00110096 (2) CPPV OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: -
BUILDING ADDRESS; PERMIT NO.
21431 MILFORD DR STEVENS INCREDIBLE K TCHEN0011.0096
OWNER'S NAME; APPLICNHON SUB DATI:
SILVERMAN MARK H AND SUSN 11620 AIBA RD 11 /17/=000
Is 111IONIi; SANITARY NO. COME ROL NO.
(800)374-5279
BUILDING PERMIT INFO
Z0 AkC11117iLTlIiNGINiiGl1: • BLDG Ii1.170 I•LUMB MI-CH
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w N LICENSED CONTRACTOR'S OUCLARNI ION Job DCSCI'Ipllolt
OZ_C I be¢by affirm that I am licensed under provi-ni of Chaprer 9 mommeneing _
Fm with Section 7lgp)o )ivision 3afthe Nminew and f•roresnian CCpNe.and my license
siTnhdnarcennle ���0 ( S BATH REMODEL NO STRUCTURAL
Q,LLyV Littnm Cluvv Lic.M_`/(�" �
%3LL Da1C_ y��I♦, Cnl,,'lt ♦F 4q
W I—i, qq//wvgS IIrI'IiCI"S USCh h[V,f��{�
O J 1 r Rho ,:iad my plans nh;dl he pled u,puhlic record, '"
�r
ti p O Licensed Profersional
OW NF;ILItl11LDIiR DECLARATION
W I herby"tfino,hW I an mm acpl tinthe Connactorn Linn¢Law for,M1c
1-z 1.5 x following m:eon.(Section 703 �Busae,and Padesions Cmk:An, it,or county _
z F❑ lith no,rio,,u pret no., her, opl&Tnalml,or rep.' any oomnare
3
plior Ill it, alki,,,nim,tire pl1'Corn lot such sernin'n, rile I sigied.T nT
that he is inemestp 'otthep fthe C l ter s Licerr,Law(Chapter 9 Sy: Ft. Floor Area valuation
(nmmvnc+ng•ithSection7pMA fDi o t of the Business:: nd .f. n 2,30 $15000
„n dna'lies Ts tom npt lu,"Irn,it and me nais Ins,he alleged.a .,r on.A,a kii.ir
I Sectio 701 1.5 by any applicant t9T'a Permit culry,t, he applicam ton civil penalty
of a,,,more than Bee hundred dollars($51)0,. A PN Number LA cupancy Type
C 1,i -ot rearm,, o ,oy employee. wins wage.,.thair roleemnpcamhm,, 326411 07. L
will rill the work,and the stricture is not intended or oflewd for sale(sec.7144. Required Inspections
Busincv and['.ife..ion,Codi, Me Contra,',License Lor.Jens nen apply to an y p
one
r or property Who builds or impmvca thercon.and who does sndn work himself 101 -• FOUNDATION
or Through his own nnpc,ao, l provided Tea nice innpto, , ,,]i me not one acd
year or
comrcd lin sue.If.however.the hooding or imprneunem n wId heilhi.did not year nr 102 — PIERS
omplainn,the ownerbuilJcr will have the buNan of proving that he did not build or
completion.the
l+..i,onnorsme.). 1.03 - UFER
❑1.as owner of the properry...rwI.%ively eonmaceng war licensed e,Tsru tor.to 104 — R EBA R .
nsvuc,the neje.(Sees 7144.anBus :rid Profes s CWR,)'(he Cncmr's
'neva
LureeLawlor,no,a"plylonnnwperol'pct,,,vl, It,, Contract... 1.05 - ANCHOR BOLTS
and who contra.,for such pmJeos with a unlruco.N 1 licensed pursuant in the
C"mraelora luRmC law, 10E, — SEWER R NATER
0
1; cacmPl under Sec. ,li k P C ha This¢ownn
owmm Dole 202 — UNDERFLOOR PLUMBING
WOR RER'S COMPENSATION IIITCLARATo)N 203 — UNDERFLOOR MECHANICAL_
Ihereby aoinnundere'emmy of perpoyom or he foumsmg dedaronon, 204 — UNDERFLOOR FRAME
Cl 1 ha,x and will maintain o ccniBeate of Const', m salf-msare rat wmkers 205 — UNDERFLOOR INSULATION
Cum,o lion, as novidm rot by Swion 37W of the Labor Cods. for ,he
perrnnnanreoftheworlforwmchthisPermitI%i.sure. 301 — ROUGH PLUMBING
CIhmeRod will,nahamnworkersConpen'tino "'Roan,aso,"Rimdhysemion 302 — TUB R. OR SHOWER
37W of the Labor Code.for the peAanrace of the work for which this Ill is X03 — ROUGH MECHANICAL .
sued.My Workeroo
Worker's Compensation Instme carrier and Policy mmiher are: v
Carrier: Poky No, 304 — ROUGH ELECTRICAL
CHRTIFICATION OF FXEMP`HON FROM WORMIRS'
COMPENSATION INSURANCIi 305 — FRAME
(this section need not he completed if the pone is ter ne hundred dollars 306 - HOLDOWNS
(SHM),an`1 307 — INSULATION
I cenily that in me rcdinn,;mre oohyywork 1 which this perm,is i...rd,l 3VJ8 - SHEET ROCK
sha11 not employ any n any'man / �bekyye whjeo m the Worker
Compcnsaion Laws lahf nn' .Dae / V— 309 — EXTERIOR LATH
AnrlicaaT
N, 1:ror Ill r.If..tiermakm&d"'CIniicaeofEean,ption.you should 310 — INTERIOR LATH
bcn,menanjea hnhe rkeh Cnmpcnsaion pros in ion,of the Ulan Code....mut
p Q h,rn,win,eoTm,ly wire .Tn nn,ei.ions or this„emu toren he deem9n rcnnkal. 311 - SCRATCH COAT
4 C STRUCr10NLENDINGAGENCY 313 — ROOF NAIL
a ' 1 herehy nlfimn that there is a construction lending agency for the perfomnnce
nrhTe work ror W&J,1mnp,to...is iara..I(See.3097.Cie,C.) 501 — FINAL ELECTRICAL ENERGY
LTJ p Lenders name
c 7 Lc.de,,Addre•n 502 — FINAL PLUMBING ENERGY
u OIarhtynor,Iho,rmail Iii,apprteadonRod.,am lia,me:thoecinh+noanoni.s 503 — FINAL MECHANICAL ENERGY
W. [.. classic.1 agree m eomply with all it,and eouay pNitil and slate laws n•being
O U ,,looldingeonstruaion.andeemay:athorizerepre.enm,ivesofthiscitytoenternFtm 504 — FINAL_ BUILDING ENERGY
>, ,hp ahuvonmwioncA Pu9mrry Tin--aysolnit Purpose.. -
t,. per, (N'J"gumots.:tvc,iano the a, ,meirinoaolaid 505 FINAL ELECTRICRL
Z Ctliabilities,judgments,ends an es of this
which may in any way acme against sail `ems
U Z enrineansenonaoIST go WILL CO 506 — GAS TEST
ra AYI'LICANTUN IiRST )s AND WILL COMPLYWITNALhNON-POINT I' b e>-/ Thl(1 Ill IIMDTh11^_ Date
SOURCERF.UI' ATI .S. ///,"� y'—vc��rrn�r�-torr c•z,ev
."Se ureob PPG a/Conuucmr eYIL D,o1C Re-roofs 509 — FINAL MECHANICAL
IA'/.ARDOUS MA'1'IiR1A1 S DISCLOSURE:
Will the a„ .1 arc future Wilding«""prem store or handle hoomc:ws material Type of Roof 509 — FINAL GRADE
ry dctlneA by The ] Inion Municipol Code.Chepmr 9.12,and the I Icalth and Safoy
C.L.slreoTnzS 2 r1 5'10 — FINRL PLANNING
❑res 0 N All roofs shall!N 4'spectMIMit1LtopEygtc�Lg Rtt�Ryi being installed.
Will nnaaptheam or It Rb"ddiagaccnip;T I use e:p.ipman or deeiees wmeh If a roof is installed without first obtaining an inspection, I agree to remove
emit hvmdous air contaminants as dctined by,he(fay Arca Air Quality Managen¢n,
ii...im all new materials for inspection. Applicant understands and will comply with
i ove, 0 N - all non-point source regulations.
1 lime read the huvarrouv Tnaerialn re9nimnam,n under Chapter 6.95 of the
Cali I'ma"Ilcuhh ft Salcry Code,Suctions 255115,25511 and 25514. undcnland Ihm
it Thu hn'ddiug docx nm.armory hove"saand.Thin h is my rc,Du,,hilil, ,,ruby The
oe...an,of th yuixinema which noire M met prior u,Issuance of a Cenilicam ul
°iupa"`y' Signature of Applicant Date
o», .poli a uagent `IN i� ,;,,e All roof coverings'to be Class "B" or better
OFFICE