NO PERMIT NUMBER (2) CITY OF CUPERTINO ,
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADUHHSS: PERMIT NO.
OWNER'S NAM2 sv GREEK BLV ) ASSOCIATED CONfR A . A'n . I U 90 -
'uowa: DE ANZA - SANITARY NO.
'I.111I M406"J 14VJFD IIUILOING PERMIT'INPD
O O O AltClll'1'IiC'I'IIiNGIN9iR'' I{LUO 1].1im 1IICI
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LCENSED CONnRACrDECL,RAIWN
Job Description
I hereby that I am licensed underprovision,,,(Chrince namnsncine
ninm3ofihumsmlwF; ith Section 7000)at Dleninln,Code.andmy license
y
LL_ '-in IYll force and CR
s ce a I.;unxc Class L;c.e_ O /L _�
�-U Date q„_14 n,mmtm�t itq,_ INTERIOR IMPROVEMENT
5 a.v'i ARC Il 1Cr'S DECLARATION c ^k
1 understand my Alam.hull be used as public tier , L,
ii S p O LiccnncA 1'ralcnaourn
OWNER PUILI3EIt DECILAILIPION
I beKhy firrn that I ane exempt rmn.die Comms, N Ul,enw law far the /
ndlowine wa-ur Ns,I n 7031.5,Ilur;no.and h.dn..ion.Cade:Any city or county
which I Intuit to coastal inprIse,doinnol,Jr. p.air any structure '
�3� pr'orl I l; i, �'h 'pi I'hn II I"airl II y J.tmcmcn
that ha is1sc-od pr....an m they Int c n ne.,License 1 (Chapter9 Sq. Ft. Floor Area Val naticV
(c... ting with Section AXI(nof Div n 3 of the Rusincss and Prow"ims,0.IJ
o,that he is exempt therefrom and Ili,basis Ibr the alleged men,lion.Any violation
of Section 7031 S by any STI can,for is permit s.bj.i,,hc applicant m a evil perally
armanow ]a.&I,hundred dollars(S500r APN Number OccupancyTyp
01,an awns err Ire pmiserly.a mr employees.,in wai as their ale compensation.
will Jo the work,and the structure is not intended or offered for.ale(See.our. -
Basiline sand Professions Cale:The Contrwmr's License Luv Jen3162609CWC filred Inspections
not apply to an
owner of property Who builds or improve%thereon,and who does such work hil if
through his own employee,pnw'Ided thunuch ingnnvannems are not intended or
obeyed for.sale.If,however the building ar mrprovelownt ie x ld within one year or 101 — FOUNDATION
ip`II f o,he owner-builder ilder will have the burden of proving than he ddidnot build or
mprove numa,eo 1.02 — PIERS
❑1,: m ore property.a .Clum
dvely e nneting with liccare l ea,tmelnr^m 1.03 — UFER
m,recl tthe pmjccl(Sec.7Hr,R:aincm sand Prldesslon.Codm
Coder he Comencr'.
i�ian.e rprn
Lave Jae,unl apply In no owrc,or who m
build.err nnpvc, lawor, 104 — REBAP.
and who enmmnn for such projects with a central licensed pursuant m the
nme
Cmln,xLian,eLaw. 1.05 — ANCHOR BOLTS
O l am exempt under See. ,H&P C far this reason 106 — SEWER & WATER
°x°" WORKER'S COMPENSATION DECLARATION 202 — UNDERFLOOR PLUMBING
I berchy affirm under pmaily.1pe,jury one Dane rnnoxerg decimations: 203 — UNDERFLOOR MECHANICAL_
❑ 1 nave and will ma;aram a Certificate of Consent to,elf-insure fm Worker. 204 — UNDERFLOOR FRAME
Cmopemation, as pmvidcd for by Sol 3701 :d he Labor Cole. far he - 205 — UNDERFLOOR INSULATION
pe,A.........e of the work for wham this permit i.Iswe 1.
V,ni-cul w1It1n:anus;nWarker'ncampcnxaannlmmxn,c,isrequired byS.twa 301 — ROUGH PLUMBING
37uI d tie Lahr Code.for the perenlnamc It the sank rot winch m;s permit i. '302 — TUB 8' OR SHOWER
,sued.My Workn,.Compcnsatien Inxumnce ennui and Policy number arc'.
rarr;nn gT�tE CohPuS (aw:.'. _S_71jo 303 — ROUGH MECHANICAL
f/'tSC4RTinICA'I'ION OP ENEMPI'ION FROM WORKERS' 304 — ROUGH EI_ECTRICAI_
/�COMPENSATION INSURANCE
(ILS.seen in«d not he completed iflist,permitisfor one hundred dollars 305 — FRAME
ISHOumlea..) 306 HOLDOWNS
I clarify Char in the perfunnerce of the work for which this .it i.i...oil.1 307 — INSULATION
,bat]not employ any person in any insurer o as br become subject to the Workers
Cnorpcn.mionLes,ofCalifornia.Date 308 — SHEETROCK
dpprr'"t g p should 309 — EXTERIOR LATH
N1ITICIi'10 AI'1'LICANTa f.otter making this Cenilinm ol'Esam urn,roue oil
Z hecmm subject to the Wodcre Compensation po,W(ars or Leh:n Code,you must
O O brnhwdb emnply with,,acct pmvht,n.m ori,penril.bar be Leaned w—ked. 31.0 — INTERIOR LATHZ .
-
V) CONS'I'RUC'fION LENDING AGENCY 311. — SCRATCH COAT
> I hcrchy alllnn that fare he is a ermHmctlon lending agency for the perhmance —
I workfrwhichthinp,noniskaurd(Sec.31197,Civ,Ca 313 ROOF NAIL_
aC I'e"der"Naar`
7 lender's NameAddress 501 — FINAL ELECTRICAL ENERGY
U O 1lamifythat Ibase madthis ap,licmnmandsrule that he a No,information is 502 — FINAL PLUMBING ENERGY
o- F. correct.1 agree to comply with an city and county umbilical and sate mw,minting 503 — FINAL MECHAN I CRL ENERGY
O U to building construction.and hereby malw6s wpre%emmiker ofthix city to enter open
>, he mime-mculamedpro,.,forirssecronpup..e.. 504 — FINAL BUILDING ENERGY
F y (We)agree to save,indemnity and keep harmlms the City of Cupermn against
rn liabilities.judgment,costs and expenses which may in any way anemic against said 505 —,.,FINAL ELECTRICAL
U City in consequence of the granting of this l crnnt. Q
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINTIssued by: 506 - -MS TEST Dale
SOURCE REGULATIONS. y' _
Signume of AppllcancCmnmcan - Ilia' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE 508 — FINAL MECHANICAL_
Will nhen"plbml or fumrc hurdia'.1 :ml mercy,hmndle haeardou,umu,nal 'Type of Roof
as dhhacd by the Cupenin,Mi 1pal Code.Clepmr 9.12.a ad the Health and Sawly 509 — FINAL GRADE
Code.Schon 25532w)5
0 Yus °No All roofs Shall be`fnkflctcd (irkMt4.an§7FoR iR1jliMrrial being installed.
Will the apprcantmror..Niildtt,oeeupantuse ewiieex
pmcarordevwhim If a roof isinstallEdl,%4thtwtFrllsMatairPtigMirlCpcldE�FM%greetoremove
ric,mrJom air contaminant a.Defined by the Ray Arca Air Quality Alanagemem
Dw;.rticr. all new materials for inspection. Applicant understands and will comply with
0 ye, ON. all non-point source regulations.
I have read the hazardous materials mluncnmnt.under'Chaper 695.1 the
Celilo.Nldia Ileahh&Safety Calc.Section.25505.25533 and 25534 I arthropod that
i l'the buing Jacs na nlmcnJy have r rcnunt,Ibm it is nIy mspnndhilhy m urn 1,the
coram of the re"airemnm.wh"h on"be ore prior m i......ce of a Cecil!.....of
nc.....nc
r �I Signature of Applicant Dale,
c6i 6
'wal.... daecm Dale All roof coverings to be Class"B" or better