01040036 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING AUnRISS: Pr.RMrr NO.
01.040036
OWN'ER'S NAME: APPLICATION SUIT UATF.
04/10/2001.
PHONE: SANIt'ARY NO. COM'ROL NO,
1
C ce Z ARCnITEC171:NOINEER: If UI LUING PHRM I'I'INFO
Ru BLPO ELECT _ PLUMY MECH
Nab FR, -r' f-1 1=1
Z i= LICENSIiUCONTRACTOR'SDECLARATION Job Description '
0�_ 1 hereby aRinn that I an,licensed under rrnvoion,of Chapter 9(commencing
;t taq with Seer ion 70('()),if Div inion dof(hv Basin...and Pon c,,ienc Code.andnty l iccnm
¢ms< i.inmuIan=andlrc
eal.
r< PATIO ADDITION.
s s¢ Lice it Clas Liv,x
0 i U rate Cotnntern
W3 vFi ARCIIITFCI"S DECLARATION
z O S I nnderswnd It,plans.boll be used au public recent. F'I NA LE D
y ❑OI,imnenl Pm(e.wiowl
J
c,aeOWNI:R-HUII.DHR UHCLARA'HON
u1 1 hereby anlrm mat 1 am euimpt fn,ln the contractor License Law for the JUL 3 1 2001
1-ZQ foreas
lloxingon.(Section 7131.5.Ifusine. mW
e Profession Cmc:Any citym coun.y
u�1S O which reytlices a pcn nit to cerma et,ahimprove demolish.deolish.or repair any suuctare
3,moo aiortn iuiw.nantc.:dromauireumenppriant Na seen penait,a ilea,ped,a,cant
mat he is licensed pendant to the provisions of Contnanc.License Law(Chnpter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 71)(0)of Di%i.ion d of the Nminess and Professions Cmc) B ILDING
of than Ice is exempt therefrom and the bassi%fir the alleged encmPlion.Any violation
of SeOn 01111.5byanya,licrnllira"non,st,bjcs,.Ihc npplici Il o;,civil Perot,,
of not more than live Wrolned dollars(85at} APN Number Occupancy Type
D 1,ns owner of the P,.,ny,or a,,employee,with wage,as their side cona,.,,tinn,
will do he wink,Lind he onamre isInt in ndcd or Otered Por sale(Sea 7,414, 3S93i@49. OL
B.,inc.s and Prornanns Code:The Contractor',License Law docs not apply In on Required Inspections
p ny w builds nt improves thereon,and who docs such work himself
or n nmgh h nw pinyecs.provided that such impnnememe are not intended at 101 — FOUNDATION
nLet lin le.i� cl'.Ihc hnildang to no,novemmnl is sold withincre year at
imnnmd m mets �,o 1, will nanc,I 1 ,nf pins"',roar he did nn'build or 102 = PIERS
mpruse Pa r al
crl,aniescdusool ,�arng wilthun.edem,Iraclnn m 103 UFER
tjm Sce.7(Fids Businca.nJl'rufccsinnxCmc:)'IhcComracmr's 1.04 — REBAR
Licel, aw d -s n o a ply to an owner of propeny who Wilds or improves thereon.
,ad mw,can actinI such proiceis with a cnntmctntlsl licensed pursuant m the 105 — ANCHOR BOLTS
Conh:nonr, Jcuv6 saw.
❑lalr�a oma ,sec. BNe PC ionic, -.,on _ 106 — SEWER & WA'GE'R
Owen a,= / r 202 — UNDERFLOOR PLUMBING
0 dz*S Ct)yNSA 1N I .CLARAI ION
Ihcohy alEmn Linda h r one ronnwm acnamlmns: 203 — UNDERFLOOR MECHANICAL
Pena yrs pale or Oben g 204 — UNDERFLOOR FRAME
C cos, and will provided
n a qy Seco nl Cometh m ncllabor for workers
emnpenmdnn, a, prn.;am for by decline nen of me Labor cmc for the - 205 — UNDERFLOOR. IIJSUI_RTIfJIJ
performance of the work for which this IKnait is i...ed,
301 — ROUGH PLUMBING
Cl I hove the
ab r Code. ortheWorker's Corntance f t e work f a, hick this
by ticctinn
nal of me was cmc.rm me hcrnnnmtnce nr the wank for which laid permit is 302 — TUB R. OR SHOWER
ismcd.My worker's connpen.ation Insurance carrier and Percy rather are: 303 — ROUGH MECHANICAL
Carrier: Policy Nn:
CrRIIFICAi'[ON OF RXEMPI'[ON FROM wORKhRS* - 304 — ROUGH ELECTRICAL
COMPENSATION INSURANCE 305 — FRAME
nhis ,,iica nem not lie cuniple,m'rr erre panni,i,Inr on.nnnared dollar.• 306 — HOI_DOWNS
(slap ar Ie,>1
1 cnnily mar in me 1,ctfnnnam=of me work to,Want his lncmm is idiom,l 307 — INSULATION
.nail not ennploy any hcr.nn in any corner.,,a. ,,becmne..oeli in me Watkern 308 — SHEET ROCK
Compensarmn law.of Cmdomia.Dare
Apple""'
N,kal?'I'0 AI'I'LICAN'I':It,nl'Innarking Ihia L'cnilicutc of 6aenrption,you should 309 — EXTERIOR. LATH
bncome d.bj,,,In he W..We,Cii,cnda,ionprovi.bn,nf the labor Code.y"al
"ntisl31@ — INTERIOR LATH
Q p ronhx int comply with weh prosm.....Lir this lumbi,doll be accrued rc—lord.
Z
V] CONSI'RUC'I'ION LI!NDINGAOI!NCY 311 — SCRATCH COAT .
I hereby affirm that there is a construction leering agency Ran the pedonarnce 313 — ROOF NAIL
of the work for which his permit is issued(Scc.3097.Ci,C.)
Lenders Nance, 501 — FINAL ELECTRICAL ENERGY
Z 1.codcr's AdJrerx
U O . Icc ifythat Ihroewad flo—pprcaionand state that the abnreinformation is 502 — FINAL PLUMBING ENERGY
cz E, (aml l a as on.; " t1 it, J tr a 1 a.,n k lafng 503 — FINAL MECHANICRL/ td€RGY
OU uMir6 'Em 11 11 ....... I . an 'y ttric�
} w mesh a dprpcnyf . aT ,sI C)(2!D4 PJ ,R UII NG f Y
) t m a fy d A P homle Ili City f c pun against JA...�
WE hatialai in ca,,.c tand ca Inch any n am aY a,croe against mid ,.105 — FINAL ELECT
U Z Ch v n c cc bane, it ndcd pct rim. ( _ _
IC 1 D qNU. N LL COMPLY WITlI AL1, Jjll/±% Issued by: TEST Date
HAZAINOU
- 4 MATERIALS DISCLOSURE:''gna,trmnrnnplla /ARDO' Rc-roof 508 — FINAL MECHANICA,L
Will maapCoNa, Entire i,sedCosec hart Toremhandle Healthanmaterial Type of Roof
a.de.Sedbymecnpcoin,nMnnicipademecnap,ero.Iz.add meHealtnawSafely 509 — FINAL GRADE
Code.Section 15$lYla1"
0 Yes rem All roofs shall be i�fl'gted pFeJ)rft4ny Wo WNJ1tfAlal being installed.
Will 11hea,licuntnt Entire buildmgocenpam uw cyvipmcm nr de,ices which If a of is installed ottt f1—rsI09)EiniRL19Lir I echtQ"ree to remove
7n'u haeardnns Dir eonnnrin: 11 a,divined by,he If:ry Area Air Quality Mumgummnl
uW�' r
n++t� VNion
materials for ins e- to . Applicant understands and will comply with
-point sourc re 1• ' s.
the L oach n.mncdals ,tiirecaran,under Chaptcr 11!15 of Ihc Sal uty Cmc av a to H5U5.35A nor 8514.Ii nJommndthenot civ Codeody hmaens255nant,hat itismy resm,mihilitytonotifythe
hal ,'we nen"wh. t .rnet prior m I Ceni en¢of
�� f Signature of Ap - nt Date
agem Late All roof coverings to be Class "B"or better
OFFICE t