00110055 h _Q
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
RUa.DING Aj10[S1�5 SCENIC BLVD / C TERM] NO 0011.0055
OWNER'S Npp9YJ,.AnIG l_ A"'LICAI'IT$UJ'N',uziv
PHONE: ' SANITARY 070.1 7 CONTROL NO.
0iXZ T
ANCHIEC'r/IiNGINEIiR: / RUILUf• •IN . Mr1'INFU
Ll ELECT PLUMS MECH
Nj LICIiNS1iI)CON'IRACrOR'SDECLARATION Job Des tption
1 M1cmny ninrm Iha I no licensed under provisions or Clmpler s)(commencing
aXp„u n,11 lhrR .inose and �lbi Cole nmlmy license CONVER"f PA T OF A GARAGE
�� n,mu romtaoa mf of
Y z U Limen la.,_ (/sI'
Dale _ {� e'nmranm
li 3 LL'- �'- -�HMI'n:CT'S DECLARAl0- -
a O 4 I undersi my plans shall be used as public records /
p'O Liccnscd I'ndcv,imnal
�L se
Oat Ian-ItiesandIIH DECIARAy l(IN
1,crave uSim that fon u03 L5. aon fnnn the Conlon,Co License city
i for the
try
7 R,hilb rg mess a permit
t 1onstruct.after.
improve.de io li Code:Any city or tummy �a
x O which requires a pcnnil m conamn,aper,impn,ve,demolish.or repair any ummurc
poor to its issuance.also requires the applicant for such pem,iuolle a signed%fair=.,
that he is licensed Panama to the provisions of cnntraetnr.License Law(Chapter v Sy. Ft. Floor Area Va ulC1,
(commencing with Section 700X))of Div train 3 or the Ravi new and Ptares,ions Code) jGJ I�
of that he in scud thcrefann:ad the basis lin the alleged c.enscumv Any violation
of Seen 703 1 S by any eppheant lura permit euhiro,due applicam Inn civil therapy
of mol re Iran roe hundred dollar.($500). A PN Number Occupancy Type
35709086. 00
❑I.d owner or the and
the s,Lir my employees with warm aedTheir sole le Nor.
will rs Inc work.and the.whine i,not intended or offered for snot apply 7(1W.
Rushes.and P yWhonb cWe:'rne n,ntmetors,and w law hoe,not apply tu an Required Inspections
w orpn,perty employe,.builds lorded tal...h.nndwnndoes em,ampnt ork intended or 1.IDI — FOUNDATION
own'e'r
0 d line his own mnPloyceI provided Ina(sap,Impmvenm oId me not t c .r or
onmele nor.daps u;eswtoer,m..nodding or anpmwmprnt n sold avenin one year or .1.02 — PIERS
1 ,�
um,pletlnn,then,i,of oildtr will hove tilt burden of proving Ihof be did not build or
nprove for ptUast or sale.l. ' 1.03 — UFEP.
❑La, ,di the propct,n uiuxivelycontracting with licensed nmmaetul3to 104 — P,EBAP.
Liconsumer the project(See.7614,business and Professions CWC:)The Conlmctor's
cense Law docsnot applytoanowner ofpa,pprtywhir builds orimprove%prevent, 105 — ANCHOR BOLTS
mad whsv,arm,l ,bsuch proJcpn wenm
,a confactnl Rm
cer.ed par tent to e 106 — SEWER R 1 IATER
c.,nlr r' License Law.
❑ oplonamRec. RmIs cbut ntinreaa"" 202 — UNDERFLOOR PLUMBING
WORKER'S COMP�!�N'SATION DECLARATION 203 — IJhIDERFL00R IYIECHANTCAI_
1 I hereby affirm tinder Penalty of perjury one of following decimation,: 204 — UNDERFLOOR FRAME
Cl1 tome atm ill wa tibemc or Cooler to,elf „me to worktrn 20` — LINDF;P.FLOOR I hISULAI"IOI51
min ai ce,
Comprnea0ml, as nov'mm b„ by Sectio, 3700 of tilt Labor Code, lot the 301. — ROUGH PLUMBING
performance ofthe work for which this pencil iswW
i, . _
0 have and willsnainmin Worker',Compensation Insurance.as required by Section 3 I
02 — UB t OR SI-101-JER
37M of the Labor CWe,for the performance or the work sat which this emat i., 303 -- ROUGH MECHANICAL
issued.My Worker's Compens:vion Insurance carrier;and Policy mmrber are:
carrier oI'pyNa .04 — ROUGH ELECTRTCAL
CiI1 FICAI IONOFH.YIIMI'I'ION TROMWORKERS' 305 — FRAME
COMPENSAI ION INSURANCE
31:16 — HOLDOI.INS
me%welion need not M completed if the permit is(Lir one hundred dollars
aslfu)mlp...) 307 — INSULATION
I ttrlil'y m Int prall,rn,: pp or me work for wnipe Ibis per,mt is i...d.I 308 — SHEET P,OCI(
.JI not cnq,ln pmnn In un t ,npeoinp xuM1Jcct m tet Wotkcrs'
Cnn,pen.:,tn:nL 'alt . a 349 — EXTERIOR LATH
M1 pICGTOAI' .IC :at nnukingl ,s eoticate,ofExemption.you should 31.0 — TNTEP.IOP, LATH
nephro,v pipet u, �s onsonne laboreWe.you mt`l 311 — SCRATCH COAT
O Innhwith avnply wm wch Nov,nt nor this pcmul shall rte deemed revukcd. v
Fez. CONSTRUCTION LEN DING AGENCY 313 — ROOF NATL
IherchyIJRnn mm there i s a evmlm,'n frotin•aane for liar c
s bb r per 501 — FINAL ELECTRICAL ENERGY
nl tilt work I'ur which Ione Per nu m ro,ncJ(Secs 4119].Civ.C.)
i p I tde`'sName 502 — FINAL PIAIMBING ENERGY
5 z Lender's Addrc.w
U O Icenirythat Ihave mad this application and%ratethat the aMveinrormaionis 503 — FINAL 14ECHANTCAL ENERGY
'a. F- correct.I agree tu comply with all city and county ordinances and state law,rplming 504BUILDING ENERGY
O U ,buildiagcon,beeion.tad heony aminimmpresemmior,or to,city to timer upnn —
y Ptcalso,.memmnedprnperyfor enppdionporposc.' S FTON'
ELECT . CRL
1 vc ,,save,lndunmily nal keep Hama...the Cayor Ct loo ugnlnstm liana iodg,nemt,.port.ane esppn.m,winch may in any way areae:Igam.a said ,iOF. — GAT7K
on ce'4 me g ,ming ofthis permit. rjaO
AN INHERSTA!DSpNUWILLCOMPLYwITHALNON.POINI' ISStled b - I G Date
RF#I' q ' y'lcxnJCnmmam dam `1 Re-roofs
- ... ..'.. •'••-••ALS DISCLOSURE 5 — FT
FINAL GRADE
Will the nppllcam or from eullding occupant sore or handle haimall nanCrial Type of Roof
a,defined by the Cupertino Municipal Code.Chapter 912,Lind the Health and Safety F10 — FINAL PLANN1 PIG
CWe.Section 25532bar?
❑set, ❑N” All roofs shalf3Ae'finspediear0136r t(PIApkobfinbiifiTflfri@ being installed.
Wi l l the upplicant(i,future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hanrdous air conmminams its defirod by the Hay Area Air Qualify Manogtmenl
1)"W'C all new materials for inspection. Applicant understands and will comply with
EI Y- 0 N
all non-point source regulations.
I have read the harardme.material,mquiremenls under Chapter 0.05 of the
Cut,Iniad Health set Safely Gds.Sections 25505.25533 ad 25534.1 mudentunJ thm
irincb ,g Jnee nm cnrcney hereatewn6 tile it is my re,pemibility u,notify fop
a', nl the reyuirnnem which mull be net prior m issuance or a cedifeme of -
° "'a"` ,�� Signature oCApplicant Date
ownt,o,guilt....,.4,n ' —�hart —` All root'coverings ID be Class "B"or better
OFFICE