00100108 t I
CITY OF CUPERTINO, "" ` "' • t- '
BUILDING DtvlsroN .. PERMIT "; CONTRACTOR INFORiVIATION:'
BUILDING ADDRESS �. t - PERMUNO,
,104Es1 SERRR ST / �i. , ~GU T:' 6•hfS'/
OWNER 5 NAME APPLICATION SUB DATE,
BIG GUY INC
s
PHONE i ` - ''f r SANITARY NO.' CONTROL NO
^ .Q a Z ARCHITHC'I'IBNOINFER n . _- BUILDING PERMT INFO
O ,, <. CT 'PLUMB` MECH
• BLDG ELECT
=� , k � ^7'7 , <�` Imo, I-� �--1= �_�
of
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S]D CON'rRACtOR S DECLARATION' %"'
I- � LICF.N C • ,
m'� .r - >' .. Job"Desch tion
z (commercial,
1 n ny Ir n m t 1 reenact na p ren pt � '
�Z,H 'mf i ]Bons) FD 3 fthc Bu JPrehension,CJ ill myl n'• -
F Lai mr d Bet. Y- ,
a e� .e clan, '..E n • TEMP;-.ELECT I.I. at
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ARCHITECf S DECLARATION v
1 understand my plans hall he used as public ords t - 'f- I'
0000 Lc d I :: '1 - i
OWNER BUILDER DFCI ARAI ION -G s , t t e✓
I hereby mania that 1 an,asmapt from life CoproactoA License Law for 0th -
> t;ZQ toll gl a5 t ]09Lt N .' dla f :' CdcAy ty ty, tl sr'
e, which raOiras a Ineriarifttmv,olt p duarolislil repairany t la
priarto its issuance,also requiresIh appl' 'orf hpermit t tildesigd t tcnenl
math tidp - It th - nof(w c ntt r License L (CI pter9 Sq. Ft. Floor Area - - aluatio
1
(commencing Sect 7000)of Division 3of(h R .ne and Professions cede), • -
_ .1 In,he is cxe opt match,n an ad the bass for the alleged exemption.'Any vrotation -
ofSectnn70315byry up,hicalf paraffitxbject, heap,l' ,.,m a civil p ad,
x t' of no,more than five hundred doBad.($50m, ;'APN Number -Occupancy Type '
❑Pa. am of hepropens or ny cmpLYecs x'lh wage'a:thersold'empau"fon, o. L.O
will do the k d the structure I intended or offiered for sale(Sec.7044,b , -
Bu d P f ' Code fl e C 1 r f L I not apply man - ,Required Inspections
I property WI h IJimprove,there n,and h, J . '- n rk-ht am,If. r ' •t.. .
orthrough h': '
ply .p dI that schmptwaracm t'unleaded er ] Q13 — % .,-% . - -
offered for sale.If,
rh thebuilding' or nprove nem I withinfine yr(if
't
... , 304 ROJGHEnECRICa - _eompedn alawin have the burden ofprevlgthat hedid not
Imp •for porpnvcofale.). _.:
❑Id fin pnpny Iiia lye tel g. Ih l' J nr ,
'
cbrrcct thehe project IS c 91144 R t d Pr dos ons cal ).TIContractor's
n
C 1tr 0) � ' • y. r P i r. _ -
aid 1 for ern`.a.comfywnobu ld. npmeuh ,
and who omrnm far such projects with u unm aldr(.v)lice vvul pumaanl t they - 'X
Contractor pt nso-Sec ' '- ,
❑tum exempt lntlei Sec, '.BbtPCfor this r ani " h, *A' � •
Owner ' Dat µ
t !WORKERS COMPHNSNNON DECLARATION "
Ib hyR dpa l'Y fP1Y Itl 'f 11 gJl f ..- h
O 1 h 1 -di t' C Life t f C wiln If'n. cif r Wokor'e
Compensation
ompen at n as pr Ided off- by Section 39001 f theLahrr Code, for the
performance of Thework h r which this p rnr I i,.'ssued ' < -U
_ ,OO Ihue and will'maintainWcark 'Compensation 1 : culted bySection
3700 of be Labor Cude,for the dicurfunce of the work for which this per i h is
issued.My Workers Compemmmn Insurance earner and Policy mmberam. s -
Cartier: -Policy No. - t ` .r p'p '"`•
CERTIFICATION OF EXEMPTION FROM WORKERS' 'a rq�. t'• 7
COMPENSATION INSURANCE i ,t.•• - '
(This were.need not he complewdit dollarse pertnh I,for one It hdead dollais
($100)or less.), ,-
•• I certify that In the performance of the unrk for which this permit is issued,1 -
'hall not mal any person in any manner so as to become sunjwt to the Wo ked '• t
.Co p t' t Laws I California.Date - !. c �, y ,•z. - a
.Applicant• _
NOTICE TO APPLICANT If.after making this Corti Bet fE mph y should . '
latneard amble.t Chit Wtorkne,Commit dl pp .of the LaIsucdr,you arm, •. " !
' Q Q
forthwith comply w fit SuchpowLsionei or this permit shall be deemed revoked rn. '
CONSTRUCTION LENDING AGENCY • '' } F �r
a 1 her by%[firm that theis .t i lending gencY for thpromounwoL, r
Lak s'
eo f which this pc n
nun. o ed(Sec 309].Civ.C)
Q d N q
Ler ,
Qader's Address
1 en'fylh'Iihave rad has "Ificinican and.it tbar liabove inic41 - t n
•ey icor t.I g t nplY withall,ctry and county ardargal ad late laws rel t B I
'Q Lj mhmlBng vt lin and hereby authorizeflhns.ty to lime armif
Ib ,p, k.
then emenet ned property for inspection u, . . - - .hr
(W) grarm save,arrimmunlymnall pia nl thcCp `Cupnln ab n.l .t
.Fy Z liabilities,j dg v .t_'and experfas which may in any way accrue against sand s
U �y_ 013 in comicquenife of the granfingofth permit •z r
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: ' -Dat
SOURCE REGULATIONS , Y
Signature at APvlicaMContmcmr l• Dam Re-roofs -
HAZARDOUS MATERIALS DISCLOSURE 'sl
- word ppl'aum_orfuturebulding lw r JI n e- :mater w' °Type,of Roof-, - "
as defined by the Canadian Muo'e, ICode,Chapter912,and the Health and Safety A,
Cod 'action
ocu n25532(e)n' + r p •. ,- ,+ •�. ' .. If
Ely's
- -. 1:1 No •' All'roofs shall be irtspecied prior to_any'roofing material being Installed.
w ll meappl `I ! min n lelns npinha.ecy�phe 1 ', n"n '.-If a roof is installed'without first obtaining.an inspection,'I-agree to`remove '
cm t h 1 cont n nt. as refined by the Bay Arca A Q ply Ma(ag mens s� - - I
Dlat t - all new materials forjinspection. Applicant understands and will coiitplyiwith r, .i.
•rj Yes ❑Ali ' r .all,*non-point,source'regulations. - r"
1 have d theba and t requirements d CM1 pl 695 f N .d• "+ '1 ,�. S S w ' Y •',•
CalifH lth&S t IyC d Sainions 25505 25531 and25534.1 underscoredthat
u
rowhich em to t In rot'., Y p fila Certificate t - p a ^i.- f •.•'.r 4
p t of the regi le Iv, nhsth rpnoyhc ss f of _
Occupancy, - - rSignatureofApplicant Dates• -
' - ownanrannma..edaKeni; ' - f ,, Date 7- ' All'roof coveringsto be Class fB"or better - - <• --
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�' :OFFICE �,