00070181 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERA11'1NO.
OWNER'S N2. jll3 STOCKLMEIR CT APP1.1CNF106&t6li�k8.181
PHONE. SANITARY N CONTROL NO
BEACH, GARY 617/28/2000
µOOARCHITEC IENGINF.ER: BUILDING PERMIT INFO
F PLUG ELECT PLUMB MECB
,N i 1=1 FI
F N LICENSED CONfRACfOR'S DECLARA'I'[ON Job Description
pZ_ I hemby uhon I l 1 an licensed under provisionsof Chapter 9(commencing
pwtw with Scellon 71X0)ofDlvi,ion I ill'the Braine.ant Prufc„ion,Code.andnry l wrou,
m P I.,in fail force and effect.
rc ¢ Liccnic Class Lic.a
O e,ODate Chirac'”'
a.ve ARCHITECT'S DECLARATION
t oa lander.bul.hill Mncodasr,Mcre,old, FIVE (5) SKYLIGHTS
e,ce<? Licen,eJ Rofessional
°•o
weOWNER-BUILDER D[CLARATION `
all affirm Ihit I am cac,npt front the Co:nnmmr'n License Law far the
C ns¢ following rest.....(Sati7131.5.Ituninea,slid Professions Cote Any city lir county
x O which re,oire,a pennil m ionclmcl,ulnar,improv,demolish,oI repair any a...av e
w~s Prionoio i,wwce.also myuimnhc applicant for such perminnlilc u,igneJ smtenem cvoin
d%— male incing wit we,aant tame prov6itmn 3 of ilantmcmr,land Pr L;sio,Code) Sq. Io res Valuation
deare(caularis lice with Sectiono the of monion tuft..tro,incsand Pe Law nth Code)
or Ihm he I,eacnhpl Ihaolmnn and the look for the alleged aviation Ay venial n
of Sectio 7031.5 by any applicant for a pennil,nbj¢an the spplle:mt 1..,....penallya IL
in
of not mom than five hundred dollars 135101. PN ul berccup�allea ype
❑I.n,ewnerof the roomy...,my employees with wager a,their sole lorbil tier. Id 0
will Ao the work,and the nna,lar,Is not I leaned a,on"'d For rule(Sea.7194,
Businea.and Prnm,sinnx Cale:The Contractor's License Law does net apply In an quired Inspections
,of roomy who bd1d,.,innpro.e, be.,..and who does such.oink himself 35709044. IZIIZI
arthrough his own employees.provided that such improventcm,are not intended lir
offered for sale.If,however.the building or impmvemant is sold within line year of
e;lip aaen.Iheuwav,hnuder will have the nnrden 1f proving that lie did an hnlld lir 101 — FOUNDATION
nuibe Hu purpn le of,ala.),
,nnro
he pperty.annexcluveelycnntmming with rhcen,eden,mm
ncntn 1.02 — PIERS
`n,Vllet Viie projem(sat 7314.Boona,%and Prom„iun%6x1e:)'Me Cnmrnemre 103 — UFER
L en w doe,urn apply Ia In owner nl'Pnq`^ny whe build,lir Ilnpmve.thews n.
In i ("contract,for such project,with a cnmmemrt,) licensed perxamn to me ]04 — REBRR
Carl, I r. iceTO La W..
oil., tnaerSec. Bx CFar hisba,nn 105 — ANCHOR BOLTS
N)
, CJ�g7 `.03� 1.06 — SEWER R'. WATERM
WORKF 'S COPISNSATION DE LARA'f )N
Ihereny sham an lir penalty of perjury ane of the following dedmmione 202 — UNDERFLOOR PLUMBING
❑ na.e and w 11 Im.lasin a ce,aficalc of Con,em to ,eh'-il...c mr Wake,n 203 — UNDERFLOOR MECHANICAL
cnmpensaaen. a, provided rat by Sectio 51110 of me Lnln,r Code. for the 204 — UNDERFLOOR FRAME
performance of the work for which alit pennil is issued.
205 — UNDERFLOOR INSULATION
❑Ilaw,thewlll srCode.northepe CmnpcaCe(it(ie work or
hichandby Sellar
poet ar me Lunn,sale.u.,me,nett;thee of me work 1br whim tld:permit is 301 — ROUGH PLUMBING
inured.My Worker,cong,ca,ation Insurance carrier and Policy number arc:
302 — TUB 8 OR SHOWER
Curriee Policy No:
a:RTnacnrION oil EwaMl"rION FROM woRKexs' 303 — ROUGH MECHANICAL
C(1MPLNSAOON INSURANCE 304 — ROUGH ELECTRICAL
1TOis section need not be,cnnhple¢d if the permit i,for line hundred Jnllor,
($11O1arlws.) 305 — FRAME
1 cenlly that In the permrmmtee of the were flit which this penmt in i.,ned,1 306 — HOLDOWNS
shall not employ any Moan in any annual w as in wcatne subject to the Worker: 307 — INSULATION
Connrmmlan Law,of California.Date
Applicant ( 308 SHEETROCK
accurate wheel 6.the Walker',Co..itabmion provision,of the labor Code.you must 309 — EXTERIOR LATH
0 O fnnhwith comply with such provisions or this omnia%hall he tamed revoked
CONSTRUCTION LENDING AGENCY 31.0 — INTERIOR LATH
C ILerehyand mhlnet 01cna,nen%,ba,d Ile,:dmgages,for meperociaancc 311 — SCRRTCH COAT
of the work lin wh¢h Thi,peranl i.issued(Sec.11107.Civ.C.)
o p l<nder'.Na,hm 313 — ROOF NAIL
U 1certify III,I read this p1Ral 1I n 01 — FINAL ELECTRICAL ENERGY
a F. correct, s ..holy th all city and ly a e nl ri I Itns 2 — FINAL PLUMBING ENERGY
Q U .hbuilding c I tin and hereby tedrepresentatives ITh city[I) h upon VV
w mew e1 dp pnyfr and prr,e 03 — FINAL MECHANICAL ENERGY/)
1,' ''c' t g(We)agree tl,� dl iy skwhich 4y mally City way lcIll pC°e't against
504 — FINAL BUILDING ENERGY � `vim
vz ciryhh queneenlmeg. •nnhi,p,Ihit. 505 — FINAL ELECTRICAL Date
APPLI 7UNDERSTAND. A DWILL CO LY WITH ALLION-Fit ISS ICV b
SOURC F 11 ONS�r�t'1 /7 fib y —
Sign anrGAS TEST
Applicamt nmmur L(t/(—C..ril> e 'Re- o(s
HA RDOUs MArERIA1S DISCL)SURI 507 — FINAL PLUMBING
Wil the applicant lir furore wilding eceulram,hare I,hand a haraWaa Inmedal Type o -Roof
It,defined by the Capenine Municipal Code.Chapter 9.12,and Thu Hevlth and Safny 508 — FINAL MECHANICAL
Code,Salina 25512(aW
0Ye, ID No All roofs shalFR$isp-ecFcJ�lQlr.t(aRfllf Eifing material being installed�
AOL w5ll me appheamm future building occupant use equationor devices which If a roof is in.4ptll& witl�dthTAL_o0ijRftbNUhiGpection. I agree to remove
ntamin
emir haxanLm,air coant,es defined by the Bay Area Air Quzl'ny Monagemmrit
Dixtne,7 all new mater5l$4or-i+iso Ct4MI_ARpj}kLngiDdpj9M4Sand will comply with
oYe• Cl No all non-point source regulations.
I have read the hazudou,mmedol,vapAramems under,Chapter 6.95 of he
California Health ey Safety Code,Sections 25505,21111 and 25511 1 andel nd that
fit,,bullAing dxs not currently have a neon,than It in Icy re,r:n,nality In notify he
xeep ll o1'(lie reyuirenlent,which;lust he call prior 6o issuance of n Ceniticatc of
Occupancy. Signature-of Applicant Date
OwnerinIhh;mer,ed gyal Dale All roof coverings to be Class"B" or better
OFFICE