01030082 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMt4T N:
BUILDING ADDRESS: RMI'NO.
18870 TILSON AVENUE /._ —� 0 030082
0 /15/2001
ZONE: SA ITARY NO. CONTROL NO.
104
O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w RLUMB MECH
y LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm this 1 am licensed under pmv.uom t f Chapter 9 komrnnchng n
m_I-m with Section 7") dDivisimi 3 of the Business and Psofessi...Code,and my license S FDWL, 19 7 4 . 04 . 4 GARAGE
m g is in full force and cmec(. r
Date Class Lic.p JUL ;3r 2006
1° Dam Commcror
7 3 a v
ARCHITECT'S DECLARATION
C< I understand my plans shall be Dud as public records 1tFs]sf���q/s ([ryjt9 rpppJ�1([A�r�f@pyq{p� / rppg7
i a C O Licensed Professional
o LL OWNER-BUILDER DECLARATION
i'-" I hereby.(fico that 1 1. uusin from me C onion o License city
o for the
XN -
ec< whichfollowinig
cert n.(Semon]onstrBasinosend Professions Code:Anycity or roomy
X F e which requires rn permit to construct,alma improve,demolish, fi repair any uchmm $720
�3�_pe ret ail q pirommusis mefor uch Committeto es
Law,
stat t
(notch It wall Sectiottu ).11Ynim 3o the Business
sand Pr La onsCchith9 f F' Foor•yet Valuation
or that be is&wall Section]oq0).11Y,nim is J of the Bmirre and Pm@. .Code) „f•Y ;3,'/D lt0'Q 4 V tJ'f ..,4 f a f <or mm io n 3 L5 b tang r,m and the basis for the subjects
thee,iceman to Any l Mason '
-of.rou 103 m five hundred
d red deft fora permit wbjms me applicant a civil pmat(y N❑���
n a«moRmanB.enanmamnam(ssool 101APN F"bATION Occupancy Type
°1,as owner orme progeny,army employees with wages as Meir sale compcnsmmet. I
will do ehq'work.and the swnTh n not intended or en.mean for sale(see. to a,` - 103 - UFER Required Inspections"`
Busineif,ropeny Who
Code:The c Contractor's License Law rices not apply m an
owner of pmpvw Who Wilds or improves thereon,and who does tach work himself t
,or(mop n nil own employees.provided that such cement mems are not intendedar or __.. .104 - .REBAR.._
completion
foe sthe.If.however,the Wilding or improvement florin n sold within one Wile of T.;
e
ampletion,the ownerbuilder will have me burden of proving thin Ac did nor Wild 105 — ANCHOR BOLTS
impmveroepurposeofsa)e). 106 SEWER & WATER
_- -ownnr;df me Prnpen..ane,d`�� ry t t g Sol .a _. _ _._ _ __t. _ _ ............._.
_..
"°r"° 202 - UNDERFLOOR PLUMBING
_ - c nswct the project(Sec OO1G Business and Profess ons Code)The Comncmr's
203 — UNDERFLOOR MECHANICAL,'
Lice.Law d«s am apply to as carter or property who hu Id p vis thereon. ..
ami who 's License
for u<h.Pmjttts with a contractions)I tensed Wrwam m(be. .. . .._ . ._. :
co( t Lcrn L 204 UNDERFli00R;_ERA..
❑1 pt.nderSec " B&PCfnhnrtawn 205 — UNDERFLOOR"�INSULATION
nc°w ! WORKER'SMP°ENs noN 301 ROUGH PLUMBING
" Ineren affirm It r' 302 — TUB & OR SHOWER
thereby ,gena yn catedly.nq,,na .oR9wing n,for Who. 303 — ROUGH MECHANICAL
° I nSve aM will maintain o Cbnibcam of 37M o tt uLabor for Worker's
Comphnmtion:as provided for by Section 3]W or me Labor code. for the 304 — ROUGH ELECTRICAL
perfnrntab«.rme wovrlk�rm careen,this pertnd is iss.ed.I.,. 305 - FRAME
- ❑Inav�and Wilt'iwinuinworkgiCompcnwtionmsunna,ot*uimdbyScniph 306 — HOEDOWNS
3l a the Labor Code:for the pn-11.1 mosec of the work'for which mil perm,is
i.ssued.Mywarknrscamper}ationlnwrana.earner'aadPolicy monk,ini 307 - INSULATION _
Carrico f r n 1.0 1 Itkl ',rPobhNo� '• ••.4.
v'
CE RTIFlCATION OF EXEMPnON FROM WORKERS it,-
i_s ,308 j,T,;SHEETROCK-,-sr ,,
r
' COMPENSATION INSURANCE �:, - �'.' . - - __: 309. :_.rEXTERIOR_'_LA_TH�I"
shnioowed na be ucanpieied if he permit is lire one hundred dot]. 310'; :. INTERIOR LATH
Is100)m I
311 — SCRATCH COAT
' I ropo(np(pmemin -«e-net asoreouse" fict1.iis- i>td'L . .. _ . . .313 ...ROOF NAIL;),;, .; i,.a:L-'a:,- :', L.•�•� -
6h II of rep y y D< y man m t" b)a t m W kcri
cn x to uwgnrcalmma lidtq 501 — FINAL ELECTRICAL ENERGY
-502 FINAL PLUMBING ENERGY,
NOTICE TO APPLICANT.If.after mak g tis.Certificate of Ec Pfon.....hould'
z be subjectwith such Compensation nowipro .shxnrthLame eod.yo mania503 — FINAL MECHANICAL ENERGY
0 forth ' c n itis ch p pe o this pchand shall ft dee ed revoked.
-- 504 ----F-INAL--BUI- NG-NG ENERGY -
I;y `�•, `.'CONSTRUCTION LENDING AGENCY "
m.5 In ebyglTmmatm eeangag yro n'P 9th;« 505 — FINAL ELECTRICAL -.,
Lana exnimm x tt;txs.ealsee3....*.c) . . 5.0.6.._-.-GAS .-TEST._...._.
y.� code Name'
_
.. .,
D,Z I< er Arc1.hes,
-. 507 — FINAL PLUMBING p�.,•:.
I«ndy pall have read this application and state Nam above irtf°rme( n is 508 — FINAL MECHANICAL
< ,.Lague to m_PI)with all city and county ordinances and state laws relining
..OrV mWil i ...rvmon,and hereby authorize mpuriedies afmi:city to eater.repon, 509 — FINAL GRADE
: > W
the aWve-mentionedpn:pertyfor m.pemon p.rposes. 510 — FINAL PLANNING
F.reOa (we)agreem sa«li,Weiromy and keep harmles,jhc Chly'a Cvpviino aw
gair
4 liabilities,judgments,costs and expenses%loch may in any way accrue Mai"said 514 — FINAL PUBLIC WO
V..Z City iv<onscqurn2e o!tis gaan(ing of m s pmnn " -
APPLICAM1T UNDERSTANDS AND WILL COMPLY WITH'ALL NON-POINT
SOU fREGUCA-TIpy.S' , .;p �7O Issued by: Date /
Si reofnppr/<a�n✓Vc manta. . ':.,: -..,.. : . •: '. ', use , Re-roofs
. HAZARDOUS MATERIALS DISCLOSURE s ,
.,,.
Will the applicant o.future Wdd gh«uP ms. or handl neurdo smatedal Type of Roof -' _
as defined by the Cupertino M opal Chee Ch pt 9 12 d the Health arta Safety -"'-'
Coe Stttoc25532(al } r•s� ••t.-G•
A]1.roofs shall be inspected.pnor_to.any_roofing matenal.being installed.
•� W'llsbe ppTcant ruturc Wad'ng .pamusecqup e t tie'es ni<h If a tnazamo. am«m wt.a defned by the BaWAreaA owsl'ynfanagemeht roof is insialled'without first obtaining an inspectio'n';Famretd,
rem v
e
D"'"�•❑Y t- - all new materials for inspection. Applicant understands and will comply with
a ❑N all non-point source regulations. ,, r
101 have read Ne hmvd-s mammals req;25533 a and r Chapter 6.'95"61'me "
Cahfomia Health&Safety Code.Sections 25505:25537 tM 25534:1 understand that
ik' a ildtme,re r.a cuno,which,
hi uve trust
see.tet .or my mance o a
ude'upam of the,reyoimmenm which'inuu see met pnono issuance o Cenific.m of • -.
can Si nature of A hcant__
,, .,, � g .._. _ . . PP . . -- Date
mmredall t' Date All roof coverings to be Class "B"or better
'I .� ,..
OFFICE