00070062 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS - -�-a_ PERMIT NO.
1.0171 PHAR LAP DR C (/C � 00070062
OWNI7R'S NAME: APPI.lCAI'ION SOR DATE
NASH DONALD E. Zr¢H 07/12/2000
ZONE: /J SANITARY NO, CONT ROL
Mal
ARCHITEC(ENGINEER: BUILDING I;ERM111T INTO
O O RI.Dr, ELECT' PLUMB MECII
2 pp
W
„y LICENSED CONI NACrOR'S DECLARATION
:';.,o Iherebylaff hat Iamlicensed under provi.siomofChapter 9lemm, Job Description
nF will,Section 70(Xiol'Division del TaT Movies,unJ ' levslnuu Code.mmn
ij i.iafmlroreuande ADDITION 265 SGL. FT. AND REMODEL EXIST
a License Class—I> Lie.e
Tit Dam_/B.��D,_rpppp Comrucmr_ _
ZRt;HIT[CI"S UECLAN N'
Y 1 omicron nul my pkury n1n111 hu noel n.pnh- t
tu6Liccnadl'mfc..ional FINALED
OWNER-BUILDER DECLARATION
u�S—'` 1 Denny all rn,tlnt I oat c,lal fnnn the Comm,.... Lical I,aw for he MAY
F5Z following moon,ISxdass..7011.5.Bh,incand pedestals Chole a
Any city or army MAY 8 2001
i s which require% Permit it)consimuct.alter, p demolish,or rep y onalme
CC prioto it, my m therip,licon,f hpermu fill :g ed.t t meat
i 5= that beislicenodparcurna the P of the Council Lce I IClapmr9 Sq. Ft. Floor Area Valuation
�T fT
b, I g lh5 1 701X0 f1 3 fah R - 11 f.: .Code, BUILD( X145000
,rdulbc .r cnpnbcrelne Load,d the hasp lar lIm llvd r.enpl m.Any val,stun
of Section 703 1 S by any uppllcanr file a pvrmi,mhject.the applieum In a civil penally
of not more than five hundred dopa;($500), A PN Number Occupancy Type
01,a,owner ofinen,operr,m 1ny emploee
y .wiln wage,a,their still,e,
ll, mpenwion, 32639055. 00
will do the wool,,and the.nvemrc its not lineal n1oli I'ar salla(Sec.7044
Business and Profession.Code:The Contractor.LIee1,.e Law does not apply to an Required Inspections
owner of property Who build,lar improves thereon,and who deer such work himxlf
at though his own employees,provided that such improvements arc not intended or 101 — FOUNDATION
oll Iia sola If,h r.scm.,hu building u,impoolica t is old wuhin enc year of PIERS
on,pledon.the owner-builder will hate he mate,ofpo sing hal he Thai not build or 102 — F I E RS
improve far pam,.eof.me.l. 103 — UFER '
01.asowne,of(be pm,r onemladnelyconnecting can licensed comn,nr.1. 104 — REBAR
mstmthe Tourer(Sec.7044,lboioess d Pont, Cc Ir:)'rhlemr'.
File Co ar
Ln ;raon
tceme Law coca natipldy to nn ownerof pmpcny who btakkor iitlpmvor hereon. 105 — ANCHOR BOLTS
and who common Cut such pmiec¢,whh a co,nracti l licensed pursuant to the
Committal License law. 106 — SEWER &. WATER
'0l oat elect under Sec. ,B R P C fill,his reason
202 UNDERFLOOR PLUMPING
owner Dale
WORKER'S COMPENSATION DECLARATION 2203 — UNDERFLOOR MECHANTCAI_
I hereby li irmmade,peaaeyof pc do,ancof the follow ing decmmaol,.: 204 — UNDERFLOOR FRAME
I have and atm ...iol:Jo To Certificate of Conood no scllan.ote far Workers 205 — UNDERFLOOR INSULATION
Carni Dir hon, as provided for by Section 370() of the Labor Circle, for the
performance of the work for which this permit is issued. 301 — ROUGH PLUMBING .
Ol h0 rad will n,:aataid Workers Compensmian lnrnnmce.as reyuimd by Section 302 — TUB & OR SHOWER
9700 of the whoe Code,1'o1 the o,or ionsi of,he work for which his permit is sued.h{y Work*,',Compensation Policy numher amQ 303 — ROUGH MECHANICAL
Came, CG'✓1,�✓_1�_N L1123o 304 — ROUGH ELECTRICAL_
C RI IFIGAI IDN Or EXEM 1'D ON FROM WOR K IT RS' 305 — FRAME
I ICUht P1iNSA 1'ION INSURANCE
{This.section need not be completed if the permit is for one hundred dollar. 306 — HOLDOWNS
fslknn,ne.,.) - 307 — INSULATION
I ccmly d,a,in he pefmrmanse of he work for which this pl i.issued,1 308 — SHEET ROCK
snarl not employ any person in any manner so as m become subject m the Workers'
Compensation Laws of califomnDate 309 — EXTERIOR LATH
Applicant
NO] Cl:TOAPPIACAN'Ell:anormnkillg fill crail eonawnplion,ymt should 31.0 — INTERIOR LATH
become subject m the Worker's Con,pensutinn provisions of the Labor Code,you must
0 0 forthwith complyw;mmahpenv......his pmdtshall bedeenedrevoked. 311 — SCRATCH COAT
Z CONS IRUCTION LENDING AG1:NCv 313 — ROOF NRIL
a > 1 hereby attlen that doom is u conamction Iemall,agency —
lo, perlolrnance
me�m
hcwe,k for which his r ,lt is I...ed Lsec.3097,CIV.C.) 501 FINAL ELECTRICAL ENERGY
i hcollNamC50.2 — FINAL PLUMBING ENERGY
.7 Lender's Address -
v o 1re.,hyhatIhave IcoatIII,appliealionand snncthat the nboveimorinmionin 503 — FINAL MECHANICAL ENERGY
correct.I agree In comply with all city and county ordinances land state laws miming 504 — FINAL BUILDING ENERGY
U on
m huildingcswction,and hcrebyemherim representatives ofthis city to enter upon
y healmye-mem al,old pontrtyforimpecdnto . 05 — FINAL ELECTRICAL
ry IWc)agree m,save,indennif a,lnlc.. o City.,I ce amnn against
mh,hhities.' .call 1, I on act my way acemeagahn.l said 506 — GAS TEST
C7 2. Cityi coca c of, apemen
^ AP ICANTU )SAND UJ MPLYWITHALLNON-POINT Issued — NGDateso V
URCE NS, o —/v--Q y'
S •nutareof npplicawcm,lnutur Dam Re-rool's — —
HAZARDOUS ATR1ALSDISCLOSIIRE 509 — FINAL GRADE
the
it appl emit or future wildingre m occupant stere handle h.,N .,mmedal Type of Roof
a.r defined by lie capermo municipm code,chapter 9.rz.and mu Hemet and sarc,y 510 — FTNAL PLANNING
Cola Section 25"2(11)7
Ove, Cl No All roofs shall be rniplicted IThbNAlairipblfEiij(BotWORIIii installed.
Will the applicant or future budding occupant use criminal or device.which If a roof is installed without first obtaining an inspection, I agree to remove
it hazardous air contaminant.as defined by the[lay Area Air Quality Management
i.,dc,7 all new materials for inspection. Applicant understands and will comply with
O vcr Ow, all non-point source regulations.
em
1 have mad rhe fecal mmeriaka regm n.un c Chupmr h95 of the
Califnmia I{ea Safety OW tio,. Jan)' SJ4:1undcrunit that .
if nae buil ren out ill ti.n1 npnnslhility ul ramify the
'caP a the reyul wl'a aper ,.mumu nlaG'crlilican of
oe tense- Date
Q—tO—� Signature of Applicant
bwncrmatm,oli,mugcllt Daae All roof coverings to be Class "B" or better
OFFICE