00100009 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERM II'NO,
uwneR's rvmfl,8610 STARRETT CT - ArP1.IcnnoN
PHONE: SHIN SAN)IARYNO 0/06ktdi0q1` .
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O O ARCHI'rECT/ENGINED;R: BUILDING i1I7RMI'I INFO
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LICCNSpDCOVIRACTOR'SDECLARAi'ION Job Description
S v 1 Newby uDEnn Thal I am licensed under proOsiom ar Chapmr9(commencing
m I- w with Snmlon7d(XHuf Div lninn3ords,Hu.Inexvand Prnfeminn,Cale•and my license
xzi,in full free and ellem.
o w u
u License Class Lic.X
Dale Committee`
P, ARCfI1TFC1"S UF.CLAHAr10N ELECT/PLBG/MECH REMODEL, WATERHEATER
Fs 3
F v'L1' I m,dcromnd my pinnv Miall he uwd hx alibi,ceorck
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w6Pie
p ILicensed profe,mmul
W
e,?.e OWNER-HUILDIiR DECLARATION
hereby Pullin rhea III en"a!mm DIM Convacmr-,License 1,.,. or the
C Z< Edlowing reason.ISaGnn 7031.5�Emone,and Professions Code Any airy or loamy
S O which examines a gambit to consumer,oiler,improve,demolish.or repair any structure
i3ce prior its issuance,also requires the applicant forsuah pannitto file a signed canonical
romheis"'Prkal.ltwtcham=r9 Sy. Ft. Floor Area ,Valuation
(commencing with Section 7(XH of Division 3 of the Husiness and Pmressionc Cate) '
at that he is exempt therefrom and the Nxis for the alleged exemption.Any violation
of Section 7031.5 by any applicant fort permit sairpOs the applicant u,a civil penalty
„r ear m,�re than rise hundred data,,($500). APN Number _ Occupuncy¢]�pp
tuner oDhe propenyl nr my employees with wage%as their sole compensation.
will do the work,and the structure in nor intended rr offered rile dale(sec.744, ?75^r60'�9.R7ifllired Inspections.
Rusin ,.s and 1'mla,imu Cadc:'I her drallur's License Law doe.nor apply u, in v G
i ow
P,
of pmpcny Who builds or improve,thereon.and who does such work himself
or through his own employees.provided that such impmrnnenrz arc nn,intended w
offered for.sale.If.n w ,el,the building or improvement in sold within one year of
Iupintimh,Lha owmobaudel will have the harden if plowing late he PRnot bald or 101 — FOUNDATION
t„prwe farparpawof,ale')' 1.02 — PIERS
❑La,,,wnerollhepropeny.ameclu,ivelyeonmactingwith licensed eommetInto ].03 — UFER
LiIuaethe projcm(See.7014,11- n t Profcx,i Gide:)The Conanemr'n
el cense Law does all apply to an ownw er or property who builds or hbprnne.mere"1, 1.04 — REBAR
and who commas for such projects with a contrahods)licensed pursuanl m the
Comme,o' Li° '"'Law 105 — ANCHOR BOLTS
❑lame npl o I&rc fnnm,reason
owner_ -- utile l° ° a 1.06 — SEWER 8. WATER
WoRic[ns COMPENSATION Dr: Ln A'r1ON 202 — UNDERFLOOR PLUMBING
I hereby aflirn Paeer(nnnlry of perjury one of the nhuowing decloati°ns: 203 — UNDERFLOOR MECHANICAL_
0 1 have dad win maimain a Cenihcme of Crown, a,,elf-inxme for Wader's 204 — UNDERFLOOR FRAME
Comnea,ation, Its Inovided far by Station 370 of the Labor Cale. lin the
pe,rnnum,,ronhewndrorislashmi,I,vrmiiinissued. 205 — UNDERFLOOR INSULATION
01 have and will maintain Worker's Cnmpensmion Insurance,as required by Section 301 — ROUGH PLUMBING
370)nl'Ihe Lahur Coca.Go the perti,nnun a of the work for which this pal is
issued.My Worker,Compansat iar ln,oname carder call patiey 11 othei are 302 — TUB 8 OR SHOWER
carrier: paheyN., 303 — ROUGH MECHANICAL
CERI'IPIC I ION OF COMVFN'SAIIION INSURANCInION FROM WI)RKHRS' 304 — ROUGH EI_F_CTRICAL
1'ITis section recd nm He camplened if,he permit is farmehundred dollen 305 — FRAME
(SIMMarle,,.) 306 — H01_DOWNS
I cenify that in the performance of the work for which this permit is issued I
.hall not employ any perseer in any,narner so a,m wermc subject m me worker, 307 — INSULATION
Carol,raanionlaw.orcwiron.ia.Dale 308 — SHF_ETROC14
Apprctnn
NOTICE;TO APPLICANT:uadtermakingmi,Canireme of txemmion.you shoals 309 — EXTERIOR LATH
became subject to the Waders Compensator,provisions of the Lal.n Cede.you trust
p C u,rFort comply wpm such pa, tion—, his permit,hml no darmed revoked. 31.0 — INTERIOR LATH ..
CONS'rRUCI'[ON LENDING AGENCY311 — SCRATCH COAT
' 1 hereby affirm mat there is a construction lending agency for the performance
W or the work for which this crout In issued(sec.3097,Co.C.) 313 — ROOF NAIL_
Leaderdr<
z Leader',AdAddress 501 — FINAL ELECTRICAL ENERGY
z
v O 1 Otif,than I have mad this application and state that the albiwe imformanion is 502 — FINAL_ PLUMBING ENERGY
W. carte.I agree ,,ednp,ly with VII edy i I county aditanaa,and orate laws Inuring
O V mbaddingaandincti .andherebyauthoroere„rsraidnw,ofthissay"Iearmupnn 503 — FINAL MECHANICAL ENERGY
E^ y ,he aMwomeminned progeny for inspection puepnses.
(We)agreene save,imlemuiryandow,Int...dem the ChtynPCuryminoagainct 504 — FINAL BIJII_DING ENERGY
Vl liabilities.jmignon,..u,sw an”expun,cs which nay In any way "em,apainsr said
U z City in consequence anhegriurn•M It,,Farm( 505 — FINAL ELECTRICRL '� Q 2
APPLIC UNDr TANDS D WILL COMPLY WITH Yj L N-POINT DHIC
CI R���UI I1' �S by
s a I Pii 1, ' r for - — Date Re-roofs 507 — FINAL PLUMBING
HAZARDOUS MATLRIALS DISCL OSURF.
WIIl the applicam or future building occupant store or handle Intenders material Type of Roof 508 — FINAL MECHANICAL
is"Miran by the Cawainn Municllntl Cods..Ch,pnar 9.12,and the Ileallb and Sufmy
Calm Section 2s532p0!
0 Yes (71 No All roofs shall be inspected prior to any roofing material being installed.
W tilheapnnePatorHmtrehaildn"'ec,Ipraruxeeq,I'Ipmnlhlaree,iceswbivb If a roof is installed without first obtaining an inspection, 1 agree to remove
emit hmardnus air coma vents a,lefired by rhe Hay Arca An,Quality Me..gnna.m
Di„fiery all new material,] egulelaill,(4Atp 4���l�nderstands-and will comply with
❑Ye.s ❑m' all non-point sou egul< t
1 have wad the ha,ardor,orinrdal,raquir cal,order Chapter 6.95 or the 510 — FINAL PI_ANN I NG
Califnmia Hard,h Safely Cole.Sectimn 25505.25533 and 25534.I undentund that
if the be iWing Erie,not cur dy nal alenatn,mortis my responsibility to notify the 514 — FINAL PUBLIC WORKS
neer, t nl' Ir rirena a ich oval he tum prior rn ixsua Crim Peere of
(' �0 2, Signatureol'Applicant Date
awl ,room aPg� t Data All roof coverings to be Class "B” or better