00060044 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: .
BUILDING ADDRESS: THEM I'1'No
21580 STGVVV 5 Cr- ill .6�4 r uI, l; G; c?00E0044 ---
NIPk'S NAlYi: APPLICATION SUI{DATE
f-{Ir:f IUTA i_ILIk,54 W-h ISLii
IONii: SANI'T'ARY NO. CONTROL NO,
BUILDING PERMIT INFO
u O C ARCIIITIiC1'/fiNGINE[R: BLIN; ELECT I'LUl111 MLCH '
Wim-
NPE 1_1 I''=1 LI 1=1
5 yi LICENSIilICDN'I'RACI'Olt'SDIICLARMION Job Description
v: ",.,,.,iali ism That I am licensed under provinirms of Chapter (commencing
F�Cw whh Section 7NMnorDivi%innJnflee Bus;nee,nnd Pndes%ioa Code.and my license
�x — is in fall,mcfl
emad cc,. PIs!TPI:L 10"WALL 9" TALL
aeaci License Class [.it.e
O a u Dae Cmmlauor
'+%•5 u.v ARCIII I'Iio T*S DECLARATION
1 un lemmrd my plum'hull Ire used a,puhhe nvnrd,
513"'
w z p p Lianscd I'mfcninnul
c.
(lwNlilt-INILUEIi DIi'he Com ION /
=w I hereby aITImI that I um eaemp,from,he amnear's l.iccme Law for the
C < follow"',rca,un.(Semon 7011.5.Businc„and 11 fv,sinm Calc:Any city or county O
O which requires a permit to amumc,,alcor.improve,demolish,or repair any someone
ce prior to Itl,Suancoato rtgWres the applicant for ouch permit to rile a signed sw,emeal
ea. - ma,he I,licensed lu,r,Liam,othe To I...I,UftheCommc,or,Liam,cLaw fCKupea9 Sy. Ft. Floor Area Valuation
(commencing with Section 7000)of Division J ofthe Business and Pmfee,inm Code)
nt Orem be;,nxicnon Ihemfnnn and the ha,is tor the alleged exenq,tina.Any violation $500
of5eetlon 7031.5 by it,applicaut for a permit subjeen the applicant to a civil peachy
Wr OoI more Than rive I,mItim,della.,With)). APN Numberoccupancy Type .
°Las.,actofineprolodynrmlyemployeesxithnxgesas,heirnolecompensaon. 35720001 . 00
will do tee work,and,he'locaure I,nm 'arcaded nr offered for ,To(See,7844.
Ensures and Proro,iona Calc:The Carl.,,.,,License I.,w doe'ao,apply,a an Required Inspections
a'A P opcny\You l ld,or impoov,,Norco,and who docs wee work himself
or mmugh his own employees.provided that such impmvcmems arc am intended or 101 — FOUNDATION
oncred for,ale.If,however,the building or improvement is sold within one year of
nnmpdain I.the nwnerbuilJur will have The harden of proving Nm he did Bat hudd Lir 102 — PIERS
imnm,e for purpose of sale.). 103 — UFER
°L as owner of the pmpi ant exclusively comucdng with ricxnal contractors In 1.04 — REBAR
„n,tmct The project(See.7044,na,mess and Profession,Code:O nonnntmcmrx .
Licon,eaw Ldoes not apply ,,no ownc,of lit xma bndd, or InTa e, lateral. 105 — ANCHOR BOLTS
and who contracts for Such projects with a com mlorl,)licensed Pur,umn to the
Commonr,ueeno,Law, 1.0E — SEWER & WATER
°1 um exempt ander Sec. .B dt P C for this reasuo
4I]371M
wner lime 202 — UNDERFLOOR PLUMBING
WORKERS COMPENSAnON DECLARATION 203 — UNDERFLOOR MECHANICAL
ubeach,alrrmmodel it.1forjmynnoofhefollow in,dociat. 204 — UNDERFLOOR FRAME
I have cad x;B niacin a Certireale III Consent Io ne
clf-ire for woder'v 205 — UNDERFLOOR INSULATION
n,maham,:,Ttam, a, provided for by Scn,on 3700 or the Labe Code. far the
fesrmancenrtheworklotwhichthisIIIisissued. 301 r ROUGH PLUMBING
Ihave ndww ta;ma worker,Conapomalana[masa....,a,m,aimdnySeanoo 302 TUB & OR SHOWER
of h Lala Cede. nr the perhamence of tee wad for xboth this permit i,
i"ucd. ly\ oke ,Co sco,adoa In,m:mee center and Policy number are: 303 — ROUGH MECHANICAL
carrier_ _
Party No 304 — ROUGH ELECTRICAL
'IIIc'COMPENSATiONlINSURANC °RKekr 305 — FRAME
finds eaeanneednmbeeomplmednmepermiutforonehumheddollars 306 — HOLDOWNS
(slNuor"e,'.) 307 — INSULATION
I coolly that in the perrormance nl the wad for xhich,his permit is issued.I ..
'Kill nm callboy any parr',ill only aeonnu"1.1 m balome,,object I, To wodc,,' 308 — SHEET ROCK
Compensation w,orCalifornia.ha,c 309 — EXTERIOR LATH
Ndn]C nl lrrlcmro nrPl.IcnrvT:It,ager matins Bels cermcame onsaempm,n.you,name 310 — INTERIOR LATH
Haeme:subject m nee workers Compc.n:mm.provisions orbs Lubar Code.yon must
O z0 ronbwi,hamnp"ywith such provisions oreispermi,shall nedecamedm—ked. 31.1 — SCRATCH COAT
FromCONS'FRUCTIONLENDINGAGENCY 313 — ROOF NAIL
1hertb
i y union that there i'annc,ion lending agency for the performance
of the work forwnichthispem,disissued(See.Jtw7.Cie,CJ 501 — FINAL ELECTRICAL ENERGY
4 Q lender's Name
a z Leader',Addrevs 502 — FINAL PLUMBING ENERGY
U O I certify that l have mad this application and state that the above mfonnadon is 503 — FINAL MECHANICAL ENERGY
Ga r y ace,.I in me,To comply will,all city and county ordinances and state law,relating
as
O u alnuilJlug vonvmmn I E. nerebr aadmorao mprc,era,;vcs aIthis city to amerupmn 504 — FINAL BUILDING ENERGY
dee uluneanemloneJ p .pc . red in'pecdoa Purpn,e>,
F oF`, (wonmom„e•i 'ndlyuMkcepToam,1, city orcapeni"aag,not, 505 — FINAL ELECTRICAL
rq "ixbdi' .judgment. o'n n J Barents,wM1ieh allay;n any way came against said
UZ Cay I,I,egmnc', do :amino ,voril. 506 — GAS TEST
APPICA TLINES DS ANT ILL COMPLY WITH A�LI.?NON-PnOS Issued by: Date
SO 1CI!I tGIILAT S. '
W40 y'
Sitar a ,pecan oa an Dam Re-roofs
IIAZARDOUS hiAIBRIALS DISCLUS(JItE
son applicant orfuture nuimingcocupard mom orhandle nawon'mvedal Type ofRoof
dedia•d h the Cupvolno MmJclpx”Coda Choler 9.12,and the Ileahh and Same,
Ca,ade.' .255320)? 507 — FI'NAL PLUMBING
°Yes °Nn - All roofs sha�Mmspe�er tRIELy �;��Lerial being installed.
Will the applicant or future buildin,.mccupan,use equipment or device,which If a roof is in� Jed wit I�rItV�L o laEan inspection, I agree to remove
)istct?' xala'uuvaaninuntmJufincd by the Buy Arcu Air Quality Mmmgeancnt DCI
is,dn7 all new mate or in.• " T}{�tq(.Up{�Lrstands and will complywith
El Yes °N° all non-poinC, e reg I r-Ilwvlfvu
1 nave read he ,. Inun mamrials Ioyu;remems code,Chapter 6.95 of me 514 — FINAL PUBLIC WORKS
CuliR,mia I IcalN A Svf y C Ic.Satlnn,255LL5,2557!and 25574,l undenunal that
if@lib"ding does nr ma ly hmr'mnanl.Ihm it is my re,punsihility a,notify the
eelap:II r n,e rnynbaa lint I It, ala t Iw IITet pilar u,as,m,nce of a c Kriemo of
pklc) r Signature of Applicant Date
- *q All roof coverings to be Class "B" or better
(Ix'nern uutl zeI.d agent Date OFFICF
1