00080069 CITYBoiUPFN
RTNO
IN PERMIT CONTRACTOR INFORMATION:
IfUI1.DING AlllyRliSS; PERMIT NO.
y
OWNER'SSdAF1 l! . - APPLICATION SHIT DATE
PHONIC: IyIERRYL LYNCH 8 • `) SAL3,PRleIElmIT9 SA SANITARY NO. CONTROL NO.
OY ARCrECIIENGINGER: •J�t - BUILDING PH10,11'I'INFO
E Wce HI
m— RLDG ELGC�'/ I'LUM1I� MIS f,
GFay
O N LICtiNSfi a CONTRACTOR OR'S DGC n,of Chat Job Description
OL v+ I barmy u))oI mut I ren EcamW ceder provi vial,el..v Cor 9 fn,mmmnc'mg ,
Qm k; wiW Section](mind of Divitinn 1 of iLc Ilminces and I'rnrcninns G,Jc,nnJ my liccnnc
C intuit fiancemind clYen.
Rxs L"."„c""" ”" COMMERCIAL TI
°i o i U Dm, Crn tw nr
3" G ARCHITECT'S DECLARATION
CihO 4 y .-p pinm,hull he uwd u.public record. /
/r,, Profit,,
ro N$ /
w Lic mile I'role.uionol T
a•—� OWNER-BUILDER of-CLARA'I'ION L
ad m I Mail,al irm mat I tan c,cngn Irmo the Cvnvaam',Licm+w Law for the
C �� '
Z¢ initialing reason.(SRn
(,Section 7031.5. ,ine.s and Poneasion,Call city of county
S x O which[,quirt,a I„•rmill to cumtrum,alter,in,pmve,dnnoli,h,to repair any Sleeman
a
im
Raw he I,licensed p - ' u he p n. l ill,L , t ,Uremise I (Chemptc,9 Sq. Ft. Floor Area V u t n
(comaracricing withSection 700))of Division J oftt Busimess,andprofessions Code)
nr,6:n he 1 amp,Thum fn ,and the hath,our the,Iluged exempt u,.Any violation
of Section 7f1.11.5 by nny applicant for a,coo,nobject,thtipp
I,, licant,o a civil Penalty P
ofao,hear,than live handled dollars(551"n. APN Number Occupancy ype
❑L iw awner of do pngnvy,nr n,y cnmluyc,,,ill,wugc,a,nmh,olc,a,a,nanioa.
will do the work,and the ammurc i,no,intended mit offered for ale(Sec.7014. 1411 13. 17
Ha,ineu and Professions Cod,The Contractor:license Law docs not apply to an `r J egUlred Inspections
orncr of P,,rty WI haild,m improves mere..amt who does seen work him,elf
d,fnuyh In,nem employee,.provided Inst tach imPnrvmnn,ts arc no,intended or
uttered for sale.If.however,the building or itnpm•ement ls,dd within one year o! 101 - FOUNDATION
imm..plemon,me owns-bwlder will hoc the burden o1'pro ins that rte Aid not hail)of
prove rot purpose of rule.), 1,02 - PIERS _
C]1.iLN owner oftire proprly.ameseluovelyc maingwitnransedcontractorsto 103 - LIFER
�m.tract the Pon,,,(Sec.7(M4,Badness and provisions Codeq'I he Cnnencinars
icei.elzwdoesallapplytoanownerofpropertywhom,Rdsorin,provesmemon. 104 - REBAR
and who contracts bar inch projects with it contraaof(s) belittled pareeunt it,the
Co an"In"l
❑I.m..ca" orders c'. .If m P Clef mi.reason 1.06 - SEWER 8. WATER
Owlet_ jZ S NSA i!_ 7-eU
fl KLt'SCONIPENSA'I'ION'UIiCLARAUOb' 21d2 - UNDERFLOOR PLUMBING
14
Ihereby amfntoaterpenaltyorperjury....eofinelimowi.,adaration..: 203 - UNDERFLOOR MECHANICAL
0 1 have and will nuimain a Certificate o1 Conserv,to wIf-insure for Worker's 204. - UNDERFLOOR FRAME
C...npen,,dmt, toprovided for by section 3700 of he Labor Code for the 205 - UNDERFLOOR, INSULATION
,Hormone,ofine work lin which this in
pen ,is issued. ,_
❑T lino,laid will maintain workers core wn,adon mwmnee,a,reyaired by section 301 - ROUGH PLUMBING
3700 of he Labor Cod,. rase netlbamanee m' he work fn whim thI,1.,ro.h is -102 - TUB 8. OR SHOWER
issued.Myke Co con Insurance canner aW Poli,another ma
wyYd' 04 303 - ROUGH MECHANICAL
CUTnIFlcaONOFExemlllIONFROMWORKERS* 304 - ROUGH ELECTRICAL
C(LM'F.NSATION INSURANCE
305 - FRAME
This¢coon nreA nm he nnnpletW if the permit is I'or one hundred Jnllum
talon ones..) 306 - HOI_DOb.IhIS ,
l lenity half in in,pedomonuec of She work for which ads win...is i...cal.1 307 - INSULATION
.hall Dat emptor any rcr.an in a y manner s„a,m become,objet to me Worker.: 08 - ShIE ET ROCK
Gnnpensaan to r
plant
I m �a ,09 - EXTERIOR LATH
rynceT)APPLIcnve a.tiner r„akrng hi.eendiemedEsempdon,roe.Howe 3 _
Arco'suhjcc bathe Wmkcr's Compeuminn pravi,ions ofthe LuhorCWe,you mutt
Q O fom,wim comply wid,sans.......mo or mi,perdu.hed he decm,A rvvoked, 310 - TMTERTOR LA Tl
'z- ^ CONS TRUMION LENDING AGENCY 31.1 - SCRATCH COAT
1 hen'by:Jfin, m. there ix a ennstmcdon knifing usm¢y form,pefiommne,
a ? of he work bar whi,h,hnFenmtisiI..sncd(Sec.amzCiv.C.) 313 - ROOF NAZI
Q Leader',Naim
D 7 Lrler,Mines, 507. - FINAL ELECTRICAL ENERGY
U O 1 verily that I have read this application and statc,lea the above chlorination is 502 - FINAL PLUMBING ENERGY
R. F„ correct.l agree t plY ,h all city J county J' s d%ltelaws Elting 503 - FINAL MECHANICAL ENERGY
O U lItht ld ttut II by nth L r p e, -,,S h cityOrion- pn,
y m the above edp pemfor u p t p rp 504 - FINAL BUILI 3 NERGY
F 6. (W)agree ill save,inderanify andkeep hannle: the City of Cupertino against
m
flabiInael,poitnaminal.r0al and hidh nay in any way ov, ,stslid pe
7City �j - FINRL ELEC
U _ men wyue/anal oft ng
unl'thi.. nin,.
SAPPLIC OUIam.N(lCyR NDSANDN'ILLCOMYLY WfTIIALLNON-IYHNT Issued bye 6-/�AR79o— _cA Date
(f(r(ia
SigtIApplicuMContmcmr Date Re-roofs
IIALARDOUS MATERIALS DISCLOSURE SIT$ - FTNAI_ MF_CHAN1 CAl
Will the npplican,or l itmre huJdiinnygJoccupant,bare or handle haalloo,naltereal Type of Roof
M
as deincd hy,hc Cupertino Municipal Clem 9.12.inial Ifcalth amid Safety 509 - FINAL GRADE
Code.Section 25532(all CNQ/ p k0 - 6flyF�l;�f}jrAAV g
} ❑Yin All roofs shall�-t71s ectal Ibllto aterial being installed.
I Will the appbean.ormature buildinguttvpamnue4ai,nentordevirt,, hidt If a roof is instdired-withcEtIlUklobtrtihiBg_:W.ins09BKiiSl agree to remove
,all,l;,v:vAnu,aiI m..wan am,m Jelia,d by In,pay Area At,Quwity hlm,ugencn,
Dolfisl? all new materials for inspection. Applicant understands and will comply with
'D Yes c.o ail non-point source regulations.
I hoc[call the hamwous nw¢riul,rcyuirnn.1,tinAer Chapter 6.95 til rime
Qtliloaiia Health k Safety CWe.Seldom 25505,25533 and 8511 I tinden,and that
Il he ail ',,Joev nuts it It xtcnunt,,n I ,i.my or,ihil'aytonotify the
ccapa, +fm yu
ni nu which must he nmt prior m ire, m
�r,rc of u Certificate mit
reac..
p� Signature of Applicant Date
- eroraamormired ag,nt cam All roof coverings to be Class "B"or better
OFFICE