01060022 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR.INFORMATION:
BUILDING ADDRESS: PERMIT NO.
R' NAM APPLICATION SUB DATE
• AN BY CONTROLNO.
rr9 O O ARCHITECT/ENGINEER: (40G) 439 953:6
BUILDING PERJIrr INFO
Fz
to- BLDG ELECT PLUMB MEC
CLZI r'__ L i _I
NTRACTOR S
TION
el
z s h b I hereby millon Out IDam lliicensed der previsions ofChapter 9(commencing Job Description
ISwidth Section 7000)of Division 3 of the Business and Pmf[s ions o ,and my license
a m M� is in full forte d elfecr
z z< License la Lic.M
o�u Da1e cnnva<mr INSTALL 10 R+R FURNACES .
41 LL O+n ARCHITECT, DECLAR TI
k-- ; 1 understand my plans shall be used as public retorts
to n c,
u z O Licensed Professional
t9 OWNER-BUILDERexemptDECe ContmON
X a m I hereby affirm rho 11. exempt from the Commnurs License Law for rhe
F'zC followingmoon. er itt ]onsu Business aritmpr Professions Co do My city structure E e which requires a permit.conswer,alcor,improve,demolish,or repair any sweet.
a3�"prio to rs' ce,ol 9 ,h PPI'canr for sucM1 perm uofleamgncd su.menr
ther he is licensed painsirotheprossi0mofNeCutts.,sLicenselaw(ChaCode)pter9 Sq: Ft .F,loo.r,AarLe : tete.. $97(commencing lh Section]000)of Division l of the Business and Professions; OValuation. .
or mar he is exempt therefrom and the basis for the alldgcd eiemption.Any violation
of Section 7031.5 by any aplu ant for a permit wblau the applicant m a civil penalty
of not more than Ove hundred dollars(5500). 3 5 9 APN N4 m}�e�t' i r.'i.; Occupancy Type
°Las owner of the property,tar my employees with wages as their sale compensation, 0 8 0 2 u
will do rhe work:and the structure is not intended or'oBencd for sale(Sec:]OM, -'
Business arta Processions Code:The Comrac.r's License Law does not apply to an - Re�UtEw�,I,,�a���eCllOn$""' B `I
owmer property Who Wilds or imp.vrs thereon,and who a«a such work himself 204 - UNDERFLOM r'�ICFk1v1G
or through his own employees,provided that such improvements not intended or _ _ _ -___,.,,_.
P.vc
"°e a r sale.Ir;nn r m W ming , nt Ia within one year of 301 ROUGH PLUMB'I NG— . ., - t „n r- '-
co p1 uo theown W Id II h e the When of prop ng Our h did not Wild.,
imp f Nopoae f 11 303 ROUGH MECHANICAL
°I..owrrrrora. '- ' ' - - "-- "304- -'-ROUGH--ELECTRICAL-
construct
ELECTRICAL
-- '
p(Sec.7 am ex a d Prifi ssi wsW 1 d ronuacrors to
r the
License
taw oejenappl70aa.Business teoandProrwhobewrrlThrveithec.ra 505 - FINAL ELECTRICAli `•'! "`"' • " '
and who
Law dotes not apply man owner of property who Wild seimprovrs,hereon. ''
tete; _ tete
and who connote.foesuch.projmu.with a.rontmc.rtsl licrn.d.pm[uanr.ro me. ..._..... "507 � _--FINAL —PLUMBING—'_J.._......__._ tete_--tete__._tete__ tete_._...
Contractors License Law.
°I am exempt under Sec. I ' I,".BAPCfor Nis«uson 508 — FINAL MECHANTCAli'fl
Conti' ' " 'Si.`,te' - "" - 514 - FINAL PUBLIC WORKS
WORKER'S COMPENSATION DECLARATION
' 9 hcrcby uiirm under prpmty of perjur1 Cc of rhe following dedfor Wo.rr- -
❑ I h and will mm . Ccnifi r of 3 n a rot I-altssme for Worker's
Compensation;i as provided d f by Section 3)00 of the labor Code for the
- peR ret <o(ltie work for uvhich,ffiis famous is I.
1 have a tl 'ill maimmin Wok is Citim,nin,to.ri 1 nutmeg as regmred by Senian s/O
)00 of the Libor Code,for Ne perfo of the work for which this pcmmt rs
Came o ompcnsm on Insu. and P I ry umbra are: _
d.M W
___. tete_ tete
CERtIFICw ION OF E%EMPf10N FROM W - f i s t �J a.,"-.S 1 ' '
- ' COMPENSATION INSURANCE- ,.:,, ,, , I _ _
-----------
.__
.`i]',' �:.'.Il::i ',.•tete.,,. ;.r.11•'li`. �...
('Iles seci,on used not be completed if the pemat is for one hundred dollars
(S 100).1 less.)
-
1 c<nifY Nun pertomunce f the ick f hsch Ilse panus t i <d I ~_ ,-" �•• •.m,.- m,, r ( 1 } ` ' s'
'sh II -t oy any rs n m any ma to Ecco [bl ct r 'thew k "'I•N
ynp� �}ek(�
Comper(iaYpM1 Taws oPl=gl Tom a Dae - ,
NOTan T"_mr SCE $l. _. ._._ _ _ _. _ _ ..._... ._.�_ I rY _
ICE T0'APPLIG\DPIL`f al r ma g th c C rt Certificate¢ (E Pr You h la - _ - -
be subject rh er.Compensationpm so sofrh<Labo Cal.yo must
Q 0 forth th ply wnM1 M1 p o ions o th Pe t M1 11 be de ed ked
ztete ._. tete_. tete tete._ tete._ _. tete_ .. __ _._ tete..._. . .�_ tete -- ---- tete
iUO "CONSTRUCTION LENDING AGENCY. ' "I
I hereby affirm that thin,is a conswction lending agency for the performance
�;..r ofO k N,which this peturit is issued(Sec.3697,Cm C.) __tete_.._ _tete... ._. __ tete.. tete_. _ tete_ _.. . _ tete _tete.
S.0 Is d sNa a tete _ tete.... . _tete.. .__
I-siguir's Addj,,ss'
U 0 1 certify Thal 1 have rad chis uPPlirnion vnd score Nauhe aWve information is
fail toren.I agree 10 comply with all city and county ordinances and state laws relating
Dau to Wilding construction:and hereby audoitize representatki,vof ths city to enter pan
the Above-mens on01'A
ent'f speclm purpose s . __ tete
E,ay (Wel agrccd fva dke ph rml al rh Cry ofC penin° gainst
M 1 ab'1 'rsjudgmcis nd a,cru M1 ch y n a y y cera ago t said
f�'Zto on,o,onSram ,of th perm, �O/
ANTUNNOSANDWILLCOMPLYWITHALLNON-POINT Issuedb Date J'E REGUT. S. I y:
Sign o APPlican n0aaorSFIATERIALS DISCLOSURE Date,. Re-roofs
A RDOU
will d.appl- fimine Wining axa,ant sin.m lvaMlc haaydous material. Type of Roo —tete. a— tete
as def nide by the CupertinoDI cipal,Coda Chapter 9.12,and the Health and Safety
Cod.Section_'55J ( I
^'O Noy . tete _ ' . .All.roofs.shallbe.ins ec[ed. rior..to.an rbofinamaterial-beincp-
installed._.____..
W'Itrh applicant or future buildgoccuv nt use equipmentq devices which If a roof is installed wlthbut first obtaining an inspection,-I aore-e'to remove
cmi,h rt c.morin &FOxcl by he Bay Arc A Quality Mang <nr
District' , all new.mate or-inspection.•.Applicapt understands and will comply with
11 ye, 13 No a on-point sour regulations:,.::; - 1... '
::L tete
aza
the
m h...read
not ty Code.
4eions2505al, u2menrxad255Chaptererst ofhat
C a ons 23505:25577 anomporo.Iunders.nd Nm „- _ _
_ _ tete _ _tete._ tete _. _• tete tete
Vonb din dm tenant.that it is mY responsibility to notify rhe i C.-.O
r c. t of the rc e rents which mus,be met pdor;to issuance'af 0 Cersifica¢of /-
tete Oce aney.
v �� onature of AR 'cant Date
tete..' tete.. -_'--- - -- - -` - --._.
own nramhgriaeaa t - Dme All roof coverings to be Class "B" or.better '
':. tete tete . . tete OFFICE
i
tete. , . tete.
r