00050164 (2) ct BUILDING
UIN DI DIVISION.
IL PERMIT`_ :. " CONTRACTOR INFORMATION:
HU I LIIING ADDRESS: f - P[RMIT NO -
10505 MADRONE CT U3/28 O \ 00050164 "
OWNER'S NAMI • I r APPI:ICAI'If1N SUB DATE _
. THE OBRIEN GROUP 05/23/2000
� IPHON[' '�S�- v ^ - ^ ,I/,. . N]'1'ARY NO - CONTROLNO. F
LeO Z ARCI` .I'Ar GHR::/ ;vf ,BUILDING PERMIT INTO -
BLDG ELECT PLUMBI NIECE
LICI NSED CONFI RACIOR S DI CI_ARAI'ION
z 6 I hereby 11TIrm m 1 xnsm J Job Description
o z 6 JA r o-pt ry rormnc ns
wN in iinf n�IaitefI Leh R ' oWWoJdC reen,e PMR/1.4c:1 LIVING SP, 330 GARAGE
fall Juff odCn
�, Lic - CI L p -
> Lane
_ Contractor
,?q5' a• QIITECI S DECJ x,inS Y PI ns.hAl he awd a,ps
S
OO Licenced Prolax,innul -
- OWNER Iescr DLR mDECLARATION
_ -I I c.y f1 II 70 nes th C , , I L tube
C$< toll t. ee (S I' 711115E f I I f Code:r y 'ty au Ley
prioriIt 11 issuance.also requires
t r ph ,r I r1 N Y mai '
.mat n licensed p th pal at t n pc I 'r II n Ie a signed
rstatement
l rpie J S Ft. Floor Area Va�u qp
ter b hS t 7", fD'-: , fR li - dProfession,Code) �' 0 $
r Ihm he nese npt 1hr from a a1 the Insists tar the alleged exempt un.Any v alai u r
arsetth,n 703l1hinny=ppin,rar fart,pennh xahyo,the r,,hnnl to it,mlpea;dty ' APN Number,of Leat mart than five hundred doll;IA oS sag. - - CFupancy Type
❑Id f0 PLey Y 1 th k tl 1 f I - n. /
will do thic oak.and be arria,mr, t intended i offered[ (Sec.7a an -
w x :. I P I l J [he Contractor's L' J t t s
pn> Required Inspections
fP his
h 'IJ e th n I h e 'h work ,elf 101 FOUNDATION
.. .
m through has awn empto the
providedilia that.such.em,ateis of arc not mend,,or "
norerea 1m,me. vv hawcver,e,a t]Nacos ar nden eme n i,sola within am year nr ].0.2'-— 'PIERS
. ornpletian,Ne owner-hnilder will have the hmaen of proving 1hm he iliJ not build or '"
improve farparry„e of sale.). - 103 — UFER ,
C1,a,ownerat lie propeny,amenelunis-elycomractiny,yimroamedcsmme'mr,In ' ' '704 REPT-1R '
rad%m,t the pmject(Sec.)Old.Business and Professions Cbde:)'nrc Contractor's
Lleensa Law does not apply wan awm,,ofpmpcny who hued—,impra�a,111emoor, 1.05 ANCHOR- BOLTS
.
Lord who r,contract,Ler such projects nim a communal) licensed purstant'm the 'WATER
ConZaLicense Lnw. 1.06 '—
SEWER'
rl l oar caampt mrder Seo. I 9.F P C for this mu,on
20'2' — UNDERFLOOR PLUMBING•
owner is Ih S 203. — UNDERFLOOR MECHANICAL WORKER'S COh11'IiNSATIUN DECLARA'r10N. -
.s ; 204UNDERFLOORFRAME `
Ibeach,saiam under penalty of pc jury one nhtie following Jniuntinns:
I0 1 have ana'will mainmin a Cemroema of Cnn1c6l 1. self-muac far worker', _ 205 — UNDERFLOOR INSULATION
Cnmpcmaann, Lex p.aided err by Section 37M or he Labor code, far ore
pen 301 — -ROUGH .PLUMPING
rthe I
' ' fid p t I. -
CI I have mai!i-u maintAUL W a Com,croation Insurance.as acquiredhys tan - 3022 — TUB. R. OR SHOWER .
370 1'tl h CuA f II pc r fm work) 11th. p-rmtls '
.sum �rxco �.�t 1 (� nePmi” 303 ROUGH' MECHANICAL
c:,r, _ _ 304 — ROUGH ELECTRICAL
.Ult 1CATOO Or xP R a.r o e --1,` "305 FRAME
rmis,,clion wee aot be completed if pumra in R, ane mmdreddnar, _ 306 — 'HOEDOWNS _ _
lalno)orm,s.) _ - . 307 — , INSULATION•
1 cenify that m the`permrmance of me walk ba which teas hermit is issued,1 308 — SHEET ROCK
- shall not employ any,person in any manner so as to become subject to the Workers' '
Cmnpeewlian Lax,ar Colifaral,l'pisic
Apdaranr _ " 309 —= EXTERIOR LATH .
NONCI'TDAPPLICAN'rif.after making this Certinficane ofExernmime,you hawd 310 — INTERIOR LATH - -
z becomosuhjee l,thoW B -C p r,al soonda,Lh CJ yon at,,, 1
O O hadi."imanmplywith, 1 p ,i.......his peread.hall he deenned ked. _ 311 — SCRATCH'. COAT• '
^ GONSereisa uNL13NDINO AGENCY
1 hereby aRrm mal mere is 5 nmxtmnion lending agency forme perfnnnanee 31`� �� ROOF NAIL '
W > annewLerkmaaJnntm,nnrriti,i,,nmisee.3mzre.e.1 501 — .FINAL ELECTRICAL ENERGY
6, A Lender's Nn me
D z Leader.Address - - _ ' 502 — FINIAL PLUMBING. ENERGY. . ...
v0 rdifylllIhe rl . lllieul i i If"me Imn t f ad I, 503 — FINAL MECHANICAL ENERGY ,
GL �. correctI ogre r comply 1u all edy ad c t5 adn ams J safe mlm'ng
O U ,,building cam, ndn by mor p . rrf exann.city to enter up,n, 51714 — FINAL BUILDING ENERGY
lie,n tl alrpelyl 1 I' I p - 505 — FINAL ELECTRICAL
fµ3,egs eul ac Junity rnrporew,elihit l .rhe Cly mera,a s' st' S06
'Y any w y against IiJ �p
g � — GAS TEST
APPL A U DERSTANDS AND WILL OMPLYWITLIALL ON-W III���.T�t ss SV17 — FTNAI PI IIMRTNq
SOf CLR f .L TI( S J/�/ Date
Sig azure ; — rracto zte/(/ Re-roofs508 — MECHANICAL -
,znano nLSDlscl.osf `'309 FINAL GRADE
' Will meapprman"afmumbn„hre "abansmremhan e'hmaraon.rnateriai 'IypeofRoof,5 . .
as defined by the Cupertino Municipal Cade,Chapter 9.12,and me health and Safety
Code,Sneban2s532rnrr 51.0 — FINIAL F'I_AP•INIING' '
CYex - - - All roofs shall 51ihspectrfdTp lRLto fOBlIofifig hlfil&FAS,eing installed.
Will the al,,hunnoraame ng«<upnntnxueyuipmemmdcacexwhich- Ifo roof is insufflIAw+the@lldiFto ipidl Itli5n411�Iibn, I agree to remove
•snit hunrJaux Lir cannnninanl.s n ILhae A.by the I1uy AAir QualityMan:,gemnn
Daniel? all new materii&,Zf9-intj�sp� AM*jc'fLtINallerstands.and kvill comply with
°Y" all non-point s r re ul
I nave ha Lead me radon,bradmials ngoimmems mrder Chapter 695 of thi p - �+ -g ��' IN—PROGRESS
Calirn Li lleuhh.@ Safety ad,Seaton,25515,25513 and 25534,1 understand the _
If the ,*) '
1d,ngdnecnot current mco¢nan-1 land, myre,pon billty4umliOna,
mine
rcyuirtmen x <h must be mm prior m issnon of u C ficme of
' .' Signature ofApplicant - Datemat Date .; - All roof coverings to be Class"B" or better '
OFFICE