01010081 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRI!SSFERMI I'NO.
1148 S STELLING RD 01010081
OWNER'S NAME: APPLICAI'IONSU�f/D 'I'la
GORDON LU 19/2001
THOSE: SANITARY NO. CONTROL NO,
c-7 ARCHITEGT/IiNCINELR: BUILDING PERMI'TINFO
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%S v= I herehe alllmm thatlllam l iemard under p�vi6oro l i chap Chapter 9lcnn,:nencmg -ON Job Description
FyHiv withScni.n]WfpentUivi.innSnflhcBusinmsanJP:ufe,,i,anCWc.andmylicenre
I,ht 1STI2ND FLR ADDITION
a --� hill B,hc and cl'fcct.
lie...K 2 Licen,e Clan Li,.N
u Dole Counter
a a N ARCIIIIIiCr'S I11'ChARADON
C- g 1 miderai nit my plans shall he used Its public occarb.
7.
i to p o hiccnscI hereby
conal /
GW'NER-BUILDER DECLARA'HON Q
w'Z-° i hcmby affirm that I am exempt(rain the leWom,Comilowun',Car LiAnyu law for the
C¢ followhich re mnra ires a (Scott u17031.5. t.dtcax and Pre.demon Cale:Any my m camnuy Q
o wnlcat mywm.a perndt to c.natmet,alien,hnpmee.demoh.n,or renin an,y,wemae
su=m prion.its ismmee.nlm te9uine,W.pplicam forwch Perrino Blc u.igneJ snemenl
a3- Ihwnc is lkcnsedpunuanl to the provisions of the Contractors Liceaoc L9w(Chaprer9
(commencing win,Sect.on7000forDivisio I Jofthe Ba.nuea.and Prom..don.Count Sy. FL Floor Area Valuy�t T�la00
or that he is exempt thcrelnnh and the bmi,run the alleged e¢mmion.Any riddiion
of section 7031.5 by any a,plwam for a pencil subject,the nppheam t.a civil penalty
at Iran o than Bee hundreddull-($5100) APN Number Occupancy Type
C I,as owner of the pmpemy,or my cmPbyec%with rages as their role emnperration, 3622E 0022. 00
will d.,he work,unit the,wemm ie nut in,etaled or olleoll Ib, sale Isuc.9844•
Business and Pmfcs,iuns Cade:TTe Contrsmn•s License I_uw does not apply h)anRe wired Insppections -
owihar pnopehy Who hunch or improve.Remain,and who Joe..such work himself 101 — FOU�DAT I UN
rouglt III,own cmpinyecs.pmvidcd @:n such impmvemnme ore not intended ar
olreted or%ale.If,nowecer,the building or improvement I%sold within one year of 102 — PIERS
hora letion,thenwocn-builder will base,he Wo of pr o.ing Rat he did not build or
npn,ce mor unfawn onwe.I. 103 — UFER
C 1.as owner of pminny,am exclusively contracting with licensed contractor.m 104 — REBAR
Lbm. unl Ina pmjee,bee.7110,Ba,mnae and Promos.....Codnu Me Co anaor's
iceae l.rwdoe,not apply to an.wneror pmopeny who Wilbur trip novcstheacna. 105 — ANCHOR BOLTS
and
nn who contracts for such projects with a comnnurl4 licensed pnnmm m the 1@6 — SEWER R WATER
{/I for,
n exnopi under)Se. .B A I'C for ads ma,an
202 — UNDERFLOOR RLUMBING
Owner WORKITICS COMPLNSA'r[ON DECI.ARAI[ON 203 — UNDERFLOOR MECHANICAL
I hereby wrnm ander penalty of perjury.e of the lolloweg dcclao,tiun.: 204 — UNDERFLOOR FRAME
• 0 1 have and will maintain a Certienam of Consent it)'elf-mate for Worker. 2205 _ UNDERFLOOR INSULATION
Compeo.alion, a, pr..ided mor by S.1ion 3700 of the I.ab,r Code. for the ,01 ROUGH PLUMBING
pert rmance of do wort:lT r which this ImmL .�al is issua
Cline amve
twillo intainWorker'sC.ntpentionlmumneasInfoimlbySection 302 — TUB R OR SHOWER
3700 oI`the Labor tale.for the IeHmmamn It one work.lot Much this home i. 303 — ROUGH MECHANICAL
issued My Worker's Compensation Insurance currier and Policy number am:
Carrico I„Ii,,Not 304 — ROUGH ELECTRICAL
CUT'1'110CA'r]ON OF EXEMPTION FROM WORKERS' 305 - FRAME
COMPENSATION INSURANCE
("isectin,need mol bec...„ylers)if he permil is intone hundred Rhar, 306 — HOLDOWNS
ISII")t nr te,,.l 307 — INSULATION
Iccnify Rat in the"In.mance er me..ork for waio'own pennli.i.,aed.I 308 — SHEETROCK
Shull not employ any person in any manner m as m became subject to the Workers'
C.atpenitwonLr.1 or odllanti:,,Date 309 — EXTERIOR LATH
Applicant
NOTICE TOAPPLICANT:If.after..kinghis certiremeofExemrvia "In lamld '310 — INTERIOR LATH
beeline.,mienit,tire WorkcrnCompnnsati.npowisiohsormeLaforClow otmuet
,�,11 — SCRATCH COAT
O Q lomawiR mmwply with Inch pewkiam om
r this pencil shell be deemed recokea
Z
^ rte. CONSTRUCT ION LENDING endun,i,or 313 — ROOF NRIL
thereby which thin Them,iu issued sec. 010.Cagency Ino me perliurnwnec -
nfineworkrarwhbhmi,pennilk,isnedfsen.nl9zci..c.l 501 FINRL ELECTRICAL ENERGY
GA Lender's Nanm }
7 z I<ade.,nddnnl. 5@c •— FINAL PLUMBING ENERGY
V O lamityR:nlhavereadthisapplicwinntmdnwhethintheabuseininm,mioni.s 503 — FINAL MECHANICAL ENERGY ,
W. p. amort.I agree In emoff,wilh all city ala rmay ordinance,and e,am haw..remling 504 — FINAL BUILDING ENERGY
O O Ill building cunntmclion.and hereh
y authorize repiewmaloc%ofthr,city to enter upon
Fthe abuarmuml.nc•J properly for inspection pmgnne..y (WI)ngleen,a.n•ialonedrand keepiaan,dc„ [in City ItCupertino Iain, 505 — FINAL ELECTRICAL
m liabilities.iaascncc,col.andexpef,e.wmenmucoi..any way attneagainst,dJ MF, — GAS TEST
U Z Citr iti hmuyuence avast gmming of his pend. y
APPLICA TUNDERST"DS AND WILL COMPLY WITH ALL NON-POIN'I' Issued by: =yh�kP T Cal IIMA IN(Patc
.n SDURCEI .GDUT ) . 10p'.,, I pi -a � Y 7 — F NAL
—!— 5@8 — FINAL MEC
Sipnmurcofnp, a o-n am c Dal RC-roofs
HAZARDOUS MAII!RIAIS DISCLOSURE
Will the applicant future Wilidan,wanupom bare handle broccuslon,material Type ofRoof 509 — FINAL GRADE
t ildhoalbythe CupentalMudelp:dCnlc,Clwpor9.rz.and the ueathnmisuretr 510 — FINAL PLANNING
rade,Section 25s356)'f
Dy., OWN° All roofs shall be ig24te4p6biNpAny Fdd8IgMteWOFbK5g installed.
Will the arilwarlormthmbuudingaceapaatmneyrip scalordevicc,Mai h 11'a roof is installed without first obtaining an inspection, 1 agree to remove
emit haaardm%air coman,inants as defined by the Bay Area An Quality Management
Di,l...I? _./ o all new materials for inspection. Applicant understands and will comply with
ElYea _roe all non-point source regulations.
I have rend the haurtdl.u.itmmriuls reyuiremems under Chaptca 6.95 nr he
California Ilnallh k safety Calc.Seelin 1,25505,25533 and 255:14.1 understand that
if the huilJI g dun.,not currently have a rectum.that it is my responsibility to mail)the
upanl of the re I. bch Rua be and prior m iseuanm of a Cenificale of
"s"ape Y. I Signature ol'Applicant Date
I,r1�t` t1 All roof coverings to be Class "B” or better
nr u.j_i4
Owner uuaumn Da .
OFFICE