00100051 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
��k � CONTRACTOR INFORMATION:
BUILDINGADDRESS /
a 2 r+ fzczate_ PERMIT NO.
OWNER'SNAM20450 STEVENS CREEK B AYI`LICATION SUB IIATL
000
PHONE: -WINPROMETHEUS -D 1 — ;ANITARe NO. mNrRUL No
O % ANCIII'I'IiC'I'/IiNGINEER: G— IHUH DING I'IiRMI1 INFO
OG
F00
U HI. ELF 1' 1'LI1M11 MIT
N Q G I^.I 1=1 I_I CI
N% LICHNSeD CONTRACTOR'S DfcI.ARAnoN Job Description
O% O 1 herehy air irn.Iba,1 atm licensed made,p,ockiolo of Chapter 9lcommracine '
==Psalm will,Seed 171kp0of Division loft he Ibmines,and Prolia..iom C,dl it,license
is in lull fnrcc umOno—,
I. app Qa/
tie ¢ Lican,c Clens_ _ Lic.M ]S(](I_'(rcj_[7pN;�.�
aj. p_v cc SDECLm_ TEMPORARY PERMIT FOR 30 DRYS
3 ' ARCHITECT'S DECLANA ION -
ts' S 1 unJcamnd on,plain.hall be used a,public reundx
g OO LicensedI'm(n,innal
ca Dat I am HUILIIER m the DECLARATION
¢1 0 I hereby affirm that I am exempt.nun Inc es,i is Co :An,I law for the
F T n which ng rennet.Ionnit In 01ontr t.sines.mar Inde„inns Cele:AnY city structure '
so whim,da,unnpenni.,ocans,,heapher,improve,r stick am i,n.orrepair ganY,tmaunt
ac prinnolle ismmw.ulm require,the nprlicam[nnuah lnrtuiuolilon.vignW,mtmnem _
mat ben is deemed Pmsai t,o the n,,okioa. c In Canmtaor,I.iecme Law(Chapter 9 Sy. Ft. Floor Area Valuation
an:tlnlancing w,It Section 7(lot)of Division 3 of the Itu,iness and Po0o'con,Code)
m mat he is cxmnpt Flacon,and the Iwvia tet the:dleged csenti,don.Any violin o
Id Seclian 7031.5 by any apphcam for a permit whjmd,de applicant m,t civil penahy .
oft or mom than live naedri dollars($500) APN fiber Occupancy ype
01,a.owner of the pmpeny,or my employee,with wagon as their sole eompenaneon.
will do the work,and Ne structure is not intended or offered for sale(Sec.7r Lt—
Besmoss:md Pmfeuions Code:The Condiment's Liccnm law does a,,,apply m an QD keyuired Inspections
of property WK.builds or lmpmve,Ihcram.and whit does such work himself
nwr tnn,ugh hi,own employee.provided that ouch hnpmvat wins are ave intended or 1. ->/V,4�gND A T I ON
offered for sale.If.however.the building or improvement is sold within one you of
completion,thc bold will have theM1N Ip gththeJJ Ib Id or ERG
imp, d p rpt: r 1 )
1.03 FE
EI 1. tj p pent I IY t 1 i.with d , dam 1Qt4
h,c 't thep ) t(\ 71)14 Business 11 f : il 1 7Th c t t,r', —
Vc I- 1 ,Illy, tI I only Ir b,ll: p dh cot
:t d woe ,,,noel. Ili, o,n pal)uI,will, t tel o(,) Unocal]ponoand t,me 105 — AN R _TS
I_]I nal',I:mouc Law.
171:on a„�ntpt o:taersat. .B&rcnnlhis ret,on 106 — SEfAIF_R RWATER
Owner Data 202 — UNDERFLOOR PLUMBING
WORKER'SCOMPENSAT[ON DECLARAHON 203 — UNDERFLOOR MECHANICAL_
I hatch,affim,under penalty of pe,jury omeonne fnmm.ins deemtulion,: . 204 — UNDERFLOOR FRAME
0 1 have aad will mamum a Oatmema of Consent m,,elf-imme for worker 205 — UNDERFLOOR INSULATION
Compensation. n, provided fnr by Section 171X1 of the (tint, Cale, for the
performance of the work lot whichdhi,pennil is issued. 301. — ROUGH PLUMBING
01have and will maintain Worker's Compensation lmmaras' m required by Section 302 — TUB 8 OR SHOWER
37x)ill the Labor Calc,for the dominance of the work Inr which this permit is
i„nots, worker,coa,Iwo.ahnnm.mmneecanimandPalliertmlmnerare: 303 — ROUGH MECHANICAL
eanlerKt(tQth w q_�77� 304- — ROUGH ELECTRICAL_
CIiR IPIC I N Or.EXRMPHON FROM WORKERS'
COMPENSSIHON INSURANCE 305 — FRAME
rn,1„e,nonfoodaothernarleadit lmpcmd,islnrottohundred dollar, 306 — HOI_DOWNS
(sanmle,..,1 307 — INSULATION
1 teddy that in the I:erfom,ame of rte work ver winch this Permit i..issued.1 ?08 — SHEETROCK
shot(ill),employ any peovm in any manner so a,nw
,become bject to thin Workers'
Compensation Law,o(carromia.Dole
m 309 —. EXTERIOR LATH
NOI1CO1ICIi TOAI'I'LICANC IL alder making thisCmihcam of Exemption,you mould 370 — INTERIOR (_ATH
hecmne sunject to the Workers Compensation preistons of me Lahr Cale,your must Z 0 mnnwahcomply w;thsm.hprovi,inn„ ,]his rormil,hall bedeemedre,oked. 311 — SCRATCH COAT
CONSTRUCTION LENDING AGENCY 313 — ROOF NAIL
1 hereby mGnn In.,there is a constrit Iendimg agency for the performance
zof work R,r wmrn this Permit is k"mW(norm.3097,Cil C' 501 — FINAL ELECTRICAL ENERGY
Lelnler,Name .502 — FINAL PLUMBING ENERGY
z Lcndat”Name
U O ilymnlaaerennd,i,apphmnti, m<I,Imelhotnlmla,n,eiolz, ,aann's 503 — FINAL MECHANICAL ENERGY
fi F ceer I nurse n,vommlr with all oily and county onlinance%and site laws relating
O U t��nnnRdine,nn,nnminm.unit herebyroall i.e repre,mm:m,r,onhis city to color upon 504 — FINAL_ BUILDING ENERGY
the above....rann led po"ony for inspection ina"oe,.
(We)ri, save,indemnify a all keep Families,the Ci,ynf Capenino rima,, 505 — FINAL ELECTRICAL 1 O G�`
Tn
liabilities.judgments.cos..and espen>e,.which may in any way acerae against sail l
v z City in consequence of thesmntinsofthi,permit. 506 — CRS TEST
APPLICANT ONDERSA SAND 1]y LL COMPLY WITH ALL NON-POINT Issu 50:7
DBIC
SOURCHREGULER /(�I{/pJ��
'Signamreof Appbcaml orale � Dale Re-roofs 508 — FINAL MECHANICAL
HA9.ARDOUS MATERIALS DISCLOSURE:
Will lis,a,mlicmmorfuture WJdmgammpam,mreI,,handle bvnNou, moria) Type of Roof 509 — FINAL_ GRADE
u'defined by the canonical Municipal Cade,Chapter 9.12.and the Health and Safety 510 — FINAL F'1_RNN I NG
Calc.Semina 25532(a)?
D ve. 0 N All roofs shall badfjs4eclgd�r�c�r aI:�.otLn�m.lt�{i�fJ�lSGIng installed.
Will thcnpphvant or more honditteo,mmanto.c e,,,i tela n, 1wrimm,which If a roof is installed without firs( o raining an mspec ii , I agree to remove
nth ltnmrJon,air mmuminant,as d,ia,i by rho Hedy Arva Air quality Managmneld
Dknioly all new materials for inspection. Applicant understands and will comply with
0To' [I No all non-point source regulations.
1 have road the haeardmin,mammal,re,ryimnea,male,Chapter 6,95 of the ,
Candomia HeAth no Safe,,Code,Sections 25505,25533 and 25514.1 uader,mnd,hxl
if the building dee.Fnol currently have a enaa,.Ilml it Ism,responsibility n ramify the
eci pant of the reyuiremcnds which must be n el prior n issuance of a Certificate of
<esupamy. Signature of Applicant Date
qw dero,aafhorhPd attend Date All roof coverings to be Class "B” or better
OFFICE