01030086 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
wo ��. 010300e6
OWNER'S NAME APPLICATION SUIT DATE
zo9 44]�Y, 03/15/2001
' PHONE: SANT I'ARY NO. CONT!ROL NO,
°rcZ ARCHI'IPCLUNGINHER: BUILDING PINMI'IINTO
00
BI. It]IPC1 1'LIIM MIiCH
N LICENSED CONT'RACTOR'S DECLARATION .lob Description
- I hertbY IJlirnl that I an li v eat unJtt pruvisia,x of CM1llpmr 9(cummm�cing
°y�-° will Section Val, Dl...... 9 nfthe 13uxiness utul Hofuvinn%C and m licrnm
axf� wu mrfe '( � '? REPIPE NEW FURNACE, BATHROOM REMODEL.
rc 6 Licen Clans_ _,n
r
'c°LL„ D°"(p--�� f'-C1._s'FOLAR ;D REMOVE NON BEARING WA
f-LLJ° 1:Il,daraml n,y tion,shill he used u,puhlic mcnnh
ae
Ear
a a 50 Licensed atonal
x o OWNER-BUILDER DECLARATION `
W= I homily eathy allied,that 1 Inn eB d boon the Cosion, o Elevate Law li,r,he
C Z 6 following alma it ISnolal 7113 L5, 1, h ev Incl or.Sim,%ll.or Any city nr county
'2❑ which layuimsapermi,In cnnhwct,allnr,inq,rove,Jemnlish,or nTuir any.urufmrc
itm pfarmits iamnfe.also rcyuircx,he oPPlicam for well per„duo nleavigneJ am¢•„tem
'bar The is licensed Lictical-au,(ChaptIr') Sq. Ft. Floor Area Y&Iuation
(con,mfncing with Section 7)I()of Division 3 of the Bu%ince and Professions Code)
or that he i,e,empl Ibembiour It the hurl,rot the ull<ged exemption Any violation
of Section 00315 by uny:tpi llnal lite a permit nuhj"ll the apprennt ton civil penally
of not mam,dn five hundred dollars IS5101. APN Number Occu06H5ye@j&
❑1,a,aw oo of Ihf pmpenY.nr n,y<mployecs with vatic,as their vJe scon,l vation.
will Jo the work,and the,louse i,not intended or offered for vale(Sec.7(54,
Btlxine%.,and Pmmndon,Code The Canlrnmor,Lieoo,1-aw doe.mit nn,,I,to an 3662401A 00quired Inspections
,ir or NoNuy Who build,or int.nwa thenen,dal who Joos such walk hlnrnell
t though his own nophtoee,.pnwided that such improvements are nn,intended or
olfertd for sale.If.however.the building or impmvemem i%sold within one year or
�impletion.the owner-huilder will have the burden of proving that he did nal build or 101 — FOUNDATION
...la%afa......... nal..1. 102 — PIERS
❑I.Its owner of the poppy,ilio exfludvcly Iummcrng with licensed cmnmeton to 103 — UFER
nnznuc, he protan(See.7)4m
,Busine%v and Ped..to.,C de)The Comctors
License Law docs not apply to an owner of pmI who huilds or impri thereon,
and who contract,for such projects with a conetalaI licensed pastamt m the 104 — REBAR
Co.ntmaor',LI%cnhc Law.
f as e%rn,pl.„de,See. .It ea PC Car al,rca%a; 105 — ANCHOR BOLT
Owner Date 106 _ SEWER & WATER
WORKER'S COMPENSATION DECLARATION 202 UNDERFLOOR PLUMBING
I hfrehy eninonmler petmly'If perltoylure of the lbuawlllg dell"alion- 203 — UNDERFLOOR MECHANICAL
0 1 have and will maintain a certificate or Consent in ,cleinxare for Worker% 204 — UNDERFLOOR FRAME
Compensation, os provided for by Section 3700 of the Error Code, for the
perfore anceoftheworkforwhichthispardini.siswaL 205 — UNDERFLOOR INSULATION
❑1 have and will inamtafn Wed&,Can.en,lltiolI m,.macf,a,r,,loued by Scram” 301 — ROUGH PLUMBING
37)1 of the Labor Coda,for the parhm„ance of the work for which this penni,is
I...d.lay,!oker n,ath.n Insurance carie,and Policy,number are: 302 — TUD & OR SHOWER
Carie= lU/\ Gr Policy No: 303 — ROUGH MECHANICAL
Clto it CAn5N Oil Exi'M1,1'ION FROM WUItKIiRs'
COMPENSATION INSURANCE 304 — ROUGH ELECTRICAL_
('Illi%section need not ba complete,rnhe perms is roe one humlml dollars 305 — FRAME
(b I)B ar le"j
306' — HOEDOWNS
(Q 1 campy neat in the pc us an, drat Ihf wark rat widen IMS portrait a kwcd,I ?07 — INSULATION
shall sol employ w, nerals in Ivry manner w as m Mcome bugle,In the Waders'
Compensation
Law,if California.Dae
Npn —
c�av, 30a SHEET"ROCK
NUT]CE Tne'l ,,Ili,,W kI,nuermulaliohis Ccnlheate of L Labor
iom year should 309 — EXTERIOR LATH
balhwdh.b rnpl, hi Worked Canlaa,aIli,Too' turl shall
the Luber navokean nntxt •�
p C a,nllwilhcomplyw'ITh%.cnpro,ida,,.vmmi,pfm,i,hnanofdefined,f,akf`I' 31.0 — INTERIOR LATH
F' amCONS'MUCI'ION LENDING AGENCY
Iherebylfhnnthat them isconvtchonleadingac —
geneyrartl
perburmrce 311 SCRATCH COAT
'It the wad foe whieh th in.moil is issued see.3))7,Civ.C.1
y p Lendcr',None 313 — ROOF NAIL
D z LcndfrxAdores, 501 — FINAL ELECTRICAL ENERGY
C.7 O I certify[flat I have mad this application and%tate that the above information is — ,
cme,,.I a,ma I,coloply wilhull6t,add eountyordimuse,;,oil me law,relml.g JOG' FINAL PLUMBING ENERGY
OU L� lx
bdldingeonhtrmdon,andl:mchyaan,ori.crpmwatative,aln,i%city toenter npon 503 — FINAL MECHANICAL ENERGY
ma a ,vvinl:mlonfd propfny ro,oopecaon ptlq,a...
E., a 1W'e)agrccn,save.indedrily add kespharndco,heCity ofCupeninoogainst Q O04 — FINAL_ BUILDING ENERGY
Z) liabilities,prim ems,cast,and c,penses which may in any way accmc gairta said
v z cityS TEST—
mfon%equ ann<gmn, ,nni,pnna. 565 .—. FINAL ELECTRICAL
AI'PLIC E AN NDWILLCOMPLYWII'HALLNON801NT IssuedI •- Date
M t. n I
5➢gnm.mt nppran 'Irc`I [)am
Re-roofs 507 — FINAL PLUMBING
IIA]ARD s MATERIALS DISCLOSURE
Will the:Ippllcx it orf biding axnpao, locator handle haraNnus material Type of Roof 808 — FINAL- MECHANICAL
Ix d.Iined by the Reirlmo Rd Code.Ch:lmet 4.11,and the Health and Safety .
calf,se"io1,255320)4 509 — FINAL GRADE
❑Yes C3 No All roofs shall b�1 �tjecled,pr(,�� �ny� ppFff %{kl`,t rial being installed.
e Will thea Iieanl or boort buildin ml ,me,adaptation deice,which �1 ILr. ' 14 .Y,�HIVI IIVL�.
lir dby pan 1 ,roan If a roof is instal P- W(thou I� t Q talp�❑�nJpy e� gree to remove
mit htuuNnuvnironmatniwm%m Alined by,he Bary Are,,Air Quality Managemem 1 (,, nj�{,1 p !-'IJt5L 1.LpWcomply
rope ? all new materials cif Ins ec t R IIc'IIIC un(lerstan s m❑❑❑ will cam I with
OYe, Cl No all non-point source regulations.
I have read,he hazwmous material%requirements under Chapter 6.95 of The
California Health A,safety Calc.Scoions 355115,25533 and 25534.1 understand that
it'the huildin"Joe,nl fatly`ay.3lfnun1,mat it is my ruptm%ibility In na,ify the
eapant if r .%t he met poor m i„unntc of a Ccninate at
,xcopa Signature of Applicant Date
owner a a sial,. ' Dale All roof coverings to be Class "B"or better
OFFICE