01010080 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRE1508 TIPTOE_ LA MUZZI FRANK. AND C RWl6k'1N_tA B01010080
A
OWNER'S NAME: MUZZI FRANK AND CARMELLA B APPLICATION SUVA 19/2001
10 UNP: SANI'INIIY NO. CONBid,No.
n of]p ARCH]FECGENGINF.ER: BUILDING PHRMH INFO
So BLDG ELECT I'LUMx MECH
Ni J CJ CI CI
S = LICENSED CONTRACTOR'S DECLARATION - Job Description
1 hereby affins Thai 1 um hoonsoJ under pmvi,ions of Chapter 9lcommencing
CzEnFyt° wietseea+,n]IwRrommi,n+o3ofinexa.me.,anaPofev,mn,e+ae.andmyhREPLACING MSIR. BEDROOM WINDOW/SLIDIN
is in liJl l'nmc and eR i.
zto
agI:ian,c Cla,e Sic.p
o a Dale. Conrado,
143.O Iii ARCIII'TlieS DECLARATION
I male rntmd mY plans shall la mal us public nenN..
I.w i C FOicenwa ,annl
nw
OWNER BUILDER DECLARATION
1 henh .( m that 1 m.,trope fromthe CrLicense Law Bode ✓/^
^Ifolloing mmirron]Ir. aess and ,,ours Ani tiger aounry
Ise wM1J req rs%aWaIt construct, ftp ve,derf:h.orM Y fracture
aim
prior to itsc lot req the afalflharle 'u h isernot torile a signed.rtenem
Thai he is liecirosdp : tI he grovimomof thel t I . 1 L (Chapterode) Sq. FC Floor Arca Valuat
let s grit theaef l and+r a n 3 N the eua t tJ l t,rA,v,n,aNel 4000
or Sectnn 5 b merelmm;ua he nIs,.l n,r me t Ile a plHnpm any violation
f noeboa eI to by inn oppm-ooi for a gamin aarym,n,e appbeunl in a civil p:nulty
Natnn1nreot�mc�ebanarr<lannarasst>'n. APN Number 053. 00 Occupancy Type
3593E
I,as owncrorme ad The .nr illy employees Toinvullo wages a,eha,aete(Son,aann.
will du the work,and Inc amnum C na coo,Ll nr se Law lin Gale(Soc. Wim
g �1
IW Woof pot
Pn echo build or imrove%thereinaN whoadnes�uch wnklhimself 101 — FU�V�eR lTB$1 ..Oils
o groper maven A T 1[t
o�medusa hi,o va however the building tam wrn vem n t ovoid within nil intendedyar or
offered for gale.If,however Inc budding er improvement ovoid wham nae year or 110T2 — PIERS
improve
for theowe of
will have the burden of moving thin he did urn build nr 103 — UFER
improve for Purponc of wle.l.
C I,: ofine move'ny,a ,cli,lnclyeotmacong with licen,ed conmamona) 104 — REBAR
I.mamo�I Iter pmjwt 1sce,]1144.uuameaa�tnd Profarion,Cider)me Contractor's 105 — ANCHOR BOLTS
iceme Law Joe,nor apply m I owner nfp„ ens who buaki-,it..pn,vc ihemin,
carta who tmety for such pnjecla Willi a :untracmns)Beclowd pnr,omn the 1.06 — SEWER & WATER
nmractor, cenw l,aw.
❑I,tn r Sens .B,apCI tm,rcavon 202 — UNDERFLOOR PLUMBING
owDari� le L q —�� 2203 — UNDERFLOOR MECHANICAL
•r
KL' S COhIP1iNSATION DECLARATION
I hereby affirm under pcnmD of perjury one of following declaration,: 2204 — UNDERFLOOR FRAME
n 1 have and will umimam u Coodiome of Consent m welt-imme for Worker'x 205 — UNDERFLOOR INSULATION
emo:cladon. a, prnoided for by Secdm+ 37(m of the Labor Code. for me ,301 — ROUGH PLUMBING
perlimmunce of the work for which rhly permit is i„ucJ.
302 — TUB ft OR SHOWER
❑I have and will muinwin W the led letn,wimt 1n,umn f as which
his Smlin
3741 m ate Labor Q,Je,ntr the peabnninee or ate work for witch m.,penmt is 303 — ROUGH MECHANICAL
„nen.MyWorke.,Coner,ailuinsurance Carrier and Policy nuumrart: 304 — ROUGH ELECTRICAL
Cartier. Policy No.:
CERTIIICA'f10N OP I.XEMM,0NFROM WORKERS' 305 — FRAME
COMPENSATION INSURANCE 306 — HOLDOWNS
ani,section need not be cnntnleted n the petmil i,lar one hundred dollars307 — INSULATION
ISI W)or Icss.)
I cenpyatm in roe nT.fnn.tancc Orme work for which ad,penNr i, ,bod.1 308 — SHEET ROCK
ahml Ont employ dor pools,in way o�mmm aro as w hoenme aim,iun m me WorkerF 309 — EXTERIOR LATH
Clanpeoaaonn Laws orC:dimntia,Uma
Applicant
E li
N( 10 AI'PLICAN'1':If, her necking Ilii,Ccniticmc of H, n,cn+plinyou,hnulJ 310 — INTERIOR LATH
nccnmeruhjeo ,, beWorker's Coinpemmionp wiNor,of the Lahr Cold ,you must 311 — SCRATCH COAT
OO forthwith comply with such provisions or this Permit shall h,dttmed revoked.
v) CONSTRUCT ION LENDING AGENCY 313 — ROOF NAIL
� ? I hereby affirm That them is a conurvnion lending agency for the performance 501 — FINAL ELECTRICAL ENERGY
of the work for which oasis, in issued(Scc.3097.Civ.C.)
i p Lcrd,r,Name 502 '— FINAL PLUMBING ENERGY
D z Leadcr',AdJrt,a
U O 1 ifyrLtln eat
arl : plJ bt itrtn n - I ar++.a 503 — FINRL MECHANICAL ENERGY
w F .ort 16 t d n y d ry g 504 — FINAL BUILDING ENERGY
O U tubuilding IrTuriorraralI by aella,tic represcrallocs old . ty Io Tiler rim
he a dp,.,,,,y fpm 505 — FINAL ELECTRICRLL%�2 V
V)L.0WHAZAREOUS
1 .I u%fs and c,sv _we)agree to,oc.andicannand, ilk hph y.nlany wayity accom lc. m again,said ainst
506 — GAS TEST
U 7_ UNDERSEA
meg ails of WILL COMPLY
O _—Z
athA AND Ws crri PLYWrfHALLNONPOINI' Issued by: 507 — FINAL PLUMBINGDate 7
\ IONS .! �—Iq-0I Y' —
FINAt MECHANICAL
off, — ume Re-roofs
AZARDOUS MAI ER1ALS D1scLc IRE 509 — FINAL GRADE
Wm me appacant or haat,haadiog occopant,tnm i mile livard�a,material Type of Roof .
o,debned fly me Caperaoo araicq,al c«w.Cnaptet 9.12, id me Helm and Safety 510 — FINRL PLANNING
Code.Section 2553214)'!
Cl yes No All root's shall be tfA,"c(n IFi;NQ6yR14WnJ rmatW;ARK$ig installed.
Will the apprc,oloff Too building occup,ntuse ewiparent orties ice%which If a roof is installed without first obtaining an inspection, 1 agree to remove
Iha udou,air contaminants a,defined by me Bay Area Air Quality Management
iorin] ` all new materials for inspection. Applicant understands and well comply with
ores ,]No all non-point source regulations.
1 ume read the hmmaterial,aterial,requirement unser Chapter 6.95 of me
Califnrniu Health&Safely Code,Sections 35505.25533 and 25534.I undcmmnd that
If th c lailning does not currently have a tenant,that it Is my re,posodelhy m nobly the
p o 'intent E l wh unnt be nus prior h Ixwrmac of u Certificate +I'
"CC”)cat' ' ere Signature 'Applicant Date
, �� All rot f coverings to be Class "B” or better
e o not....uld ugenl IJam
OFFICE