01030077 CITY OF CUPERTINO -
BUILDING DIVISION' PERMIT CONTRACTOR INFORMATION:
BUII.IIING ADDRI-SS; PERMIT NO.
11073 WILKINSON AV 01030077
d\R'NIiR'S NAME; APPLICATION SUB DAZE
\)
I 03/14/2001
THONG SAN[IARYNO CONrROLNO.
ARCI H n:CTII:NGINI!IiR: BUILDING PERMIT INFO
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G IiLIiCT I'LUMIf MliCll1 IJ [_I' IJ
y- LICGNS ED CONTRACTR'
OS DECLARATION
o�"-'c I emhy alnrnrm mall arnwen.m anger lrrn.ici.rn.of chapter o(rwrmearreme Jqb Description
mFm with Section 7000)or Division 3 audit Business and Milli Cede.and my license
m
is In W11 fora turd ed"L
dodgy Liecn'cm.x Licca ADDITION
Dale c...incenr
F 4 G ARCII[rEG7'S DECLARATION
1 understand my plans shall be.wd as public record. I
L,2a' Lie'll Profensirr in] '�
%an OWNER-HUILDER DECLAR '10 �L , O
ul-ret I hereby affirm chat Ir
1 um exempt mo me Contractor's Licosa nw[pJflY lne D
F].Q lirllnwing t0c"m.ISeetiun 70315,1N,iness:md Professions We:Any anyorcoumy
F=n 'l" a prmil , t het, p J m li'16?`p ' uyryry
......t , .Ix,r 1 d 'rMia; trop n 4T :g4drpttr" m
— maths licensed pu.alt he p ns nn c ,mra�e : Iaw(Chapter 9 Sy. Ft. Floor Area Valuation
Bmlrrneming sans sauot'ifxnn or urvLaon 3 ur ora nnxin.e.amt Prorcalnrnl cols) ,
or that he is exempt Iheterrem and the basis for the alleged.gtt �4�olt
ol'Section 7031.5 by arty appha; I fiat u,arm it n.h,ect,Ihe.r"i `I'E
,ifmnmorethanforloomedmmar.Is5IwI. APN Number Occupancy ype
Ell,as owner of[lie property.or my<mpuryees with wages:t%their sole co nWasatinn.
wi `ll do the work.and the structure is not nncnded m oticmad
d lot sada(sec."loin. 356 :7035.
Bus and Proles Cede:The Contractor's License Law dee net apply m an Required Inspections
ar"Ouror property Who builds ori ill there...,and who docs such work himwlf
u,lgn his owrr etployee..p,.ided Inas such imprnventenrs ar am intended n` 101 — FOUNDATION
ed for vale.111 hoses,the building or improvement issold within one year ri ,
aplefik.u,mde
e owter.blm ,wRnml have tire burdorproving that he did not build or 1.02 — PIERS
� m
_ Ir,�ror p.Harw of sasses —
Thercha
e ro)sty.amexclusivelyeoomrctingeithliaenmdcontmcmnlo 103 - UFER
7(94,au.ins.x and Pror xxiun,coduo'nr<Contractor x ].04 — REBA R
Nsol apps m an owner ofproprly who builds or improves mere...
to, i PtrJea,a widr a ranr,enu Is) ncan.W pursuant m the 105• — ANCHOR BOLTS
Ctvs lal❑ J< 'c. &PCto, hisrcawmn 10E — SEWER & WATER
oDate `2 �01 202 — UNDERFLOOR •PLUMBING
O 'ER'SCOMI'ENSAI[ON ECIA xnoNantmder II of one of the following declaration: 203 — UNDERFLOOR MECHANICAL
n :,r.l y,r ' 204 — UNDERFLOOR FRAME
❑ I hoc and will noidon a CcnilSect of Consent m ae"but th Work tiro
ctmpe utinm as pmtided fire by seado. 37u or me Lanor awls: for ora ee^05 — UNDERFLOOR INSULATION
pr onnina onne work fur which ami..Pcmdt is ixxua 1. 301 — ROUGH PLUMB I NG
❑ibase and ,ill mahout Worker vC...nle'was,rel.lnxuranea.,l.tv,luirednys<etioo 2 — TUFA R OR SHOWER
37M of,he[..No Costa.ra mhe prfa
mmnce of the work for.vhuh oris permit is b
^Q1
issued.My Worker's C'ompn,.it it Insurance currier and Policy Immhur arc:
303 — ROUGH MECHANICAL
Carrier. cERIiriEAroNOFExp. PION FROM WORKERS' 304 — ROUGH ELECTRICAL_
COMPENSATION INSURANCE 305` FRAME _
(Thksection need not be completed it the permit is for one hundred dollar 306 — HOLDOWNS
0100)or lull.)
1 army that in the,t n arice if the work rut which ori,permit is kst d,I 307 — INSULATION
.hall not employ any person in any runner W as In bocma s.Efecl to m<Workers 308 — SHEET ROCK.
compensation[,ws or Calirorti..Data
Applicant 309 — EXTERIOR LATH
NO]CE'1 O APPLICANT:11:arae nwk'mg his C11 iOcae of I!senlption,gnu should
become suniea in the workers compensation provisions of Labor Coda you mus, 310 — INTERIOR LATH
O Q Hmhwith comply wan such proloionx or this pond 111111 be domed revoked.
z 31. 1 — SCRATCH COAT
4 CONS'I'RUCTION LLNDING AGE CY —
a Ihcmbyaflinnthal,herds aetmstmaionlendinpagomyfor the eformancts 313 ROOF NAIL
a C ormeweNfor wMcnthis panni.iamW(sss.3an.Cie.c.) 501 — FINAL ELECTRICAL ENERGY
sit da,lxnak'v Name
z Lender's Address
U O Icerifylbar lbase rea his aPPlicminnand slabo
cthattheaveinfinm
ohmis 502 — FINRL PLUMBING ENERGY
w r:. Comes,.lagreemcomply will.lof(yand aotratyor,limmaaand'Imt,law.ramnns 503 — FINAL MECHANICAL ENERGY
O O m b.l g construction, d thereby Ih r u, semmives r this Cty t enter.,.
meal dPr1 n,hn im,,un,po,o,c, 504 — FINAL BUILDING ENERGY
Iw) .:r I ry dk rh 1 .:meaty rc len Dasa sat
V) habit d p n I y r,rmy y said ) 505 FINAL ELECTRICAL
C.7 z City conte, le ca ofth gearingofthisprmn6 3, Z L/'_p.,
SFLI,ICA11 rUl,)I'RDNSNUSANDWILLCOMPLYWITHALp O � Issued by: 50E — GRS TEST Date
FINAL PLUMB NO
Signatnm of pelican Gmmuaanr Date Re-roofs
n'rARDous MnrERIAls mscLusuR: 508 — FINAL MECHANICAL
wiu our appltaam,mer.mrt hdldilmg ualp;mn,ltlrrc,rr nrlmnc harnNt.l mmatial Type of Roof 5@9 — FINAL GRADE
its defined by the Cupniuo Municipal Cork.Chapter 9.13,and the Health and Safely
CLW.,Section 25532m)?❑yes ON. All roots shall be%i .1ilQcted fFUM0lan�P ,k�r� I W&ial being installed.
Will me apphcatlt or forme,building occupant use equipment ordevi«.whish I f a roof is installed�Ahou[ �r�t�t iain�t��-i �pel����;ree to remove
eon narardt.s air<orieninamv an define i by her,Bay Ar<.Au u.ahly Managamem
Ductus all new materials for inspection. Applicant understands and will comply with
❑Yea ID No all non-point source regulations.
I have read he hammJo.s materials retltimmcnr under Chapter 6.95 A the
C'alil'urnln Hth k Sale,y Code.Scetiunv25505,25533 and 21534.1 undm
etsn l Ibut '
if the buildngAtes not contrarily ham a tenant,that it is my w%fansibilhy,o norry the
occupant of the re(junreolants Whim,most he men Prior In issuance of it Canaicrue oi'
Zupan`y' Signature of Applicant Date
IF( ,arorloth„rvedagem Dam All roof coverings to be Class `Br•or better
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