01040026 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
El11LDIN(1 ADDRESS;
PERMIT NO.
6 N.IRWIN LA 01040026
VNHR•S NAME: APPIACATION SUB DATE
HN R 04/09/2001.
PHONE: SANITARY NO. CONTROL NO,
t]
BUILDING PERMIT INFO O'tO r\RCfIITECr/ENGINIiIiR IILDD M ECT _ PLUMB MECH
5 " Job Description
N Lon han in CONTRACTOR'S DECLARATION
p Z o I hcrcby a0im,thou I um of med under Prod ud,d.,Ced 9 undone
Hncing
C=ytom wi,a haclloaaaarlOrDivision3nfthe litnincsN and Profesniom Cede nnJ mylicensc
C�S I.,"o,class detfrc` Llc.a INSTALL EXHAUST FAN IN BATHROOM.
Ko}aw U Date Cnmmemr
m u.to ARCUI'rECTS DECLARATION
1 undermml my plans vh ill he used m public me d,
i p O Lianarl I'rolcsinnal
(IW Nlcut Corrupt
fr DECLARA'T'ION
ia+1 m I,frau) (Sec the,I vat eBestpt rano the Contractor's LiA n a Low fm the
my
Cb< (ullnwiremason emitnli]onstr t,ahcnsamd Pn,fc.enoli Code:Anycity or county
i3E x p which its i..s r puma,m amnmct.char,improves drmnlish,ore Asir tanyed suvcmm
m herhesiror,dpratuan wife Neappncant fur suchpcnne toicense Lt.(Chapter
(,tnei.rnr,wiltS,,Ii( 7mrvmt-Nmmnnhrcemmcter,,.nemeLmyCsCore) Sq. FL Floor Area Valuation
a,nnmceis with Serum 7mID1ofre basis3ofine Bmineexamt r.a.An vi late)
oa thin he is mgt ihit,ain li and tire basis for the alleged mcmrn:n.Any violation $1
f notion than iv any applicant for.p<•nnit sublease Inn applicant Ina civil pevelty -
nrnot mnmmanE.�ehundred dollars tssaE. APN Number Occupancy Type.'
El 1.as owner of the ppeny.o n,y etnployees wim wager as their compensation. ='7
will du the work,and the structure is not amended or 011emd for sola(Sec.7144.
Hnnircu and Pmfcsslum Code. the Contncctra*s Liecnw Love Jtwr our apply m an Required Inspections
orr of progeny Who builds or intprmos thereon,and who dares such work hammer
through his own employms.provided that such imgrovanents are not intended or 304 — ROUGH ELECTRICAL
offered Int one.If,however.the building or improvement is sold within One You of
cmnpletion,the owner-builder will have the burden ofpnn'ing that he dirtier build or 501 — FINAL ELECTRICAL_ E14ERGY
'mgnwe fnr putpnse ill s:JaJ.
505 — FINRL ELECTRICRL
I,as owner of the property.can ex sines Y contracting with Hamm emnmctotom
nstrva the does
n 1appl]titan Busmen anti Profoho b coded The venthereon.
Licenw Lux'Jws nal apply m an ex'nrr of gmgcny,cath,twills or improver thereon.
and who rnmmns red.such pmJeeu with a rammer Ne licensed prorant tome
Contmner's Liceno,Law,
. Trona '' ll It IF re for sols naso
-11 no
11
- wn \ Date —1 —�—n\ - .
WORKER'S COM1II'IiNS,YI'ION DECLARATION
I hourly attic un dergrnaltyorrerPOy Oncofthe hallow ing Accl.ionion¢ O
❑ 1 have and will maintain n Ccrtifeme of Cwunn to self-ralum to,Worker's
Cnntgens:nien, as provided for by traction 370() of the Lehtn Cde, for the
performance of the work fnr which,hiv permit it issuvl.
❑I b:tve and will maintain W'orker's Cmnpensntirn Insurance.as required by Section
371(1 of the Labor Code,for the perfnrnwnee of the work tin which arise permit is
sued.My Worker's Cnngwnsmien Immunes,cmriar it I I'nl'ay nutnhe,am:
Comer: Policy No.: '
CERTIFICATION OF EXEMIn'[ON'FROM WORKERS' r
COMPENSAI]ON INSURANCE
('This Necnmo nod not be cor,land If the per nit IN ha one htm11me dollar.
(S I00)of less.)
1 certify that in the gorfmmance of the work for which this permit is issued.1 - -
shall not employ any perm in any manner so as to become subject et the Workers
Cnmpensade.Laws of Crahromin.Data
Appllamt
NOI ICH 10 APPLICAN'1;II,uncr tmtkirg thin Cenirnne el Eaartana ,you mould
hrnnw sabien m the Worker's Comisco,ar n Fouisions nr the Laher Code,Toa mint '
Q O forthwith rntnvlr with such pomidnn nr this permit shall M dcamed revoked.
f' COt flam CTIONLP.NDING AGENCY
a I..k to,arnmt that there ix n s...Mmaien W)7. agency rot the Ire'rlOrmancc 111 do work Inn which this Pcrtnit Is ismcA(Sec.3fN)].Cl,C.)
L Q Lender's Name
7 LenJcr's Address
ke, 1 mfg that lh h.1 ty application J tt thnh W f tonin
0 1.., aura t b t I ly to II 'ty ty dart t P poo
O f..J nr Hall . t.. T , II by e, P I'I c red tyf t gal �s
j- (sed the ah f Jp d1 ' M1( P P
E" M.4 twrlagreetsaves mind expenses
whikeep ch
terC aofcom against
h liabilities,judgments of
and granting
of
which may in any way accrue against wiJ
$ AlYinttntsey UNDERSTANDS
the grantingO thisWILL CO o y� 7 � Q
S URC
UNDERSTANDS ND WILL COMPLY WITH ALLNON-POINT Issued by: tP /4.11/7Q
tit C-- f Date
SOURC I ULA"il S. y'
ig oret'Appluar Con Our nate Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building e, upant store or handle h:naNtws ma¢dal Type of Roof
us defined by the Cupertino Municipal Crvrc.Clypier a.12,and the fleahn and Safety
Code,Sc,rioaa25532m11' //
01 ye, All roofs,shall be inspected prior to any roofing material being installed.
Will the apglirntnr mtun buildin,weepant me ry.ipment nr drviecs which If a roof is installed without first obtaining an inspection, I agree to remove
emit hreardom air contaminants as def ins by the Bay Area Air Quality Management
t Di.rtrirt7all new materials for inspection. Applicant understands and will comply with
ClOil 4.°N 'a'<✓ all non-point source regulations.
1 hmc read the ha.amoaN materials mquimmcnts tinder Chapter 695 of the
California Iica th a Safety Coda.Sections 25505.25533 and 25534.1 undroarad thin
Wthe building rocs not currently have a tenant.that it is nay responsibility to notify the
tw<upm of the reyuimments which must M mm prior m issuance of a Cenifcatc ill
ran, ��� Signature of Applicant Date
.rt �,It ord.bent Da,r All roof coverings to be Class "B"or better
OFFICE