01020025 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: I PHRMI'I NO.
10460 SERRA ST#2-12 0 01020025
OWNER'S NAME: U APPLICATION SURUAIE
THEryBR EN GROUP / ✓^�" ^ '� 02/06/2001.
PHO NF i°/., � /r�� SANITARY No CONTROL N0.
nat AR 1111'I ECIIIIN6INEUI:% U� BUILDING PERMIT INFO
F lil.lK IiLECY PLUME MUCII
UU I'—t I_I- Cl 1=1
di
SB= LICENSED CON'TRACTOR'S DECLARA'I I ON Job DCSCCIpI1Dn
I li by II"m, 11 n l :ed ori p sof Chapter 9 Immmc,w ng
Z14 p 'tit 5.1 atalu),f 3 ftl Rain l uls', a,J sty l«see
;ser ae•R sw¢ FINAUM�IVING SPACE, 723 GARAGE
Live CI IIcM v
� V D tc !t� Curl 1
� ,y CI II I1 6'I S Ill U to
LLo, t,lan nr 'nalln n Ja'ti. AUG 12 2002
License)Profe„innul
11id I ou"BIPLUHRthe
Contractor's
,_ I hereby,sv,illion tit.,1 U,Burin from eche Contrm,Co Am,a last for the BUILDING
I—]>' li,llnwin mason.IScainn)1111 s,Business and Pndcwninns CnJe.Any oily or county
E,x c which m It ores a .it m co-:ruch miler,improsc.Jemnlish or action an,,stew,,
u5� footnotes l�euance.uhnlegULrestheupRlicnnl L,r such permit to file it signed sunement
mal heislicenweJpuraunnnmepmsislonnofthe Comers License L,w(Chapta9 Sq. Ft. Floor Area Valuation
(commencing with See, 7S)(L of Division 3.f the Rusiaes'end Profession,Ca.l,)
or that he is exempt therefrom and Ise basis Ion the alleged exemption.Any violation
.f smarm,7031.5 by any applicant ran Permit InNOO,me appreed no.a civil penalty
of not mom than Five hundred dollars SNKJ). A PN Number Occupancy Type
01.a,ownenf the pmlamty.or my clnployeew stili,wages a,their sole lumpensaaun, _•� _
will do the wok,and the structure is not im,d I d or olfned for sale(Sec.7(W.,ions
business and PndcsCwle:The Caution
Liern,a Law docs,sol apply man Required Inspections
owner of pmleny Who build,or fn,pmwew thro ,and who does such work himself
or ough his own employees.provided ma,catch bmnovcmems are len lmelmed or 1.01 — FOUNDATION
offered for.sale.11,however,the building Or improvement is sold within one year of
iompl.ann,me owncOutim,r will arx 0,blm,n olnnnvb,g mat h,did an bald o, 1.02 — PIERS
mprove ler pum„'e.reale.).
❑1,as owner Of the property.antit,exclusively contracting with licensed cormorant, 1.03 — UFE R
r.wd the pk.Jeet Ise,.9044.Ruxhe.w,mill Pmmmnr
,orex,ion.Code)The Contract,,, 104 — REBA R
License Law does not apply to an owner of pmpcny who build,or in,pmve,thereon, -
and who contracts lop sacb prgiects with a ct moon,) licensed pursuant 1.the 105 — ANCHOR BOLTS
Comrvcmrs license Law.
❑1 not c,cmpt mala live. .b s P C nn,hi,reason 1.06 — SEWER & WATER
Owner rade 202 — UNDERFLOOR PLUMBING
WORKER'SCOMPENSAIPON DECLARA'r]ON •203 — UNDERFLOOR MECHANICAL_
Ihereby aninit under peer,orp,rjnryrare orthe muowingdeclarations: 204 — UNDERFLOOR FRAME
❑ 1 have and will mutation a Cel ilicae.r Comcnl to self-nwre for Worker's
Cm„pennaaon. :s provided far by Sceaf o. 3700 . me La1a,r Code, ler he 205 — UNDERFLOOR INSULATION
lien!ole,anceof theworl,forwhichthisrennaisi„sed. 301 — ROUGH-PLUMBING
❑1 have and will maintain Worker's Comilwnvtion Insurance,as actluined by section
3300 of the Ialwr Cele,for he pertmemo,of he work for which mil pronal is 302 — TUB & OR SHOWER
icwcd.Me Wok�fs Compen':Idol, n, u cr a.,d Poll me,-mre: 1 303 — ROUGH MECHRNICAL
Gamed— u 304 — ROUGH ELECTRICAL
C '119C\ ON OF F:XE 10 FROM CORKERS'
1\ p S ANCA 305 — FRAME
(Ihis,ccu.I,need mad.Is,...npleled it the peme,is nor.na barbed dolka, 306 — HOLDOWNS
alas m 1„a.)
1 One ify ma in the pedm,aper
once of the wort for which his mit i,issued,1 307 — INSULATION
'hall len emptor any l or'.n in any mummer co:,s ro become,object t,,m.Worker - 308 — SHEET ROCK
eomllco,aaon Law,of California.Dae
Apphcm,t 309 — EXTERIOR LATH
NOTICETO APPLICANT:11',after making his Cenilicale if liscmption.You should
le. me sunca„,the Wo:Aer''Co:npcnsuti.I,Is 1,1on,nr the Lmlwr Gods,yn.aesl 310 — INTERIOR LATH
but OO .
, ply amhash such prwisian,nr this phall ermitull he droned ree.kcd.
Z . 311 — SCRATCH COAT
CONFTRUCfION LENDING AGENCY
> It,mby elnno mm acre is m construction braid,all,trcy far the penr —
omminee 313 ROOF NAIL
(s7 ofine ,NnamewbicM1,histiermili,i,c.erils,,.31,n,ay.G' 501 — FINAL ELECTRICAL ENERGY
Q of,lo,m,u's weak I.,
= 7lander''Ariake,,
502 — FINAL PLUMBING ENERGY
U O 1 cannily mat I have read his application ane state that the above in utonnion is v
I. P correct.Iogreetocomplywith all city and county oNmancesand%ratelaws relaeng 503 — FINAL MECHANICAL ENERGY
O U heaboingeon'wcdonoperty ari smhmimacpeents. tivcanithiccity n,nnclupnn 1504 — FINIAL BUILllING ENERGY
W theahoirr, or,hoci m,and hfm Inspmmionpumme:.
,t'r„ L (We)agree in.w.vc.n,dnanly and keep harmless the Color Co,rino l,guinat _
V1 liabilities,judgment.,,costs and cspaLses which may in any way acme a said 505 FINAL ELECTRICAL 3 _ZZr.o
Uz City,n go,,,.,on he gpm,nn. hots l„runik 506 — GAS TEST
APU C NTULARSTAYD.' WILLCOMPLY WI N issued by: Date
I Is
—� . NP
Re-roofs 508 — FINAL MECHANICAL
HA%ARDOLIS limTERIAIS DLSCLO”URE
Will the applendOr mmac ealding n„op:mt'm..e hem lm h.rn1oo..macd.l Type of Roof - 509 — FINAL GRADE
as dehnN by the Cupcnino Municipal Code.Chapter 4.12.and the Hicalmh and Safety
Codc.Section 259321n11 1 r t
❑Yes All roofs shall be "S acted ,for an �U71tt# or
A��rial being installed.
Will the apPlicanl nr future�goccupunt use egripmcntnr devices which Ifa roof is installC �w#ihom IIIc tai I ]KIPM,
� MrAgree to remove
snit hurardous air..nmmin:uns as AcfneA by tit,Ray Aro,Air Quality Management
District _ all new malerialsw nspectFt pFkp�eLu PsAhAnd will comply with
����,
C Yes �— all non-point soulE4?kZgu4atift8OF BATTENS
I have mad the h:¢andons materials mquircmcnts under Chapter 6.95 of the 604 — ROOF IN—PROGRESS
California lieal,h k Safety C,Ne.Sections 25505,25533 and 25534.1 undcramd that
if the h,A.11__Le.num cu,mmyk a nlenrnt,thm ins is mY re.ry,nu IitymnmifY the
tee t o the on,rem in w el must lin Inez prior m Iswunen t x CcnJ ':ate or
O`a' Signature of Applicant Date
t - )„m� All roof coverings to be Class "L3” or better
innaOFFICE