00110115 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
NUILDINGADDRE S: PIiR )
10955 N WOLFE RD l�c�j3. 10115
OWNER'S NAME: AI'Y1.CATI)p SUIT I .
PACIFIC BELL MOBILE SERV. 1 c1/ 00
PHONE' SANITARY NO. CONTROL.NO.
p z Z ARC]111'F.CTRiNGINIMR: BUILDING VERSE I'INFO
1{L Hl_E i- PLUA MECJY'
O I_I IJ I 1_I
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LICENSED COMRACTOR'SUECI.ARATION Job Description
pO I hereby ufhnn that 1 con lirensed,miter Pnrvisinm of Chupfor 9lcummuanse P
rnH with Scclian 7lNIR)ol}� Sinn:la,l'mc Ruxincx and mfesai „Code,nn n license
xf� is in full fork and55t. L 3 yj TENANT IMPR.
O 6 License elan F/ Lie.« — -- _
W 3 n Uu¢ �7�s-�con,real
C,
ARCIII'TGC T'S DE CI: -
�'=0 S 1 undcomnd my plas,hall be a, as , , cc Js
O O Liecr,cd retire al /Iv
a. OWNER-HUILUER DECLARATION
uNl C 1 hereby.(lien that tun cacr,pt tram Inc aWoll,la fi Code:Any
Lave o k,o the
H Z Y which ire requior res
a reunite]ouster, t.bilal exs and improve.
dir oro h. Any ciy or county
s O which requires n penult m ro,ntmn.alcor,i l li—li damnnlim,or repair any structure
3� prion t' .. Inn y In ppl as t l - n pe sin file h L tatemem
flat he I, Ip na it II 1 t,of it,C ktc 1 In,a'a"9 Sy. Ft. Floor Area V' tion
(can g ,hSce 901 )of pit'sirs I of the B sea dl f..' nC,de) S45�f�r�
or that he in e.¢mp,merefnna and the halt,for he alleged eseril Any violmwn _
of Seu,ion 7011.5 hr any applicant fora p—ril,uhe''l,ibe applleanf u,a civil"rally
of con more than rive handred dollar,(ss01). APN Number Occupancy Type
❑L as ox'net of the Propcny,or my employees with wages a,their will,cmnpenxa,ion.
will Jo We work,and the structure is not imunded or offered for,ale(Sec.7(144.
Business and Professions Owl: no,Conuncmr%License Iave Ace,not apply to an Requi red Inspections
owner of property Who build,or proves thereon.and who doe,,rch work hhnself 101 - FOUNDATION
aimIhmngh his own eny,l.yeus,presided,hut such impovenmnn are nm intended or
offered for sale IC howeve,the building or improve nen,is old within use year.( 102 - PIERS
ompletion,,he ownerbuilder will have the W,den of proving that he did not Wild ur
mlo—C fe po soc"I lale) 103 — UFER
01.as owner of be propeny.anexclusively contracting with licensed contractors to 104 — REBAR
Limxmtet the project(Sec.7(94.palaces and Professions Calc:)The Conuanor s
cen,eLawdoesrotappymanownerofpropclo, I wild-,io,pmvesthcocnn. 105 - ANCHOR BOLTS
and who entries lits such propers with a contractual)reenwd pu,nuato to the
cmacnetors Liccrm I.ew. 106 — SEWER & WATER
01 am.... Dean,Sri. ,BSPCI...do", 202 — UNDERFLOOR PLUMBING
owner WORKER'S COMI'P.NSATION DFCI.ARAr(ON 2.03 - UNDERFLOOR MECHANICAL
1 hereby.lG.0 under penm,yof pi our of'he fdb,wmg dedarallons: 204 _ UNDERFLOOR FRAME
0 I have and w;d n ommin a CctdRc.m .f Coracm lose -insnrn barW..ke., 205 UNDERFLOOR INSULATION
Cm.pe.,all r. as provided for by section 37W of the Labor code. for d,c 301 - ROUGH PLUMBING
pcdorica ce of the wc,b far which his permit i,issued.
0l have sad will tine in workcr,Com1'en,mion ln.u,ana.as rey.iFed ny Saedon 302 - TUB & OR SHOWER
Pat of the Lulao code lar the pmformana of he work Tor which his pen„it is 303 - ROUGH MECHANICAL
.a is,u,d.My untion lnxurantt caele�J1'IT�Ii$,l�,f^�I./
�( Canicc_ policy Nn.: a / l7 / ( 304 —ROUGH ELECTRICAL_
CLRI'119CA1'ION 017 EXEMI'TON 17ROM WORKERS' 305 — FRAME
COMPENSAI ION INSURANCE
(Thi< reian need not be compincd if the peril is forone hundred dollars 306 — HOLDOWNS
SI(p) rlc,,.) 307 — INSULATION
1 certify that in the I,kcrNrnrvr a of the work for which this perste i,issued.1 308 - SHEET ROCK
,hull notemploy any,.....in.ny mourn,,o a,to heroine rt,hj,ct m the Workers'
Gnnpemstion Lawsal California.Dam 309 — EXTERIOR LATH
Applicant s p 310 — INTERIOR LATH
Nfy1'Icant APPLICANT:If,ufnr nwAin this C'crtilicum til Escm tion.you,haul)
Ohesnnne suhjeof to Ilio Wo ke,,Cn tret walion pm.,ori,of the UNT Codat you nmst
forthwith cmupywith such ptovidonsorthis pe,rotshall helearned mocked. 311 _ SCRATCH COAT
CONST RUCI ION LENDING AGENCY 313 ROOF NAIL
I hereby anis,that there it.con,waion lending agency for the performance —
ofinewnrkfar which his permh i,iaaed(SiteFINAL ELECTRICAL ENERGY
a ° Lea'er,ls"" 502 — FINAL PLUMBING ENERGY
7 z I.cadca'.c Addrtu
U O lenelfym:alhavert'adhis.rpplicatiolead title lost lhcaboiciaroocam.is 503 — FINAL MECHANICAL ENERGY
I,. pot correct.1 agree to co toply with all Lily and court'ordinances and,tate lawn,cmBl'g 504 — FINAL BUILDING ENERGY
C U to Wilding cervical and hereby.ul,onre representatives offhis city u)enter upon
s-
e d,eaWve.,ncndoralpmprtyforolfactionpurla„es. 505 — FINAL ELECTRICAL
[r 6. (Wc)ngrec m ova indemnity and Karl,hnnnlc..r�he Clty.f C,y,enloo.,gain,
fA City inks,ocipernn,corn and.1 di which may in vitt'war ac sai,n,l said 506 = GAS TEST j
U ti Cityinumaeyuenre of the 4Mie permit. ( P
conucn GNI4?R. ` AND .hc 1rB ALLNON-POINT (,'sued by507 FINAL PLUMBING Date
O —
.nureolApp�ic.mvcta,m,Lim
[)are
Re-roofs
uAZARDOOS MAIER1AL5 DISCLOSO , 5�7k9 FINAL GRADE
Will the applicantor frown Wilding a'culunt nmre m lu„dlc hmatJom nuncrial Type of RU(
a.,lefined by lac Cupenino Municipal Code.Chapter 9.12,and the llealmand Safety 510 — FINAL PLANNING
Code.Seek 25512(a)!
Oyes 0N All roofs .511#beinsl-pdckkgLpri(R4U3An�ri)oW6b9rial being installed.
Will the apl,Iicam m ILane budA'mgoccepart.,a aluq,fncm or device,which If a roof is installed without first obtaining an inspection, 1 agree to remove
emit harardous auct nninuic ,a,defined by the Bay Arca Aur Qualify Mmayemcnt
• Milk,? all new materials for inspection. Applicant understands and will comply with
Oyes 73 No all non-point source regulations.
I have real the hazardous material myuimmema under Chapter 6.95 of the
California Health k S.fey Core,Section,25505,11533.ad 25534.1 understand IFa,
it the building Jac not cu huvut mns.nnhw h o my r• smlliy m ar y me -
,ecupant of the mlui id,nma be met pail soare,.1 a entirclle of
Signature of Applicant Date
i erorkafnori>L ose.-.� - .D—,-•/� All roof coverings to be Class`B"or better
OFFICE