00080183 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
IIU I I,DING AUURISS: ' PERMIT NO,
INC 00@901&3
Uw'NIiR'S NA. lis APPLICATION Suit OAni
ONE2 _ — 08/25/2000
..
ION[?: -—• - SANITARY NO. CONTROL.NO.
7.
Op-/O AIICIII'IJiCI'IIiNCINlililt: — Iil11LItINO I'IiIiMIT INFO
H w BLDG 1!LEC'I' I'LI1MB "MECII
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F- LICF:NSLIaCOYI'kdunderprovisions
O[CLNtN'IUN' "rl Don
ZO Z I_ Eur 70 X uof thin 1 r 3licensed under pa.I reads of Chapter 9(e,mme"citw ��"�'�,
Z,,4,_u with 1.11 foreland cf Uivi,inn Jnf theBmines+unA Pm(e+einm C,xlc and mylicense
i. Limmollli,mcandeR«I. m ai
�$ ucenwclaa, Ling— TEMPORARY PERMIT
E,.-U Dam Co.
ARCHITECT'S DECLARATION
= O 4 I nndenrand my plana shall he uwd as public records
ce
Re i O O Liaenwd Pntl'v,amsl
OWNER-Ii UILOER DECLARATION
1 hereby affirm that 1 ran exempt turn the Commem,'s Liemi,c law sof the
H Z C fallow my renes fSeAnn 7031.5,business and Proteesinne Code:Any city or corany
S p wI',h na,unm,a p it t 4,mm. flue,improve d Wror term, y if Imre
i 3 pr, t a I. y 4,h pi 1'e 4,t h pe lu y d n t mem
tird lle 11Ira,swpa,sn 4,t (lie at as the a,ba, c Liv,(Chapter 9 Sy. Ft. Floor Area Valuation
lummmming with Smmn 7dXd of C,oimn 3 of Inc liu+inoa mid Protcav'n,a Codc)
nn hpt Iaie is exemlhcrefrnm and the husk far the allegem
d cxn,ion.Any violation
of Scotian 7031.5 by any appiiemn for a pennh subject,lie applicant hl a civil penuhy
of m,4,mom than live hundred dollars(S500). APN Number Occupancy Type
❑1,m,owne,of the property,or no,employre,with xa,,,it,their enle enmpcn.vtion.
will do the work,and the sweure is not intended or offered for sale(Sec.7044,
Business and I'mfesvions Code:The Contractor's License Use does not apply to an 72eyuired Inspections
orr of profit Who builds or improves themon,and who does such work himself
through his own employees.flamideJ that such iniprovcmenty are not mumaded or
offered for%ale.If,however,the building or improvement is sold within one yea,of 101 — FOUNDATION
ompletion,the owner-lbudder will have the burden of proving that he did no,build or _ ,
improve for purpose nr . F
Saler. 1.02 IE R
SS
❑La,ownmothe p,,cn,anne.elusivaly comerming whh licensed tomracmrs w 103 — UFER
L.n,truet It project flee.7044,lia+mea,amt Profen,ua,Cods:) The Ca»,m,b', 104 — REBA R
icense Law d,cs sot apply to an owne,of aa,mly who undid.or Intpnrves thereon,
cttel who ca,mmon mr.ueh project,with a conlr^clods, roe^sed InnsemR to he 105 — ANCHOR BOLTS
ontractors Licnuu Law.
❑1 utwniplmnder Sc,l .B Fd P C int this ma nn a 106 — SEWER & WATER
O,ur Date 202 — UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARAI ION
203 — UNDERFLOOR MECHRNICRL
I hereby affirm und«penehy of perjury one of the fnllnwing declamtionx:
❑ I have sad will annul.a canibcatu of consent ,,wR-m+rare far worker, 204 — UNDERFLOOR FRAME
Campea,aana. a+ provided for by Section 37st or the labor code. for the 205 — UNDERFLOOR INSULATIONperfom,anceoflhew-orkforwhicnthisIpermitisissued, 301 — ROUGH PLUMBING
❑1 nave aha wits maintain w'orkera annpen,:nn,n Instant,a,required by Section
11(XI nl the Ichor Code.for the performance of the work fon which this pemifl i, 3@?_ — TUB 8e OR SHOWER
-anal.My Workers Compensation Wsumn,e caller a all Pol'my mmllhc ale
' 303 — ROUGH MECHANICAL
cod« A FEcy Policy No.: WSR/G 4116 3 3_ /
CII:Nfu71CNPION Ol7liXEMPr1ON FROM WORRIERS' 304 — ROUGH ELECTRICAL
COMPENSATION INSURANCE 305 —- FRAME
Innis sees....need.,it hctmnpleted'dme pem,il i,krone handled duller, ' 306 -- HOI_DOWNS
ClIgn or le,)
I ccnify that in he performance of lie wink fm which his pend,is d,Lied,I 307 — INSULATION
,hull not employ any pecan may mea m hcmme t the wbrkm' _
cnmpcnsati»n laws anomia /—�" 15 "� 3@8 SHEETROCH
^ppBed^' 309 —' EXTERIOR LATH
NcyrICE TOA 1CANT:IL armnnking this CeniEcme ofE empuon.you zmmld
Z became object the workers Compen,atina provisions of the Mbar aut yam must 310 — INTERIOR LATH
Oforthwith comply with such provision,or this permit+hall he deemed mended.
Z O SCRATCH COAT
CONSTRUCDON LENOING AGENCY
311 —
C > 1 hereby affirm that there is a e^a.nncaon Ending agency or the pemtmmnce 313 — ROOF NA T I_
oI the walk for which this permit is i,w,ed(Sec.3W)7,Civ.c)a p Leaw,',Name 501 — FINAL ELECTRICAL ENERGY
z Lander,Addle,
vO ltedil'ythadIhave read mi+u,rani... aridnulenn —
udteaboverC al 502 FINAL_ PLUMBIMG ENERGY
IT. Femma.Iugreetocmnplywi],all city sad,o,mt,onina ee,:md,toolaw,neladng 503 — FINAL_ MECHANICAL ENERGY
OU ,,b .sndho
tdldingaonuc,ion,and hereby arusa repre,crunnict, o1'this city m ellml. ntt
> m the^M,ve.mento,nedpropenyfor inspection lampposts. 504 FTNAL BIJILDING ENERGY
d (We)agree tosave,indemnifyand keep hannles.+the City of Cupemna against
N liabilities,judgments,costs and expenses which n,ay in any way active against said 505 FINAL ELECTRICAL
U Z City in comcymn,e of the gmming of this remain. _
AI'PhIC UNDERSTANDSAND WILLCOMI'LY WITHALL NON-POINT Issued by: 506 1SST Dale
SOL' _CULAn �S
Signamrc ulAPPI1e HAZARDOUS MATERIALS UISChOSURE Dat Re-roofs JO;8 — FINAL MECHANICAL_
Will the applicant or future holding occupant wort inhumbe hazardous material Type of Roof 509 _ FINAL GRADE
m AdineA by the Cupcninn Alunicipul Oxit Chapter 4.12,and the Health and Safety
OMs,Section 255320l:' pp�p T
0 Ye, Li No All roofs Shall be-idS ected rJc�ll i��-anyFFy�tl6ttY1 1nN1[ b ng installed.
will ane mppdc am o,mom bdddmgo,al,uais,atntipmcatordeAct,whal, If a roof is installe�ll ithTnn W%taiAT�I�ln' I�sp� ,Tugree to remove
d4,bua:udnun air enmaminann as dclinel by tine Bay Ams At,Q-111,Ment,awan
'r all new materials for inspection. Applicant understands and will comply with
O yes 0N . all non-point source regulations.
I have read the hazardous materials myuimnamd,ander Chapter 6.95 of me
Culilomia Health M Safe,Code.Sections 25505.255)3.,ill'31 undersmnd rant
if the huddling does not currently have a It that it is my renrynuibilityrn notify the
mearn d the re 4,y^which nun be amt prior n,issuawe of a Cenifcac of
f pan // �� � � Signature of Applicant Dale
'"fine,or aamodeed agent^t m All roof coverings to be Class "B" or better
OFFICE