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00070114 (2) CITY OF CUPERTINO + -•-- .,.aun.DINc DIVISION, PERMIT t, CONTRACTOR INFORMATION: BUiLIHNGA T1V332I : N DE ANZA. BLVD ,,#, •'t t , PERMIT No. . OWNIRS N VbURBABAIE, NAHRW. ' J• APPLICATI -ear _. r PHONE. SANITARY NO.- CONTROL NO .n z Z ARCHITECTIF,NGINEER - - f BUILDING PERMIT INTO , BLDG ELECT' ., PLUMB 1 •MECH - - e'h- �_J' C Iheeby If�m th�lltm ONTkAdCfOR ISr DPC1 ARAC10 y( g _ - ,. ]Ob-DOSCI1pGQ• I oz-a whnseen,n7non)nrD aan3onheBu ,e and Profession, n :�PLUMBING� - FOR 1, 91 2 RND . YER I. , .<M 5 's m full fine and effect. . '• a < IJcevw Class - Lek �' 3"a' Date Contractor i - ARCHITECT S DECLARATION 1h d I i , d Y plans had he cu,ed o,eublier,crads I ip O Licca ed Pr fen:'ael t °J oOWNER BUILDER DI CI ARAf10N s >-is, u'3 I hoorby iffirm hat am escrudf the Commamr,,License Law for fact, - ' Z.Q following g (Section 7031,5,[3u9iness and Professions C d Any bity0raturry ' Fdrzm wh hj' permitto-construct, It p d .h 1' E y:tf emre . , •• ,d 3 pati t t' .9 d ppl t f Pe n 1 file .'g, e d,l menr 'Wet lieracedpraturatt the p : I the C t License L (Chapter 9 _S Ft. Floor Area , .Valmnio renanencng send,Section 7000)„fDvii 3 rlh H :t and Poof Cod) Q' or'hat hes b.curpI therefrom nd do,bases I..the alleged escium n Any inflation ofSection 7031.5 by any applicrimf a to, it. bl r,th a"licamaRic civilPc by - itfoulmeare,than five hundredJ ll' ($500) +�,.:, AP OCeu ane e I .��91P�!P104. 00 ' « � P Y•EYP ElLsonvenoriffithe, I tty ye pLy ,I g� th su le_compess inn "f` s �+ h r.. ME do the k d the structure1 riended or offered f (See.' 7094 F d P :.' Code.TheC t t License L J t apply t 106 _,SEWtcRui6y "WAj cERms ow fproperty Wh n Id p thereon, d -0 d 1 workh Ir orthrough nply p adtn, np t t once or 202 'UNDERFL00R PLUMBING'offered fo'sle If;howc,.r, he h'llnk ' - .. pr,enen is:old within onev' l - ompletiondteownethahard completion, lderoillbasethebrtiofficergthathendnothoil x;301 -- ROUGH PLUMBING ` [3 1, Ith Property. exclusively couractiog wild1 e t -t 1, 302 .TUB VOR SHOWER ' . nlnstuctfire project(Sec7194Busne ndProfessions Cde:)The Contractors 502 "FINAL PL'UMB,ING' ENERGY License Law does not apply t' t property,who b' Id:or improvesth ' - ane who contracts he ,nen project.with contaaaoa(s) r .etrpnts,ant .n me 5,06 —`'GAS, TEST•iCande DIam°am exe`ptcideLSe 507 — 'FINAL, PLUMB . ❑1 am exempt under Sec. B&P C f r this re r p - - WORKERS COMP NSAI ION DECLARATION r Owner Date , Ih hY ff n d penalty fps) y of the followingdeclarations •I' �� ❑ 1 have and will manta (Amtifiaato of Consent to It' for Norknrs r i. o Compensation, as provided forths Section 3700 of ,he Labor Code,'tot the L/ performance of uhf work I' hh this permit Issued. ir:d b fa r ❑M of the Labor tun m ar k C p t w a 9u reti by Sect nn 979 of the Lnhor Co 1 f to p f a craw work lot which thus permit k sued.My WorkersC p anon Insurance carrerandPolicy rummerare -{tL,• _ , ' ,Carrel - Policy N • CERTIFICATION OF EXEMPTION FROM WORKERS' 'f COMPENSATION INSURANCE” ^; + •, t+ y (This'cfnn need l b w nplete 1 Rh p rm`1 Is fo undmJ d°fluty n I ($IfNp drlenn) Ic ffy tl at in0 'ped inane f,h rkf wh'h,h, p ',' :.medl ' jc' �`(.+ shall out employ any p y as to bee,ma b) t 1 theWorkers t. G ,I :11 )Jq fqy fpry Dt -(� OI ICF 1HdPPLICAN�f'B ttI lir 1 IE y 1 la , u m bje n rthe W k C 'p t p ' term the Labor C�d y most - „ , Q onh ih amply with h p°.stuns nr thi:1 t shall be theme ret awd. CONSTRUCTION LENDING AGENCY I hereby alfirm that there is a constriction lending agency for the perfor n c q +. of the work rurothich this permits issued(See 3097 Cis.C.) t m' 4o,Q Lender's Nam .. kr LenJ :AJJf V z Ic ,dy[htlh Jth'. ppl'atinmti.tlanh M1 e f tms F., corrc 1 Pagree 1.c nplywithall city and County ordinariness rfd',Iatclaw, relating' 0 V tom II guurcunio,atdhembyauthnnrereprsetnativUauf,h'setylnentef°Pon' W ,he bo foand property f specti purposes. -. - • '4 'd (W)agreel va d fyandk h Icnx theCry iC,sc Vy liabilities1 ,: , P . wh ,may.n any Y g' vt d « 'n 1 V. Gt 4 f th ........ f t .pa 1 LIC TUN)F STANDS AND ILL MPLYW TDA L ON-POINT .,Issued b �V V OU B IL 10 _ by: Date -/9 ignunm of Appleye Cm utJm ^ Data ( 'Re-roofs r ' 1 HAZARDOUS MAT RIALS DISCI OS(1RE will the applicant future building t t ,rmuch,n m st dl TYPe of Roof as J f J by th C Pro M iPa1 C Chapter 9.12,ai d th Earth and Safety - Cod Section 25532(x) - t - - °Y s t' ' ' 'Ali roofs shale^be ins pected'priorto any'roofing�m venal being installed. W, red, or future bnlilamg rmcxpxm nsc eynlpmentnr desires wmmh' . 'Ifaroof is in without,firsfobtaining an inspection,;IF agree,to remove ' emit a"iin4ms air commn...deals as def eJ by the Hay Area Air Quality Management F - DLvin`oYes � - - all new materials for inspection.•Applicant understands and Will comply with._ ,alfnon pointsource regulations., t c I has red lie hesitations neater als ' u i,nmie Ch,p, 695 of the CallinuoulficalthAr, sidcSeaons 505,2553 and 25594,1 understand that •. ' - iflho.hmlJ'ngdoes oteum. Jy hon imus, a l'I" myresponvib l'ty to totify the necupum of them ulmmem I'h, le a met trio ro issuance ofn enilibate of ' `pa°`y` Sig_nature bf Applicant , _'Date _ Owner or:11 oraod agent ,e , " �All,roof coverings to be Class "B"on better '