01040129 (2) croF(wP SION o
BUILDING VIPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: P13RM1'r NO. --
115FA SEVEN SPRINGS DR RFRVTrPS SERVICEES 1@401.29
OWN17R'S NAME: APPLICATION SUB UNIT
MET9 KARAKIIIZUK 1471 MARTIN AVE @4/24/2001
I'IIONE: SANITARY NO, CONTROL NO.
C d'Z ARCfIITIiCilIiNGIN[iBt • BUILDING PERMIT INFO
t=C - BLUE 1:1.1:��� PLUI�M ME}_�,/
a i 1
'S `b LICENSEDCON'IRAC'IOR'SDECLARATION
H= 1 much,art,.that l a,n licensed ruder fChater 9 contractual, Job Description
g_C ) pro.imonNo r
w wah Srcuun 911)111 [ n,l runt"BmmoN unJ ProtcxeionnC de.nnimyliccnsc
SYc� Unde
owu i,io full I"" r � C r 3 L
z s¢ Liccn..e Cln,s Lae M �—
i < O 11_rR'CT'S DELLA r•/
wulurntun s s I he as pnh c
MAY 0 6 2002
eO Liccnad Prn cc,ionul
Oar I a., mroptI to.the RATION
I hcrchy affirm Ina 1 am, hoar t Gum me Qmaari,C's Liana law far the
I�].a kulowhichi nprcr%a. ermiiatoca tu.aiac.improve.derona C,ormpian...turcme BUILDIN
o which reyuire.a permit m comwc,,abet,imrmve,demolish,or¢parr any amemre
6 3 m that r u LINd e ensed ja ala rcyoithe provisions
s o Ibr Contandoev Li erase Law
(C nemem
ma,hefiheeaeJhSectio tome of[)Iimp.n3ofteBustressand,.alawlChameru Sq. Ft. Floor Area Valuation
(commheeI,ewish laurel ANNE)of he
Jr the a Business Pmfcsigns Code)
or that he is exempt Iaumrrom and the basic Pert the cts di J emmrnon.Any viNaion 7
of Station a than
5 iv any applicant for a permil whjro„Ne applicant m.a civil penalty
of not therm mon siva hamo-ed dolwa asfan. APN Number Occupancy Type
❑LaN ov,natidthe ptopcdy.mmy cmdoyuc-win,wages ere lhcir.ole eomrenadion.
will do the work,and the structure in not intended or olrered tor sale[See.91114, -
520A R
Ibusiness and Professions C de:The Contractor',License Law does no,apply to an Required Inspections
f pro,ery Who buil ,r
buil, it in, avas moron.and who docs fuel,work himself .
to thorough hl.,own r.dwy,cs.provided mal such m,proverned,am sol imended or 101 — FOUNDATION
uffined f r one.If,however,the bdldtng or h„prevuweat is sold whnn,one year of -
completion,the immer-brilder will have the hunlcn of proving that he did not build or 102 — PIERS
improve for porpoa of ode.).
O L as owner or the propert,:am exclusively contcting with licensed«mtmcue%to 103 — UFER
ensure,the project(See.9144,un,inewr and rrofc„lyre CoL The Comramor. 104 — REBA R -
License Low ares not apply u)an owner of propcny is ho builds or improves mercnn,
and who coatmcte for such projects wd,a contemner licensed parsaant to the 1.05 — ANCHOR BOLTS
Contetm's License Law.
❑Ian exclop, mder sec. ,B.k IN C lin this mason . 1.06 — SEWER & WATER
Owner Date 202 — UNDERFLOOR .PLUMBING
WORKER'S COMPENSAnON DECLARATION
203 — UNDERFLOOR MECHANICALI hereby anino under licnnliy of pepary one of the following declamdons:
204 — UNDERFLOOR FRAME
❑ I haveand will maintain v C6,Suee of Latham m sLabor for Worker's
atnlet,,don, „ pn.ded r,r ray section 3900 or the Lnn,�r rose, for the 205 — UNDERFLOOR INSULATION
perinnnance uf,he xnrA for which oris permit ix issued.
301 — ROUGH PLUMBING
❑00 ve)f the I-ab r Code,
the peComeareeof the work f as hick t is Seainn 302 — TUB & OR SHOWER
374 of the IaM1ur C,xlc.lin the perlbrmnnce of the work for whim this permit is .J I_
"wed.M ker,Compel„aronh,.aram�eearriera,di'oliey3ndw cc / 303 — ROUGH MECHANICAL
Capri Policy Na.: O 6 //1 �-
CERTIIICATION017ENEMIsnON FROM WORKERS' 304 — ROUGH ELECTRICAL_
COMPENSAI90N INSURANCE 305' — FRAME
shin eeenon need not be completed if tire permit is for one hundred dollars 306 — HOLDOWNS
(SEINE err less.)
I cram,mut in he ncrformno,c oI the work for Jd,b ed,pt ann is ia,oed,1 307 — INSULATION
,hall am rmNoy any perx,n in any manner.n as ,,became stdjrNa m he work`•” 308 — SHEET ROCK
Compensation Laws of ahforria Dam
Applicant 309 — EXTERIOR LATH
NO1ICE TO APVLICAN C If of crimaking this Cenilicme of Exemption,you should
neroine..Ijcs,to the W..kcr',Cotnprroaam,ntLow a,onhe Labor Code.rout,"I .310 — INTERIOR LATH
Q 0 forthwith comply with such provisions or this permit Noun bedeen,d revoked.
Z 311. — SCRATCH COAT
(n
CONS'IRUCI]ON LENDING AGENCY
> 1 hereby anima that mere is it connection lending agency far the vabrue nce 313 — ROOF NAIL
of
Lender's
iO Lcndus Nune 501 — FINAL ELECTRICAL ENERGY
Ixndcr',Address
U O 1ocnitrthalohave mad this a,di,aion and,,are Quit dmaboveinfnhadouis 502 — FINAL PLUMBING ENERGY
s r- cercd.I.,reel,,comp),with'It ehyardcounl,wninanc c,Lord.,,am laws mlming 503 — FINAL MECHANICAL ENERGY
O U to huilding constradirn,and hcrchy authorim repnsamatives ofthw city to enter upon
ym the dawnamunonedp...why orhxpeetierpnpose,, 504 — FINAL BUILDING ENERGY
rr P• (We)agree m save.indentmly and kn Ie,s the Cd,of Cupcnina erg ins) —
m uanilitie,.jrdgtnc... en,,, ....
w e, uses may arerac erg:,inert,aiel 505 FINAL ELECTRICAL
l..r z City in ronxy�TANO
o!I s pe'Onil. Y i 1
SI'I'LICANT ILLf 'I,Y WIssued by;TV 'r-A@6 — GAS TESTDate
pnaWIAIIIRUB NIAISUI5CLl15URE Re-roofs 5@8 — FINAL MECHANICAL
Will the appraumores, cl"Hah",,al,am.tomnrhandle nr,mdou.n,munal Type of Roof 509 — FINAL GRADE
a,Jehned by the Cupertino Municipal Cede.Chapter 9.12,and the Ilcalth and Safely
Cada.Section 25532(x)? ,
C Ye, El No - All rooJ:s shall be ihR, Merl pfBoP7' tt1N������n�y Qofiifl��ViNffrlli(atlobeing installed. -
Win a,c a ueam m fwum hul,rn•mer t use ee ui ,a,dc,lccs.hill, ' t NQk- n�-'tn'Ii R rlflrlr`I it
np s the nrQu If a roof is instnlle itfioul fps ni c tee to remove
emit hmardou,air contaminants as dchncJ by the❑ay Arca Air Quality Management
Di„tier all new materials for inspection. Applicant understands and will comply with
0Yo 0 N all non-point source regulations.
1 have read the ha'ro faun tndcrials requireanem,under Chapter 695 of the
Calil'omia Meana&Safety C,de.Seaioas a , 5533 and 35534.1 undeo and that
it buddo gdoe,rat rrcn,ly bourn ,:un,th, nlsa n„ihilhym entity the
Vaccupam of the rc nem,w m h n prior u t u ce of r Cr dices of
Oct' ,fry' - Signature of Applicant Date
, t�I,odmaagenl - 1 All roof coverings to be Class "B” or better
OFFICE