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04080170 CITY OF CUPERTINO .......��71,tutu-eT—� BUILDING DIVISION PERMIT �t,0NUAW,T NFORM7, BUILDINGADDRUS; CRAFTSMENS GUILD INC FERMI I Nu.04080170 , 122A ynPXqPTRP. IpR ERT NAME: PERMff L95UE DATE ^9 _105156 S 1`17 ANZA P117 N SANITARY Nb NE: O OL NO. E: C ARC (4Q8) ,;it;r,-1 non BUILDING PERMIT INFO PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I rombs,affirm Net I am liberated under provisions of Chapter 9(commencing Job Description with,.j..don ).fDI,i,kw3.fdoB..Ww" MC�7diryfic.mwa roc dli, M'. Lai. REMODEL/ADD 464 SQ. FT. (MS BED & BATH) ass_ - Dam Compactor I ubdeaga{SWy Plus ARCHITECTS DSCIATION 'N, &WIllicamaduptil, cowards, 6 U.—.d Professional OWNER-BUILDER DECLARATION I hereby aM.that I sm exempt from the Conlowtoel LTmsC Law for the EDO following reason,(section 7031.5.Business,and Profession Orion:Any city or county which requires a Permit In comemback star.hatenown,dental W,ars repair my simulate FZt prior to is Waves,aim requires the applicant for such permit to rile a signed tromarmat Nuc is licensed ruminant in the provisions of as Connector's Uccom Law(Chapter 9 Sq.Ft.Floor Area Vadtltn (earramancing wide Schon 7000)of Division 3 of me Bananas and Professions;Coca)or that ime a exempt therefrom and me basis far the alleged exemption.Any violation of Stiction 7031.5 by say applicant for a permit subjects the.pplicaust to a civil penalty of 3 02bi Milrber 0 0 Occupancy Type act some man flue hundred dollars(M). 0 1,as owner of the properly,or My CMPIOYM Wide Wilma U their sold Courameadmi. will do ite work.and themoomas I.net husband-arcessd for Wei(Sm.70di Bus. Required Inspections .it Profiessions Cods,The Committee,Umse Law does,Out Apply W an—1 Of prospanny who builms to improws,woman,and who doesi such work himsellOr through his most canploycat,proo,mical the,such impronamerits are nOtlnd or offered for sam.11. however,me bufflding or improwment is mid Main am year of carepletion.ran amen. builder will law tis burden of paoing Win se,did at Wild or town.far porpose,Of []1,as cancer of the property am wicladvely contracting with Immeand contractors to MAY common We project(Sot.70414.Business ad Proliessime,Code:)The Coruscate,U. ccnsc Law does not apply in an owner of prapeny whe Miss or Improwe,woman,and LD who contricus for such projects with A comossions)licensed panders to the,Comrsuctoes Lie new,U 0 1. corld,under Set _.a&P C for this beganne u1milvo Data— WORKERS COMPENSATION DECLARATION 67 1 be.by afflne motor penalty of perjury an of he following doitarflons: M I have and will maintain aCcelim.w.fComem to adf-Wum for Waime-C-tabim- cation.a provided for by Sector,3700 of the Labor Code,for we performance of the work for which this permit is issued. 0 1 have and will mainain Worker's Compensation lasurisrux,as acquired by Socibut 3700 of me Lither Com,for the Performance at the work for which Nis Pines is Issued. Myo'lk,e' pw.�z1ga .,IF and Miley number 11. : 0 t, Cartier.b '. CERTIFICATE OF EXEMPTION FROM WOR COMPENSATION INSURANCE (this media wdoor latcompleted 1111m parelt Is forces hicamcd diulaw($100) par less) I certify that In the performance of the work for which this Fermat is Wood.I shall not employ any poison in any manner an a to baccourc subject to almWorkens'Compensation Laws of Csliforni&Dam APPIwmL NOTICE TO APPLICANT.If.after making ibis Ccniffeam of Eactaption,you should become subject to Ow Worker's Compensation provisions of me labor Code.you M49 OZ forthwith comply with such provision or this permit shall W deemed monclaid. CONSTRUCTION LENDING AGENCY I binary OMM Net there 11 A COOMInelmn leading agency On the PCrrOmwwC Of ai> use anal,for which this permit is issued(Sec.3097.Civ.C.) ELender's Name z .mrs Add. U 0 1 ondify shat I him mail this applicaflon and saw Na the&how information is Da y with all city and county ordinance,and saw[am relating to 0 building constroction,and hereby authorice represumadoes of this city in order upon the how-ranadmind PMPCny for WipiaLikin Plarodum. agnim to (We) u".Indemnify ad keep harmless the City of Cupertino against comec"1'"m a cam" ,M Imbilitherjodipme.u,coca and.spiamor which may In any my ocrao.ganual said City U In consequence Of am treating of Nu Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-1OIMT Issued by: Datef/Rl/(6- 101�0 Re-roofs 'Signman,of ApplicamiCantramun -Dam HAZARDOUS MATEJUALS DISCLOSURE Type of Roof Will the 4pplicent or futuact Wilding occapant core or Much,havrodous material] as&limit by the Catarina Municipal Cods.Chapter 9,12.and th,Heirts and Safety .4r.Swd..Z55324y? All roofs shall be inspected prior to any roofing material being installed. -0 Yn No Will the applicant or future building Occupant um equipment in devices,which If a roof is installed without first obtaining an inspection,I agree to remove emit him,,oweas aircabawo senan fined by the Bay Am,Air chiefly Management all new materials for inspection. 0 ye: No I have raw the lawardwas materials recrifismants under Chapter 6.95 of the Califtar. ids licalds&Safety Code,Secomine,25505.25533 and 25534.1 undecrund and if the building doo,not concaudy he..,kwwa;,ffU—TF"y ompubsollity 0 Wary the occupant of an Dam Z — - i REVISIONS BY 'D,k -O - �t GFI 1, f) GFI Il .° �% GFI FIRE - 14' �f 00 SKYLITE:' 711 —�— _ CUPERTINO SANITARY DISTRICT Closed circuit video inspection of property line cleanout,point of connection f and street lateral required prior to passing FINAL CITY PLUMBING yy�, � �'� // "! J� l i'• LINEN / INSPECTION. Call the District(408-253-7071)for an appointment. yj "2] -- ----- -- 00 v o 0 a �Ov_..� pq I• - - ----- _ MASTER BD. > V- �I N� 6°X Z° I a Il J� k ! II N WALK IN CLOSET — 22'2 '- II i -" 7'6 V ----------- FAMILY - ------FAMILY a — rLINEN EQ�jR fi 5 _ ----- II 5'it 8 to 1 4 Vote ;I1I _•'� r �� TJ BA�TH Aq- .......; 11V 6 1, 11 KITCHEN _ i '� Xy ---�-r�-.-; !� L .Y'115 ovens pantry OF C"PE rn o f ��� N N 'lUii�Cj �! ---- --- 13' ----hood KITCHEN !BATH ;REMODEL DINING RM. G°xY°�c°x j APPROVED McCULLOH RESIDENCE to imoa ` 10255 VIRGINA SWAN PL. zl CUPERTINO CALIF. 'I'm 7, 95014 �• rGv �' $1� /9L E / qtltPfawseciktptgBekM UlZ ana it is ORr � V Cx.snNG fz o08? j��Pzatl, � 1 Ih� rtt gPIAam 3 #f i+liT ba(ley i0 orm,or to Oe jai ke' 6Gfl any a9+10oes Zi Z• �/�/� jZ�.rtor✓s= �. n G��j'- FX7U�r'��' - Ti�� � . � PSH (r JEx/5r/nJG LUDIC ©GW� i1 A*41J �Hi /Lrx r �__� � _ /� itJ GC/ !J_ Ovt �Y'c� Z%_Ir'� � ,S. r uJ j✓t v At a r,oc! --�krUrc � � �TL , e t/ -- - O Su2FRc�= 0 7.G 2do/ 4-Vlir ,�! 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