00080180CITY OF CUPERTINO '
CONTRACTOR INFORMATION:
It UlLDINgIII VIS ION PERMIT
BUILDING ADDRESS:
PERMIT NO,
OWNER'S NAME:
APPLICATION SUB DATE
30000 i]ORRE:11
sGUTHBAY
COI+ISTRUCTIUI'
omyomro
1 PHONE;
SANITARY NO. CON'IROLNO.
—
' U
" CIN STREET
013/24/2000
ARCHITIi /EN" : _
IN"R
BUILDIM1'G I`IiRNUI'INFO
40A) 7�79-0400L/J
BL—DG/. ELECT I'I,UMB INIECH/
t
LICENSED CONTRACTOR'S DECLARATION
Job Description
I herchy affirm mal I am Ileuuul under provisions of Chapter 9 (conm'ancing
with Section 7(XX))of Divi' 3oflhc Bu,ina„and Prom, sions Coda nJ ny raceme
.-In full li'rce and
hiccnse Clv,s Lice
Uvm CommonR
tar ON
ARCI I I I ECT' S DEC ION
I unJu.ax tuns Ie 'I pu rnoNs
COMMERCIAL
11:
oc
ON Iiit,lf ILD
m he Contractor's for he
I hemp saltie on 1 it, usin fmm the Casio aCo I.ittmc
tyres
reason. Section nJ Professional Code. Anr city mcouny
%hichire consu.H alter sus demolish. nr
which retain a permit a, etm,wm, aper.
e a sig ed modeler
for signed em'
I y tireI such pi n
S {7t. Floor Area
�:
Valuation
tpritnr hat he le
math r' Il .e u d P IIs C I' t r.s, I LCI
scold a'un'U'dcj
Lcon... sarismoSwefromn i ptID'vao+3ol he ode)
rion
or that he is orthealeged exeicanoo Any violation
fun nd the brei.) for the cts
therefrom
for a pmni' subjects the applicant n' a civil Penalty
31.5 b the
of Seamon 707 any applicant
A�P�NNumber
Occupancy Type
n v dyedol
hrntmaremanhrdnammaaanamLSS0ul.
Tri C/
❑I,a,nwne orthe progen, or my employed, with wages mmeir olc compensation,
Required Inspections
will do the work, and the snnnure is not intended or otemd ter sale (See. 0)14,
un, m1 rose, -un, code: 1me Contmcors J ante Law does nal I,I+ply Ina
a,. n
w r orh y who buJds or i nod who nil, such work himself
provided that such, arc am intended or
ar erect pit his awn employees, pnwWen
[its o
36902030.00
or mpr vement k sols
olrmmd pursuit, If, however. % building or improvement i, mid within one year of
completion.me owner-noir.). small have the harden of proving that bedid wr build ur
aprove
fn,
Tsar nam"e of ,ak.l.
101. —
FOUNDATION
oLrrovsac,of he pmpeny,nln c.cw,lvely eaatmehns with licensed cmnmaors a+
ea2ymc' Ile project sed. 7044, Business ; J Prm'e,xkn, Code:l'rhe Contraetnrx
1.02 —
PIERS
Licen,d Law docs nm apply or an owner of pmpeny who hands or improve, thereon,
rnr hsco,sd m Bit)
103 —
UFERQB&PCs'^ti
rad whit contract, zh' 'ise's wdh a ctomaanrls) pursuant
104 —
REBAR105
[ , A )N D hnitA ON-
—
1 iZIF,
ANCHOR BOLTS
SEWER &I,IRTER
I hmcby aBlrm under perp, of perjury one of the following declarations:
202 —
UNDERFLOOR PLUMBING
h, fnr Worker:
❑ I and will maintain Certificate of mar
adn. iateo Convert
—
LJPIDEP,FLOOR MECHANICAL
Lidssvm
urthe.s IaM,r, for and
a, nmafor by 370) o
cumpen.d provided f
ens
203
perfm'nnmcd of the work rm which this permp is issued'
204 —
UNDERFLOOR FRAME
❑Ihavcxadwilllnaimain\VorkersCompea,art,nln,nram'e,asrequredbySecBm,
'the
205 _
UhIDEP,FI_OOR INSULATION
f the La'r Code, fill the parhnmanm o1work for whorl' this pc.,it is
3700 oM
„ueJ. My Wodd1, (Comp) 'tion/J�/,r.. S<r:rnd Policy another am:
�L^m"I`olic'y vmt �l
,^yfiyl —
ROUGH PLUMAING
Carver: n�n�r W"IG W ZKJ7RS
roRRV
3302 —
'TUB li. OR 51�IObJER
l;I RTIFIGATION OP EXENIP NPROM IiNS'
COMPENSAI ION INSURANCE
303 —
ROUGH MECHANICAL
([his sccyion recd not lwemaplemd it l he permit i, fnr one hundred Jolla.,
304 •—
ROUGH ELECT 11 CA1.
151 W) nr le,x.l
305 -
FRAME
I )miry that in he penonwnce of he work for which this perms is i... ed. 1
,hall hilt mark, any pcnnn in any loaner,,, a, to her me, subject m the workers'
30E —
H01_DOWNS
CnnLadr lllon Laws of CUllfornlu. Ua,,
A,dm:Inl -
307 —
INSULATION '
NOT ICH 10 APPLICANT: II; aftar netking mix Cmd1i'd t 'it Lia you should
treaodsubject In the Wmkerx Compensation po,kim" of me Lvla,r Code. you mast
308 —
SHEETROCK '
ded. its coney with such nro, Went, or his pemat ,hall he Remora m, Liked.
-
309 —
EXTERIOR LATH
CONSTRUCnoNLENDING AGENCY
I herchy mina mat mere is a emnxwctian leading agency for he perfonaced
31.0 —
INTERIOR LATH
of the work rat whish nix Ix,mit is issued ser. 7097, civ. Cd
Wonder's Notnt
311. —
SCRATCH GOAT
Lander', AJJIme
313 —
•
ROOFIVRII_
I maiee tom I have mad this cityand on nay store mm me rMrvt laws relati is
elect.lacontrcomply
represmmna,andmmytoentrupo6
501 —
FINAL ELECTRICAL ENERGY
,andheebyiabodcounty
ill a ld B construction, an I hereby h 1 ' i ,a' m' city to t upon
mean dnrare, art inspection purposes.
502 —
FINAL PI_UhiBIhIG
(We)ad sit 'fy nik pl m Cy fC I t B'n.+I
agree
I, dug�estom
—
FINAL IdECHR ENERGY
1anal' ; Ig L.c let,dx Taitnnywy
Sir
APPLICANIU D.. 1PLY WITHALL Nf,- NT
•
•_9.13
_
Issued by:
YhIERGY
l'. JAIT III Ir+ tR,I]Y-It
8 e,
so
—
Re-roofs SOFT —
GAS TEST
A lieaa nhoasn- me
HAZARDOUSMATERIALS DISCLOSURIi
wiumer"Ilieant n, It eclJddr"oemp:Inl,nalc m Ill did lm,ntasinatcrhd
Type of Roof507 —
FINAL PLUMBING .
a, relined by the Coenine pMunicipal Cade, Ch her 9.13, and Ihe Health and Sarety
Code. Section 15532(u)Y
ire, rr'"'
71 —
All roofs shatl�gsliuk�e
I I r
to�(��'tFi(�'}���m,hIr erial being installed.
Will the applicant or future heading occupant use equipment or devices which
❑iil��tspeclpedTTp,JR]'r
If a roof is insra'I A Wlthont
PAffi-o Dt an inspection, I agree to remove
harmJou, air comnlninanbtndefired bylhc Bay Area Air Quality Manvgenent
/
o
all new materl5Mbr ms�i1A4@J—Ail
nn}'
CWi �sitf &tstands and will comply with
'call
D.,"”?
saves oNn
all non-point g94rge rcgglaiippgf_ PUBLIC WORKS
1 hard mid the In... Wool mmerials mtuitanems ander Chronic, 9.95 of the
Ci ikmiu I Ical'h At Safety Code, Sections 35505, 35573 and 255TL 1 undec,mnd Thal
r num rot it is my msrym,ibil'ny
if the building does nmc beady am
the LnN lel ,t b' nCl nriar'o is,u:mce nf' '"upoy/Signature
AlMn'nl
/ 7
of Applicant
All
Date
to be Class "B" or better
Q• ar en
roof coverings
OFFICE