00080139 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
IiU I ILD I NG A DDRCSS'. PHIRMI'INO
OWNERS NM1hI 3 WireDAHL PLUMBING 9
TY � AONE: NT I.
G se 2 ARCHOECAENGINCER: G — BUILDING PERMIT INFO
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ucEN5lincONTRd etude,SDIi...mid TON Job Description
01,40 I hcmhY alLnn do 1 am IianxJ under provi.inn.of Chapter 9(commencing ''
c, with Sediane mpol Division Jof the Husincss unJ Profc<.ennr Cut,ei nJ my license
x < is Lin lull lura an /y �() MIA
n
C 2 [)air C 1(�1j Lic.N Flt'( Ll
ods Dam_ a cm,m,emr A/C UNIT/FURNACE
u3.O ARC111'I'IiCI"S DIiCLAR 'ION --
1 understand my plans shall he used as public records
as
i'>.❑C Liucnwd Ismfc..real
OWNIiR-RUIIJ HR DECLARXI ION
I hindw infirm,hal I a mnta tiom,hc Comsat...,.'.Liem,c Low fin the ,
5.1 behwving,nmon.(Section 7o3L5,nHu.unes..and Pndes.io I,Crcle:Any city," . ly
x p which requires a permit to amalrvet,alit,improve,demolish,or repair any souaure
u's3_ primed its issuance also requires the applicant her such permit to file a signed statement
a. that he is licensed pursuant to the pow%ions of me Con Tactor%License Law(Chapter 9 Sq. Ft. Floor Area Valuation
(tutamen ue,wire SecJon 7000)it Dir,ion I of he anwi....and Prmx.aion,Coda)
urinal be ix iwa to mamfm.n i I the ba,ia tot me alleged cxcmmtion.Ar,violin... -
of Salon 7031.5 by ma,appGram for,I,a nut objects doe apphcum to a deo penalty
of not mnmthan five hundred dollars($5(k). APN Number Occupy t
01,m owner ofine pmpeny,or my employees with wages m their tale compcnwtion.
will do the work,and the atmemre is not intended or offered for sale(Sec.9144,
lou. aand Protea .Cie,:The Connamr.Lierese Law does not apply To a 4006RWired Inspections
wvre,m'......Icily Who huild.nr Imprn cx ms con,and who does such x,ak Ilii,self
or through his own nmploycei,provided that such improvmnems are no,intended or
nd
offefor sale.D.howe.c,,the building or improvement is Hold within one year of 303 — ROUGH MECHANICAL
omplem.n.the owner-limi erwillbasetheburdenofprovingthathedidnotbuildm
improve purpose n 304 — ROUGH ELECTRICAL
0L.,owner onhep,nperty. �� xcle—clyeommetingwith,hccnscdcmmnmor.m 505 — FINAL ELECTRICAL
menar
mens et,hc does
ser. to a,owners and Pry whoa.CaWep The Cu therro's
and O Law tracts for such pan roces m th a contr who tic.m hnpmvus dtothe 508 — FINAL MECHANICAL
and who contracts for such pmjems with a commnorlsl littmed pursuum,o the
m
m's Liccndelaw'.
El Iam excnWt under Sec .H&PCfor this nam
Ownur IrceT -
WORKER'S COMI'ENSIiNSA'l ION DECLARA'ITON fv.. 1�
1 hereby affirm under penalty of perjury one of the following declamfipnr.
Cl I have and will maintain a Ciddi,e a of Conwm m ailf-irran, fur Wnrlet's
Coo.. srfon. ,a novidid rot by S,..im, 3700 311 de Labor code, for me.,if..anarre If wod,fur which mos permit i.......d.
01 have and will maintain Worker:.Coni,enwtinn Insurance.as required by Section
37(10 of the labor Cale,for the performance of the work for which this permit is
Issued My Worker'..Cmnetration Insurance carrier and policy mandar ares
Carrier' I-i�Rl ''ICAI'ION OP IiXII\I"IION �WORKERS'
CONIPENSA'I'ION INSURANCE
(This eGiron need not hecomplefed if the..could is for one hundred dollar,
(S10(b nr les..)
I ocnify that In,he paifnnnn wr of d,work It,,which his perm..is i...e 1.I
shall not employ try ""a in dry mmmer sn as m becmne subject m de Wodmi
Compensation Laws of California.One
Applicant
6Ul'ICI?TO APPLICANT':If,after making this Cenilicate of Exemption.you should
Zbumdse
c. e.nbJua,o e Waker I Cramen' to i n,..f the Laor bCO le,you most
Q Q 1'onh,vid comply win,nu,h,rv,kim,.o.III,permh shall he deemed revoked,
'L
F` CONSTRUCTION LENDING AGENCY
I hereby which that acre is a construction(Selending agcmy forme perform ore
mf the work for which this Permit is i..nucJ IScc.3097.Civ.C.)
Q Lender's Name
D Z hcnder'n'AJJres.
1 ocnify mm 1 hav<read this vrmiraur.and.one dao the above information is
F correct.I agree to comply w'nh all city and county ordinances and state laws relining
Q rJ m building constmaion,and hereby nmhonic representatives of this city a,enter upon
ry) the nhov-mentioned property for inspection purposes.
6, (N ) 6 t I .:Ihu C'tY fC . t nag,inst
.. V1 loath IT' : j goon c 1 9 as y DIY y baro„said
l„Iz City mennxyuentt,I,hegmnt nbul mi,permt �i�
.. SAPPOULI UN TRS )SAND WILL COMPLY WITRALLNONI'OINf Issued by: Date 0 a
y �
Ig acme f APPIlram/cnmmrror Die Re-roofs
IIA%Alt DUOS MAI IiIiIN,9 DISCLOSURE
Will by e Cupertino no MunicipadCalls. hapt.mre omm�dle H alth tied Safety
'type o(R f
as defined io the Caprninn Municipal Cole Chapter 9.12.and the Health nnJ Safety
Calc Section 2553200?
area 0N All roots shall be inspected prior to any roofing material being installed.
Will the applia,tin,ratnrcInodi,gncenpamnxcmiipmommdc,i,r,which If a roof is installed without first obtaining an inspection, I agree to remove
6an hem,dn I.air m.namiwn,as delhmJ by do Hay Arca A.,..Biddy Managemcan
;,Iran? all new materials for inspection. Applicant understands and will comply with
14 0y ClNo all non-point source regulations.
1 have read the hl,andous materials relmom us under Chapter 6.95 of the
Culilinniu Ilculd&hufmy Coda Seniums 25505,25571 nnJ 25.571. undcrsumd,h,a
If file building docsnut c,mmny Ince a(,it that i,iv my mpumiMllty lenotify do
occupant of,he rcquireme Is which mu.a be tan prior to iauncec of a Cenill,me of
Urn y,./-, p Signature of Applicant Date
X Owo aG o� air All roof coverings to be Class "B"or better