01010012 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING n OURHSS: PF.R, TN
11000 VIA SORRENTO 1 10012
OWNER'S NAMp. AI'PI,LCA'1IS) If1)Ol
STERN
40 1IONE: SANITARY No. COMNOI.NO,
MQO All171=1ENGINEER: BUILDING.PERMI9INFO
m❑ BLDG ELECT PLUME MFCll
5 N Job Description
LICENSED CONI under
pr DEC rs of ChUN
I hcmny affirm that 1 um of
licensed under provisions of ms Code.Ecommecense
H= w wimScninn]fXXBofUivision3OfthcRuxincsanJPmleaionxCWaandmvlimns< KITCHEN REMODEL
in ern rune and t. x
at w 2 Licence G ass_— I.ic.I, 6_$0''''}/'`�
pue
I I ARCIeall he "S OHCLAIcN ,ad«� ��CCTTr«<------����
1 unJentnnJ.ny plana shall M1c used as public raxndx /
} 3S p p Licensed Poncio,iould
o a OWNER.BUILDER IJECe Cienr ON
=' 1 hereby alAnn on 1 L5exempt from the Comractnr's Liceme Law for he
Fa< whichire remna.Exaction]0315• t,ainess:tml ve,ddons Ca le:nor dry armoury
iO whish y ry )t t t It li c I'.h repair r waste
� nr�,n r oe y In nor 'np II -6 Lrremen
e. Ihwl II -_.: n .I I x 111 L . 'I 1' Iawr1119 Sq.Ft. FloorArea ion
(w .ng and,Seat....7(X101 of Uv n9 of the lbonexx and Prdessinns Cale) $�
of
or that io is 31.5,con,ab zany applicant
me basis I, hi the cxcnWtinn Any l Estr ioa
of Secno:lone than % xnr direal canllin x500). whjeca rhe applicammacivil revelry
m no:.non moa fisc Itu.tamd danatx assn. A PN Number Occupancy Type
°1,as ownerofmaproperty.ormyemplmeexw;hwa,a,asthat,xolevorp,nmum. 31601041. 00
will do the k d tire qmucture,is not intended or offered f (Sec.7(W4, R
H : a i r ul I Th o f e 1 o t apply to an 1,01 - FOUNDAT L 6Td Inspections
wniauf Nhibtms:pr watsu tad hod t l rkhlmxdl
Or Through his awn anplOrcns ha idoa Incl sten i.nprov mos Luc am inu, cm or
comps for, he.II;however.Inc nleve t n.burden
n Ofcuicrin
moving
sold within ane rend or 102 — PIERS
��completion,impose Of uimf,will the nmden orprovitts mar ha ata not Haim or 103 — UFER
tmrox�e for rtm,xa ur.:de.I.
❑Loxrnfmepmrert,,amexclusively contracting wimhcensedaoatrunorxto 104 - REBAR
Ltnswat enc project(Sac.7Rly 9udiroxx and Professions Ca,10 The Contractor.
icense Law duex not apply to as owner of On ser,who hold,ar improves maeon. 105 — ANCHOR BOLTS
Roral who[....suss for such projects will, a sonnecon 1 leased ressuall m the 1.06 — SEWER & WATER
Cunhace,rx Liam..Law.
°I an,cxa,ga tonal"Sac. .n,v r C l.,:This re"on 202 - UNDERFLOOR PLUMBING
Ownef Da1e 203 - UNDERFLOOR MECHANICAL
WORKER'S COMPENSATION DECIARN'ION
Ihereby affirm under penalty ofrerjuryone ofthe following declarations: 204 — UNDERFLOOR FRAME
-1 Carl m 1 nava mal will ...:non... a CenConsent m .all:imure for Worker. 205 - UNDERFLOOR INSULATION
Compeasmion, a rlooided ear by see.iun 3700 of me Labor Coda. "Irllu 301 — ROUGH PLUMBING
pernnmaicc or ilia wind,for which this rant...is issued.
IIhc adw;nmammmWorker',Com tiiInsurance.asO 'own scion 302 — TUB & OR SHOWER
p.txn yin. y.
I
ar me Laver crate.res he i homoanm of he woo dor nuwhich mo prmta ix 303 — ROUGH MECHANICAL
issued.MrwMker..1}c�u�,mpeyn�.a�tion ntxtmnee eameranJGor7ymmmn0 304 - ROUGH ELECTRICAL
carrier:SCI':k111�I 1I�(-1 be,'IONF K'(IRKIiN.ti' 305 — FRAME
CO)MI'(ENSAI'ION INSURANCIi
30E - Hol_nownls
(Thea uxtinn vecJ not w romplemJ it rhe permit is for one hundmJ Dollars 307 - INSULATION
1511X11 ur le".)
I certify that in the performance of rhe work for which his permit is issued,1 308 - SHEET ROCK
shaft as employ any p,,.in any manner xo as m become mhje,m the worker: 309 - EXTERIOR LATH
Contl'Omalion Laws of Carromia.Orae
Applicant 310 - INTERIOR LATH
NOTICE TO AlIPLICAN'r:II:atter onAmg In,CmiRcam of I:xantptlnn,you xhntld
Q Q nee Oc,unjearoflea WeakarsCnny,<nsal neLal o.Code.y...al-t 311 — SCRATCH COAT .
loolo im comply with such rrovi.aons or flux Pernod.shall be dec ned revoked.
Z r= CONSTRUCTION LENDING AGENCY 313 - ROOF NAIL
1heregafrrmmattherris.construction lmdingagencyforded perrum.anee 501 - FINAL ELECTRICAL ENERGY
Of the work for n Inch his permit is fixated(Sec.3097.Civ.C.)
y p 1<nder',Name 502 - FINAL. PLUMBING ENERGY
.ti. z 1.11 der's Address
U o 1 cild,,lia,I fineven,rd this,pphea d lace e rd l .li is 503 - FINAL MECHANICAL ENERGY
c3. F corn ' 1 , ' Ily th It !Iy d tr d d Od I lams 504 - FINAL BUILDING ENERG
O f�
yatwld''y r r dl by rh P tf .ritl city(center tpon
L4 heahoarlw f .psi r
505 - FINAL ELECTRICAL
g t e J Jk ph th Cty fC pen g Diu
V :AI-14
Imes.,Jgmenn,ensu vm ses whsh mar in vny JY as<rae.,ain't - J 506 - GAS TEST
U Z m eon enteaa Orme g tf ,r mix permit.
•ur Turvnr:Rsr O 'l1.LCOMPLY - f11A1.1.VfN `OINT Issuedby``�07 — FINAL PLUMBING Date Gr Nit s.
� -
aoinp—p.CJa.i' - a - - - - - D re �— Re-root's 509 - FINAL GRADE
If A9ARDOUS Mding wIALs OISCLOSURIi _ '
Will me arPrc:tnr nr rtmm wading ac lappa smro nr hamm Healthtan Safety Type of f
mdefnedio the Cupcnino p:rl Crile.Chapter Y.l2.and the Health and Safety g@ — FINAL PLANNING
��f{{{near
Crile.Section 25572(x)? \ Fp JL .xl g'rlgl Tr. W rsrr t
❑Yes No All roofs �I�I�tbe tat, ri r 3o t dial being installed.
WBl It,applicant,oilloan,he Idle,ace upar.....cem.imneal ordestcex whirl. If a roof is installed without first obtaining an inspection, I agree to remove
un.ir haed .a
cal a onntin.. -del i net by rhe bay nn:.Air Quality Mintyameot
Dixaia?mJ all new materials for inspection. Applicant understands and will comply with
❑Yes e NO all non-point source regulations.
1 have read he hanoux
NminNu iscrem,under Chapter 6,95 of he
Calif. cahh R Safe,Cmle.Section,25505.25533 and 25534.1 undpram d that
i c huildi g does nmcumenlynor um.mm it is my,Naxnihil'ny to notify the
,ocupace r the raluiremmnx w m M1c mat prior I i.'wance of ce ifcam of
ec '
Ott m
—e. / 1 ; O1 Signature of Applicant Dale
a or umhmimd agent _ JR, All roof coverings to be Class "B" or better
OFFICE