LATH.
NO lilieeTU APPLICANT':Ill allennokin&this Ccnilicute ill Cxcn,ption.Ynu shnulJ
become%unjm[to the wmtar,Cornpensahnn provision,oche Labor code.yoa,nasl 31.0 — INTERIOR LATH
Q Q harm,its comply with such pros,,inns or permit shall he deemed mocked.
HcorvsTauc'noNulNDIrvGnG[dNcr 311. _ SCRATCH COAT
I hereby OGmt that there is a construction leading agency for the perternenee 313 ROOF NAI[_
of the work for which this permit is iccaed(Sec.31197.Civ.C.)
y `p I.ende'sName 501 — FINAL ELECTRICAL ENERGY
Lend,,',Address
UO [lenity that I Imse realud,application ead,ore thuuhe area.infnnnation is 502 — FINAL. PLUMBING ENERGY
p correct.I agree to comply with all city and county ordinances and state Tawe relating 503 — FINAL MECHANICAL ENERGY
rebuilding 'I i do Eyth p t rues fhb's 'IYt m,apan
ment 1 port t' t .p 504 — FINAL BUILDING EIVERGIL
a(we) nt t 1 lytied k phaemilcv�the CilyofCap,matege,rat
F' tn liabilities.lalloricosts amlexpenses h n may in any way iscloic againstlaid 505 — FINAL ELECTRICAL
tJ sZ., City in com'cyuencent the ',g of this penntt.
FfNAt PLUMBING
APPIACAN'1 UNDER$Ti DS CDWILI. 3T 1 .Y1YITH ALL.NON POINT St�f6 — GAS TEST
SOURCE REGULATION a fC7r/__ S�3/u, Issued by: Date
Signamrenf ApplicarmCounmea )etc Re-roofs
HAMRDOUS MATMA1S DISCLOSURE: 506 — FINAL MECHANICAL
Will the apNie,m or latim huddieg acul,antram or handle he,.amta.,mmcdal Type of Root'
xdecadbythe Cnln'ntnoMnmcipalCodc.Cnarvera.lx.:md(1,eue:dmamlSmetY 509 — FINAL GRADE
Code.Section 2553$al'f e
O Yea sur - All roofs shall r6lilk,l,11 pecteffpp ��I1�1isp��Ito atrt�.�if'�- tW'I`LrhjbA'Ateriatl being installed.
willlhe attuned III Whom hn Idingtnapm,tuse e,uipmemordc,ima which Ifa roof is insta�Id4withollE FlHt,t)htiRA%allrns Ml 31 agree to remove
emit haaamouv air c namione,asdroned by the Bay Area An Quality hlmumensenl
Districtall new materials for inspection. Applicant understands and will comply with
0Ye' yNo all non-point source regulations.
I have mad the hazardous materiall mymrencros under Chapter Ess It Lha
Califomia I Itb.F Safety Cade,Beelines 25515.2557 unJ 25514. undcmmnJ that
rhhc bun tg
%S. me
it,harcamnant.that it is my responsibility m mildly the
cupam en- arnulnO xJ. h///y��t h t prier m er,macc of a C/e/p(,ham of
Oeenpnney. s1 �
W Signature of Applicant Date
Owner nr aathern magcm use All roof coverings to be Class"B” or better
OFFICE