00090161 CITY OF CUPERTINO �—
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING NO.
c nonerss: 00090161
T Rn APPLICATION SUB DATE
OWNER'S NAME: 09125/2000
PHONE: SANITARYNO. CONTROL NO,
BUILDING PERMIT(NPO
G 0 Z ARCHTfIeCr/IiNGINF:f:R:
w O O❑ BLD ELECT PI,UAIJy— h1LC�-.
Za
L LICf:NSED CONTRAGnderp DECLARATION .106 Description
0 z j o bcrchy n1Rnn mm um lian,xnl under ,provi,i..m of Cblpter Y[conuncncmg
to withSeen I7(X)0)tarDivlvinn3oftheBusinessand Pmfc..ons Cock,antimy I fan,
� t bill Face e an'te'r`e` TOWNHOME 3180 LIVING/1102 GARAGE
z a License cl;lss Li<.«
cao ai O Dam (]omm..Or c
w3a,„ narmrecrs DrcLAR,vgfhN (190 SO. FT. I_LVING SPACE R•
Iunler%ands„ypl:ln.'Fall benocda.Public record, 551, SO.:FT. GARAGE/EACH UNIT)
ou o o ueen,ed rrofa„i..nal
OWNEWEUILDER DECLARATION
uXl o c,, I hereby affirm mat I v,,I exempt from the Contractor's License I."w for the
t_z¢ following maw...(Section 7(131.5.Business and Poor estoo,Cale:Any city or county
5. Q which require..a Penni)m conswct,alley,improve demolish,or repair any mremrc
i3� prmbo its issuance also”vim%the applicant for such poorly file a signed statement
may
c is teemed pension to the pownsion,nfine Confracmrs License law(Chapter9 Sg.F"Ioor Area Valuation
(commencing with Section 70X10 of Division 3 ofine Business and Professions Cole)
oc,that he i.exempt merchant and the basis for the alleged exemption. Any violatio
of Section 78313 by any applicant for a permit%objects the applicant uw civil pear t APN Number Occupancy Type
of not more man five Formed dalbrs($500).
❑1.as owner of me p,opertr.m my employees with wages a,meir.ole<ompemafn.1 2�0 9476
will do he wak,and me.wculre is an,amended ,,offered far sale(Sec.704cl. Required Inspections
Business and Prrcaion,Cade:The Connect.,',License Law does not apply u,an p�r
9@
owner of prapeny Who builds or improve,merver.and who Jots such work ninnelf
or through his own enmloyees.provided that such improvement'ore not imendef or Bu'LDI1r�G 5 7003. 00
'offered for sale.It,however.the hadding or improvement Is sold wl,Fyn one ye".of
completion,the iwnenbuilticr will have the burden of pmvlag tbut he did not M1uild or
,m
we bpa,v,va1,Ic.)' 101 —. FOUNDATION
6rf,oXnway,ohne,.spent,an exel..ively......deans"In rcen.ed<onrnalom to — PIERS
mxln¢I the p1',,ISce.71004,Bm and Prafc,wi ,.Cod,I I'he Conracmr'x 102
via e Low m„s oil")ply 1..1111 ominerof pmperoy who anedx or iapro es thereon, — LIFER
mol�wb..nmu"r.1, fn.such p oiecuhh"a..mm.mr(.) li.enud pus,mlm n,doe 103
cin.ml..nl.iam`Iaw. ,1+xrrclnrmi,masan 104 — REBAR
❑I.,,I escmpt under sec.
Darcy += ._wu_ 1.05 — ANCHOR BOLTS
OI :E
WR'SCO - 'SATIONDECLARAII(iN 106 — SEWER & WATER
I hereby:drnn under penalty of l<iuO one of following declarations: 202 — UNDERFLOOR PLUMBING
• ❑ 1 have and will maintain a certificate of Consent to self-imam for Worker, 203 — UNDERFLOOR MECHANICAL
Campen.winn, as provided for by Section 37M of he Irbu Cash. far the
perm..,anceonnework forwldemmi%penritisissued. 204 UNDERFLOOR FRAME
0 l have and will maintain Worker,Compensation Insurance.as requited by Section 205 — UNDERFLOOR INSULATION
3700 of the labs CnJe,for the perr.nnance of he work for which this recruit i,
issued.MyWorker.Conp<madonInsurance carrier and Policy noml,erare: 301 ROUGH PLUMBING
Carrier: policysc, 302 — TUB & OR SHOWER
Rill%CAI'1
' ON 01 EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 303 — ROUGH MECHANICAL
This se.tionnedraliec..mplmedifthe permitisfor one hurdled d,hate 304 — ROUGH ELECTRICAL_
($10(otalexx.) 305 - -FRAME
I tend,That in be podnnnnnce"I the work for which tlhi.Irermit ixIn heti.I
'hull a..f.nhploy'any)corm In any manner oo as to bCo ole%object ti the Workers 306 HOLDOWNS
C..nnpaooi..nI.awsafC:hlooia.none 307 — INSULATION
Apel lay..
NDIICH'In AI'I•L1(JAN'k y,ullcrma,ali tl,isC ...no o of Labor iortoll nh..,old 3@B — SHEETROCK
n«lore shj,,I to me Worker's Con,pem;nlnn pmvisinns of the Lubar Coda run mom
CZ C roohwid,....„ply with.ue,pmsl,om,c,this cm"t,hall hedcm,admonkey. 309 — EXTERIOR LATH
Z fn CONS]KUCFIONLENDINGAGENCY 31.0 — INTERIOR (_ATH
C7 Ihemny ofdrm,hat there is a construction lending agency for th,pcffonnan<e
m nnneworkforwhie,wisp.mitis issued(Sce.3007,Cil C.) 311 — SCRATCH COAT .
0. Q Lench is Name
z LeldehAJdms 3i3 — ROOF NAIL
UO
1 certify that 1 base mad this application and state that the above information is i
❑. F.1 correct.I agree m<or,Tly with an err and county ordinances amsore law.mmtbg 50.1 — FINAL-ELECTRICAL ENERGY ,
O U rnbuilding combustion,and hereby summieempa,cn,atoesofthis city inenter upon 502 — FINAL PLUMBING ENERGY
The abinbe- critioned property for impe<fion porpascs.
Ew y (Welagrccto'me.ind<nmify and keep hmmles the city of Cupertino against
ln li —
abilitic,judgments,costx and cxpcnws which may in any amount aagainst said
5@3 F I NRL .MECHAN I CRL. ENE
u z Citym.nn ynenceonnegramingarmnP otos 504 — FINAL BUILDING ENER -L-L-O-�
APPLICANT UNDLRS,' $ANO WILL COMPLY WITH ALI.NON-POINT Issued by: ate
(TUR 1' �(!Of Tr10N.. �—•�_�or yy0 —
S' ataranfA,,15-1t/contnetal” I) Re-roofs 506 _ GAS TEST
HAZARDOUS MATERIN.S DISCLOSURE
Will me appli.Irl or tat,nnildmg i.e"pmn.fonn hater,woLmous aerial Type of Roof' 507 FINAL PLUMBING
w delin<d by the Cnpctlina Manicipd Cala.Chame,9.12,ad tbo I Ia111h and suOy AN I CAL
Cost,Se.li..o 25s32af, 508 — FINAL fLM�ELpCpH}4pa
17 ve.. ❑N.. All roofs shall b` ec[ed a [i Y(HUC' material being installed.
L Will the applicant ,,(Lore building occupant use eynipincnt or devices which If a roof Is instal Igl,QQ1((tJJ�� Ithouf..J]]fry��Qtj���1R tion, I agree to remove
mil harad..ax;a.....,n.„n,:hI,soeoRned by The Bay Area Air Quarry Minngena.•nt - 1 F1141Y (� �s '-'
fu,tda.r all new materials''ffOOiiirii"'hllllnspeclllUUlli 1 Ilii pl c t t U Stan �,tnIT�� will comply with
❑Yes El No all non-point souFaSftgalatfod.JNA PUBLIC WA9
I nave mad the hamrdous materials requirements under Chapter 6.95 of the 602 ROOF PLYWOOD NAIL
Califon, Heahh N safety Code.Section,25585.25533 and 25534.1.nJaxtaid that
innebhudi.gdoes yo, ad th a"renant.met it i,myreslnmalAutytnaadfyme 603 — ROOF BATTENS
tarpon,of the next ane, ,which must M met poor to issuance of a CcniBeate of ;
'Occ.I.m Signature of Applicant Date
�!(r All roof coverings to be Class "B" or better
Ow<,oraatho ed agent
[/ OFFICE