00030184 CITY OF CUPERTINO ' - -
BUD.utNGDIVISION ",PERMIT• CONTRACTOR INFORMATION:' _
Run.gwcA $ria:l SF:RRA S'i' PERM)I NOfdO)0)30 .-J.84
142 .
Ow'NERY.Nh�11jBRTEN GROUP. , APPLICA,'IkT��i"t`7.°T.4/�?t!JtdOJ
PHONE.:. ll J/ FJ +- � SANITARY NO, CONTIt0LNO.
d t
d
S.O ARCHITECT/ENGINEEll, " BUILDING I'ERMIr INFO - ..
�
ZZU� �,. , 'BLUE ELECT PLUMB MECIi
w u, - IJ ''LJ 1.I 1.I
Z H bLICENSED CONTRACTOR'S DECLARATION - .v ,Ipt)'DBSCrI [1011
I hereby Aima that I am licensed under provisions at Chapter 9(commencing p 1
with Section 7000 f Division Sol Im Business and Proliixiae,Cod,id to license ,^ SP. ,' " '. " " '
a" � is in lull l„rce and elleet. ' r .. 46,54 1-.110146,, 784 GORAUF_
oW Licenx class Lic p - - -
3 tar,
Dole Contractor
- Contractor .
as ARCHITECT'S DECLARA'HON
C�'O 5 I utidcrsmnJ my plans'shall be eclat us public ncnrJa •
pO Licensed Prnse,in tai
o OWNER-BUILDER DECLARATION -
1 hereby dBrm that I am amount from the Contractor's License Law bathe -
F•Z G fallowing mums,(Section]1131.5.Businms m ad Ptn cssinns Code:Any city or county
hi ,
E rs O wch rebates a Ixmait to ccrobact.alta,Inrynrve,demolish,in repair any smrnum
al3prinarto itsy the ppl tfr suchpv ill file a signedstatement
Nn licensed r : mr the on fro c t r t Lier. La (chapter9 S Ft. Floor FlArea
A��h���ym��O_•
v(ocommencing with Section 7")or Division 3 so the Baser and Profession,Code) - tJ' - WaPY]i'r r"/'J
or that he is exempt frouraam and tin balls far the..mll,ill extop0on.Any violation
of Section 9031.5 by any appliewn fur a Permit subjects that"'Ibelnno a civil p rally
• m not more than live nm,dred dollarsdollars(slut). - APN Number Occupancy Type,
11 Las owner lir the property,army employees with wages as their sole con"revi imn.
will do the work,and Ne stratum is not intended or arcred rot sale(Sea 9041
Businesl and Prof w�n Cad�'rbe Contractors
License
ic xeL wasuchotpplytoai 101F0LJA��yt
Jffpections
opia,waynprveue ambles a
othrough -
his own employees,provided that such impro4cnetns am not intended or ,_- g;,. -
offered for sale.If,however,the building or improvement is sola within one year of 1.02 I;IERS
nmpletlon.Ne
.,act border will have the bounders.1 proving Net he did nm bold m` 1.6!];3 ....' UFEFi '
improve rnr purpose of naiad. -
❑Li,snw,aermnhe prnpenr.ante,ewh.elr enmactmg w;m hecnsed tmmtmemrs,n ... 1.j@4 REBAR - '
construct the project(see 74W,Ruaine.,and wdfessions Codei)'um Cprhaanmrx '105 .... ANCHOR BOLTS'• .
License Luw Jce.not mpply m nn owner of ProPeny who bullas lir Improves Nation.
sad no co mares lot such project,wiN a cooractmr(g) licensed pursuant fin the 106 •- SEWER KWATER -
Cumne,ons License Law. '
❑I xm exempt under s,c. .B&PC forrhi,matron 202 •• LINDERFLOOR PLU11BING
Ow^01Dam 203 UNDE:RFL.00R I'I'Cf.'1rlAlel:f.f.:Al_
WURKCIt S COMPENSATION DECLARATION '
Ihereby,mrra underperaity ofp lr of the following di,damow 20141 ".,UNDERFLOOR 1 (PIE '
'• ❑ I have as will m n al eel 1 f C t to: Bin for worker, 2015 _ UlADERFI:_OOR I LJI_AIJON
Co a i n p s provided r by set 37001 f theLaborN
Code, for e 301 R01.16K PLUI*IBTNG
lo,forriance or the work for which the permit is issued,
302 — TI.IB R OR SHOWER
❑1 have and will maintain Worker',Compensation Ie war f a, hick this
by Senium '
37ue lir the latkr coon.for the perfomancecmrer workfor which ms permit is :301:3 — ROUGH I'1ECHAI51TCA(_ .
Came,My Worker's Coaopenxatmn hsaricy No,hr moa,rorty nom hath`: 3014 = kbUGH EL_F,.CTR.T.CN-
cnr;en cmiF1cATIoNOEEx°elMPrIONFROMWORKERS' 3f!1'.'-i '-• FRAI'IE .
COMPENSATION INSURANCE . - 306 ••.• 1'IOLDOWNS
CI'hiscooia'n need not be c.nnplead if the pcmtit Is parent hundred dollars -
Sl W,urles,.) 3fd'"/ — :I:IISUI,AT:C01I'
1 cenify that;n the Performance or the work hat which this permh is i,savol,I . . 30)8 SI-IEF_'TFif.1Cl:' ..
shall nm employ u,y per-st 1.troy manner so un to hmturtmo bjee ma the Workers' r,
. cm,npenaatmnl.:,w,mrc:u nm;a.D„d 30.) EXTERIOR 1_AI'I-I -
Applicant 3:1.01 :I:hITEF{IOF I,_ATII
NOTICE TO APPLICANC If,ufm,m rkia,do,CeniNmm ur Emna,flon,you should
hetnoe subject the Wmtkers Cmrpnasrrmaa prmei.amn,mr the Lancer Code rmirmot 31.'.1. `- SCRATCH C0A•f
'O Ibrnwith comply win,.men provisions or this pemtt,han he deemed revoked. ” .
Z `3 CONS'I'RUCTION LENDING AGENCY 313 "• I'\GGT' -I*IAIa._ '
zIherebyafirmthatthemisacon,tructionlendingagencyfmrthe;prilonntnca 50:1. -' F:I:I+IAI... 'ELECTRICAL_ ENERGY
of the work Ivor which this permit ixixcl d(Sec.3097,Civ.C.)
5012 FINN- PLUMBING ,ENERGY
Lender's Address ,
U O Lender's AdJreza - ,.. _ r613 F'1:IalAL I'IFiCHANTCAI_ EhIEFiCiY
IcertifythatIha,ereadntsapplicathaund„atathatmc:,bovelnrmtrtioni,m —
e F.
correct.I agree to coolly with all city;and county 01dortne0carel state laws mining :105 5014 -' F':I:IdF1L LSU:f.l_D:I:hICi IEIaIEai('aY
Q U to building construction,and hemhynnnadm representatives or this city to carer upon r r... -
y w he dave-numtnnedpmpenyrarinspection arp ,. . - 'FINAL, ELECTRICAL
F0. (W).,metis maternally andkeep h ale theCil, t C,wmirma,r t n”
.ZZI Imbifilic,,mil,mens.cast,and p ,cx Inch no,in an, y arsomea,mans id , ' 5036 — GAS" TE=ST
U Z_ City'in ciaw,rer,eaf th samfia,af ni it - - Y_ - c
APPLICANT
UNDERSTANDS
Issued by:AND WILL COMPLY WITH ALL NON-POINT • SGT` '1`1(-11_. PI_.UI'IB.T.NG
SOURCDate lS-'•�•3�UC).
Signare.ml'Appli...07mormN, ,' . - .. Data Re46ofS 4: .. _ — . •. ' .-
. HAZARDOUS MATERIALS DISCLOSURE 5Of r� "' FINN.- GRADE ,
Will the applicant ornure bailatag;<copm,tom inifterinfle n, N usmaterial ,-Type of Roof
nxdeenedbythe Cupi: M p.a o Cnpter9.13.aaN a mandSftY 11 Cd F:fPl6al... f-'L_AhIWThIG .
Code Section 8533(a)'
/yc, r
El yes /N All roofs sliall belts act 'I i ,
y,J�'(tf�pz at•beininstalled.
wiuNennprdantmrurumndurhngeccupantuue9vipmenrJpacvheawhhn if a roof is ins[fal�d�'with �� St obki'l 11�'S n,� i n, 1 agree to remove -
corn d nt rs it rated AirQud,yMan,eacon 333
• Dist t r all new materiltl°s0�cti{'iBSp' '. t• Ylerstands and will comply with
oY N all non- oint s r-
I have read Nen .art u,r,merim - ri i� cents under Chapter 6.95 at the pt
Calr H alti Sul ty CW 5 tion 5505 2553v and 25534l a conA thw - /�J/(��Q/�
tllh ba'Io' g r 0 ale t th al'. r:p 'br.0 aril,the r -�a'� p
u p i r e b u.d m t. I C n Ewre he
°c p y ig p cant -Date
Ow rodagen s -,,e y, - All roof coverings to eCluss "B" or better