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00080134CITY OF CUPERTINO CONTRACTOR INFORMATION: BUILDING DIVISION PERMIT BUILDING ADDRESS, PERMIT NO. OMMAM ';4 OWNER'S NAM1:0585 APPLICNFION SUB DATE 08 / P 17091 w rIONE: URUGESAN� M SANITARY NO. CONrROI. No. ARCl11 TIiCT/ENGINEIiR: BUILDING 1112RMrr INFO 0 RLUG IiL[CT 'PLUMB MliCfl j w 1=1 1.I I_J IJ j I.ICENS d)CONTRACTOR'S DECLARATION Job Description I hereby aldno that I am licemed under provisions of Chapter 9 (commencing ce with Section 71)(Sd of Div isinn 3 efhe Emmess and Vedics,ions Codeand on, licers, fall nicez Icdem Lii,.4 "°"`s`GI"as Li°'" CONVERT PART OF EXISTING ROOM TO BATHR Imo cam ' ARCHITECT'S DECLARATION 1 understand on, p1m, shell h used a1 puhlic reroN.a -1 Y Licenmrebaonal OWNER-BUILUEIi DI!CLARA'I'ION I heerebyyffinm that I L exempt Tann the Contractor's Luw for the Coe: Any 703L5.construct. ainosand a,si.ns C, Any emy greresa follwhich prove, r structure, _ which uyuims a permit toaihialtar, improve, demolish, or repair any semen permit priors slcensed.also inquires theapplicant for suchrerminnfiles I.aw(Chamem - matM1eencingKdlScelan, pro, Sq. Ft. Floor Area Valuation A1;.ions,,nhecel3rono,iden.el.awon,C...at) o70MPnd iGude) See'll.nr an.I'le belt, oofeal,,,d.,and or thel he iscelm Any m, mat he is ealoopt thcrc Irvin and me basis Tor inn aucgm cacmpnoo Any ] pendod of Section by any applicant lar a permit eubkna he applicant w o cis I] penalty APN Number Occupancy Tyepe, or not more man dee bmu,ed dollars tss0p. a than ❑ Las owner of the property. or my empl.yms with wage.%as their rule compensation. ,y R CI llred Inspections will do the work, and me suucum is not intended or nrtcted for sale (Sec. 7044, Bmugus and Prom,ok r, Code: The Conmuuuia Licc i,o Luw docs nut apply in an wncr of property Who hullds or impmve, thereon, and who does such work himself fir through he, own employees. presided that .such imp locoents art not intended or offered far .ale. If. It cvct. he building in, improvement Is sold within one year of 101 — FOUNDATION completion. he owner-builder will have the burden of proving that he did not build or 1.02 — PIERS 'mp/,ova fur purpose of Sade.), G2sc ,of'he propct,y, am excluai,dy emn:tcting with hcenw,l ourra,or,te 103 — UFER mstmet the project (Seo 7144. Business and Profesdon, Code:) The Cmtmctnre 104 — REBRR Licata Ina, does int apply m an net of property who build, or inaltdoes hereon, and who uuntmut, r such parsec, wild a comtucmrb, ueersed furtaan, m he Luw. 105 — ANCHOR BOLTS Cnmr+cmr<Lie , O°'"° ❑me cxcnn nRKe BNi 7.0E — SEWER 8 WATER PLUMBING 202 — UNDERFLOOR c��rONcptrdl'Isre`,win mmrToo ENS f� 203 — UNDERFLOOR MECHANICAL I hereby affirn under penalty of perjury one of the following declarations: 204 — UNDERFLOOR FRAME ' lose and will n;dmain n ccrtlnwa of cntam In Sud-bstlrc ror work Coriensarnn. as provided for by Section 3700 of he Labor Cudc. for the 205 — UNDERFLOOR INSULATION performance of the work for which this permit is is,ued. 301 — ROUGH PLUMBING ❑ I have and will madman Workers ConTeroetion Inwmill, as requid d by Scrtion 373) of me Lanur Code, for tne,perd,nmance of the work for which this connit is 302 — TUB & OR SHOWER Isancd. My Wmker'a Cumpcnm,ion Inemuncc mrria unA Ii,Lcy number arc: 303'— ROUGH MECHANIL'RL . Carrier:___Policy No.: CERTIFICATION OF EKItfuTON FROM WORKERS' 304 — ROUGH ELECTRICAL COMPENSATION INSURANCE 305 — FRAME l'fhls ernon reed oat bo sunt,loel if the pmrul11 1111 one hundred dollar. 30E — HOEDOWNS ul0) or Ic%,a.) 1 mrofy but I. he peffomtntiI of he work fur whim this I,c.it is issued. 1 307 — INSULATION shall not cold., t o, person in any mama, so as or became subject to the werkers 708 — SHEET ROCK Cmnpcnna o Lows of Calllbmly. Date A,pl"a"'09 �+ X— EXTERIOR LATH NOTICE To APPLICANT: it, after Inuklng this Ccnlliutm of Lexcmptinn, you should Z wi subject to the Worker's Compenoamil provisions of the "her Code, you must .., 310 — INTERIOR LATH still edmvoked. forthwith comply with such moidcao I, his pe.it .anbe 311 — SCRATCH COAT 7] CONSTRUCI'ION LEND] NGAGENCY 1 hereby of irn mall there is a eonswetlon lending agency for the pertormanue 313 — ROOF NA T I_ saw of the work ror which this Penn if I, Il omd (Sec. 3097. civ. C.) Is"d"'''°Name _ 501 — FINAL ELECTRICAL ENERGY T Iseder'x Address 502 — FINAL PLUMBING ENERGY 1cerifythatIhave read this application and stake that meabuseinformation is unmet. I agree to uu oply with ad cit, and wormy ordinance, and date how, matin, cultism 503 — FINAL MECHANICAL ENERGY J huntung aI ir,lun. and nervhy I hou io, ropmo,nlnivunnhis city to cot,upon he ahuvo-meatmned property R,, in,pem"n purpuses. 504 — FINAL BUILDING ENERGY y (We).,me It a,,. indemnify and keep bunnlea the City of CaNdom against n liabilities, judgmens.costs and expense, which may in any wily, acme against,aid ,Z. c of mming of this permit. �INAL ELECTRICAL �J_ / 'OD aw DERNDS ANU WILL COMPLY WITH ALL NON-POINT IssUCd by: S0 RS TEST Date LATR��J'onamr- 4y�r� 508 -- I FPL PLUMB 11413 FINAL MECHANICAL DateRe-routs %ARfHlUS MA'1'IiIUALS DISCLOSURE Will the applicant or future building occupant.aore or beadle battalions material as defined by the Copenino Municipal Code. Chapter 9.13, and the [health and Safety Type of Roof 509 — FINAL G RADE Code, Section 25533047 ❑Yes El No All roofs shall bel?II cte2] 14 �� T 15113 . iT) IHn hd flat being installed. will the applicmm fir future building rscupant use equipment or devices whim If a roof is installdalAthentt FirINML•inW]M-iTiGpcHnl.4$gree to remove nit han'd's air,mmulant m defined by the Buy Arca Air Quality Nu nagemcm all new materials for inspection. Applicant understands and will comply with ;,Ir;c,7 El Ne, 0N all non-point source regulations. I have read the h reardou, material, mquimmcuts tinder Chnner 6.95 .f the California Health A Safety Code, lection, 35505, 25533 and 25534. I understand that if the building does nm currently hats a tenant. that it is myresponsibility to notify the cupant P11he rl,mmuce s which must he met prior in issuance of a Certificate of Oce,,/ Signature of Applicant Date �7/p � All roof' coverings to be Class "B" or better — e or Date OFFICE