00070089 CITY OF CUPERTINO
1111u.DlNc DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADURP_SS: PERAII'r NO.
OWNER'S NAME: AI'I'LICAIION SUN USE
6263 SHADYGROVE CT 00070089
PHONE: SANI'ARY NO. CON'IROI.No,
BAKER BARBARA 07/14/2000
^
RUILDI NO I'LlUdi r INFO
40 0❑ ARC1 IITIiCf/ENGIN[I?R: PLUG ELIiCf I•LU}til MECH
FEW I`I CI I_I
¢d
'S�= b Lon thaa I?UCON'TRdCTOR'SDECLARATION lob DesC[Ip110I1
I barehyallimndon :nmol Bledome"Laori,ionx of ChnPtcr 9lcommmacing
is.See111 aLo7(Kglof altar. unl:d lM1aHminccsund Prulcav'ionv'Calc.andmy Gcenx
i se s, i.,in lull IixcumJ cllccl.
¢ Liaen,a Class' ' Lic.k
5 ° Dam Commmor
rn ARCIII'I1iC'SDECLARATION
°g 1understand myplans shall b used a,p.hire records ADDITION/425 SQ. FT. /
YVY% Q
Liccn,eJ Podeeunnal /
OWNER-BUILDER DIiC1.ARAnIIN
v1 1 hereby affirm that I ren exempt Ginn the Co coaco r',License I..w lin tha
tolbwing.,,,a (section 91111.5,Buonco,and Pcofeviwo,Cela:Any city ar conity v
FSp wbclin i oil Leel it i itt (R Le soh 11.i retailIIf I,I a I I I'i 1 11 a y.tnImm
a 3 prim t......acm,likon,,pre,thea,phelim knoith,,crall life b J: t mm
- ro,,Into,licensed por...not lit,mepowi ons oft heclnmarlr,License).a lchaper4 Sq. Ft. Floor Area Valuation
(commencing with Saban 0X10)of Divi,mm 3 01 the Nnsinas and Pond..on.,Code)
or that he is exempt therefrom and the basis for the alleged exemption.Any violation
of Session 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of at mom man rise hundred dmnars($500). APN Number - Occupancy Type
o L us owner of pmpen,or my employee,with wage,or,meb,ole compensation. $41059
wilt Jo the work,and the xtmemre is not intended or ofercd for sale(Sec.1134.
1 and Prmfes 1s C,c'lhc Conmanor',I.1move Law dlcs not apply m a Required Inspections
Its('.i progeny ovi���r 6lald,or iptpnwe,maroon.road wnl:dae,'all'walk him,an ' 7541029. 0171
orvthnmgb hi,own entplaflows provided That ouch intnmvmnen'are not imended or 3
Lm,c.l rot sale.If.how r,me building n ntpm ens',,old within one yea of
imcompletion,the owner.hander,'ill have the burden ni!pm,inb that he did cern bairn on
prove ler purpose of.,ole.). 101 — FOUNDATION
01.as wner of the foolery.am ewlud,ely contracting with l icenwd common.,as 102 — PIERS
names me project(Sm.1044.Business and Padessiuns Cade:)The Contract
License Law does not apply to an owner ofoot who builds or improves thereon. 10,3, — LIFERand xam
'ho contracts for such projce, with a trwtnds) licensed pursuant ms the
Cinrman,Lima-Lav 1.04 — REBAR
Cl I ren cxcnIDt under Sec. .It&P C for this rIaotar
n D„tit jl0y lap^ 105 — ANCHOR BOLTS
'.
IN A, N _06 — SEWER & WATER
I
barely a".mode pemlry of pelma ata unbar ahrwmg decmmfia"a 202 — UNDERFLOOR PLUMBING
❑ 1 have and win maintain a Ceaihcae of Canwr wB.m,are for warkar's 203 — UNDERFLOOR MECHANICAL
Compensation. as provided for by Seniors 3700 of the Labor Ca{e, for the
I rfrnmance of the work for wpe
hich this mt is issued. ^e04 — UNDERFLOOR FRAME
❑Ih:weandwiumainl:d6WorkersCmpen,alianlmamme.a%recaitedbySectir 205 — UNDERFLOOR INSULATION
also 0 the Labar Cade,for me perfnmancc oI the work or which mi,won.,1,
„um.My Wnnkar,Campc txu ion Insumme Ill and Policy article,are 301 - ROUGH PLUMBING
Caviar: ParcyNo.: 302 — TUB & OR SHOWER
CER'1'IPICA'IION 01;EKEbIPTION FROM WORKERS'
CO.MPL•NSATION INSURANCE 303 — ROUGH MECHANICAL
(This section need not ba completed if the permit is for one hundred dollars 304 — ROUGH ELECTRICAL
(aHgnmle"' 305 - FRAME
I certify thin in the icrlinntamc of the wnrk lin which Ili,permit is issued.1 306 — HOL_DOWNS
'ball not engtlny any tenon In any manner,,a,to be,, le sd,jwt to the Workers
Conlpan'miort Law,A C.IhN..ria.race 307 — INSULATION
Applicant
NorICETQAPPLICAM':If.Idm,mak{ng In,CenincntcarlIcmpon.yo.shoul`I 30B — SHEETROCK
lot subjecna(be Wader',Compensation provision,of thei`,AL Code,you must
Zz0 fanbwhhcomply with sumprovisions declined 309 — EXTERIOR LATH
FconstructionCONS'I'RUCr10N LENDING AGENCY 310 — INTERIOR LATH
1 hereby officer that there is a construction lending agency for the performance
4
of the wmk for which this permit i,lo,ned ser.301 Civ.C.) 311 — SCRATCH COAT
Q Leader',Name
5 o Leader',Addm„ 313 — ROOF NAIL.
Ieevifythat lEliot,rand Ink Loplieadonand.Ionic ntallheabove mfommtAni1, 501 — FINAL ELECTRICAL ENERGY
correct.i agree ret comply wire all city and county ordinuneeo and.amc laws relating
O e� Iahuildmgloommucron.amihembyaumar;.erepm,entahve'anli.,citytoemarul a 902 — FINRL PLUMBING ENERGY
�. pry) he aMwe-mentioncA property far tn,pectinn Pumtl,.el.
p-,
Q. (We)agree m'ave.indemnifyLand keepharmless the City ofCupertino agmmr 503 — FINAL MECHANICAL ENERGY
Z liabilities.judgments,coon and expenses which may in any way license against wid
v z
City in «uen
conqceofthesnonfn,ofon,povit. 504 — FINAL BUILDING ENERGY
"
APPLICAUL=LZFMNDS AND WII,COMPLY WIT BALL N�ON]�P�O1I/j4T Issued by: 5 � � Tlf-Al oI r=CTO1- Date
SOURCE REGULAT .. iillOD y' 13QIv r�ce.*-r�r_�c-cTTc-sT+AL
Citi APPlic: ICruo,,an {{Dam Re-roofs 506 — GAS TEST
nn'/.nluxnl5 MAfERIALS,m.rem DISCLOSURE otmerim Type of Roof 507 — FINAL PLUMBING
Will the upplicons nr lutum dot
m defined by the Culmina Municipa Chaplet J.l2.mafine He Safcry
Cafe.fiction.255320x)9 oNo 508 — FINAL MECHANICAL_
i
All roofs shall�0ipspectflfqqiALtoSpA�mg material being installed.
Will me applicant lir future building accupem use equipment on devices which If a roof is ins11{,,,,,yyyl1�f withri[�q ob` n r,�Iy.jgUection, 1 agree to remove
nit hazardous air contaminant,as defined by the Buy Arca Air Quality blanagemcer 1p 1JQFi1_ Ffl IV 11V13
Districrt,re, ❑No all new materi• Mar ins p�yrlLlll�Nl�ll}H,ILA� ��ladcrft and will comply with
all non_-point so L regu at
1 have mud the ha; too, in renuL wgdirmnem analChapter 6,95 oI tba
ClJifnrniu HenllM1&Smt'ety Code.Section,255115,25533 and 25534.1 und,cmand that
dole building docs not conically have arenact,taut it May re,geoihility ,,notify the
occupant of the requirements which must be net prior to issuance of a Certificate til
oaupars'. Signature of Applicant Date
1 lwnl authorized agent Date All roof coverings to be Class "B"or better
OFFICE