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
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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' ($500) +�,.:, AP OCeu ane e
I .��91P�!P104. 00 ' « � P Y•EYP
ElLsonvenoriffithe, I tty ye pLy ,I g� th su le_compess inn "f` s �+ h r..
ME do the k d the structure1 riended or offered f (See.' 7094
F d P :.' Code.TheC t t License L J t apply t 106 _,SEWtcRui6y "WAj cERms
ow fproperty Wh n Id p thereon, d -0 d 1 workh Ir
orthrough nply p adtn, np t t once or 202 'UNDERFL00R PLUMBING'offered fo'sle If;howc,.r, he h'llnk '
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..
pr,enen is:old within onev' l -
ompletiondteownethahard completion,
lderoillbasethebrtiofficergthathendnothoil x;301 -- ROUGH PLUMBING `
[3 1, Ith Property. exclusively couractiog wild1 e t -t 1, 302 .TUB VOR SHOWER ' .
nlnstuctfire project(Sec7194Busne ndProfessions Cde:)The Contractors 502 "FINAL PL'UMB,ING' ENERGY
License Law does not apply t' t property,who b' Id:or improvesth '
- ane who contracts he ,nen project.with contaaaoa(s) r .etrpnts,ant .n me 5,06 —`'GAS, TEST•iCande
DIam°am exe`ptcideLSe 507 — 'FINAL, PLUMB
. ❑1 am exempt under Sec. B&P C f r this re r p -
- WORKERS COMP NSAI ION DECLARATION r
Owner Date
,
Ih hY ff n d penalty fps) y of the followingdeclarations
•I' ��
❑ 1 have and will manta (Amtifiaato of Consent to It' for Norknrs r i. o
Compensation, as provided forths Section 3700 of ,he Labor Code,'tot the L/
performance of uhf work I' hh this permit Issued.
ir:d b fa r
❑M of the Labor
tun m ar k C p t w a 9u reti by Sect nn
979 of the Lnhor Co 1 f to p f a craw work lot which thus permit k
sued.My WorkersC p anon Insurance carrerandPolicy rummerare -{tL,• _ ,
' ,Carrel - Policy N
• CERTIFICATION OF EXEMPTION FROM WORKERS' 'f
COMPENSATION INSURANCE” ^; + •, t+ y
(This'cfnn need l b w nplete 1 Rh p rm`1 Is fo undmJ d°fluty n
I ($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 '