00060089 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: .
BUILDING ADDRESS: PERMIT NO.
NEI'SNP81I 2I ,STONES AV LEAVITT npPLlcnrt 0'009
PIIONIi: t�I x, SANn ARYO@O/14
4/CK.1Ii.LN(N NO,
LeAVITT GL LY
0 O Z° Alteril'1'FC'DENGINI ER. RUILDINO PERMnFO
'IN
m 2 NLDG ELECT I'LLEA3 MECH
FtU I_I =I =I 1=1
6y
Z y I.ICHNSHDCONTR.I cold
ol d.. DI.CI-n RATION Job DOSCI-IptlO❑
hurcby a0imt that nm licensed unJurprnvlonee lit ion'C ter,ra,mmmnnng
rr, eHw with Semon]1X101of Div Lsinn9of the Hu,ines,teal Profeeatmn Cada and my Leemc ,
6 F in In full loo,and cffea.
X O�yR 6 License Clu..a Lia,k
de O,d V rata S DFCalnr •`
Iu 1,a v ARCHrrLCI"S DECulefic l(lN
-w°< Ianderewnd toy pbat<,bau be tired panha record.. RDD POWER FOR A/C
ac ;
u+ O O LicmuuJ Pr^Icssionnl -'
OWNER-BUILDER DECLARATION
wo I hereby o0irn thus I 1 racmpt fano the Cantor,(',Lleeoc Low lis(the -
I".,Zai< E,Iluwlr rcasron.(Section consort t.alneas nail Pn@seism Coda:Any city o twenty
]:° whth rif,rs n permit ba intima,alcor,ifor such
perio sh,or rept( vlacnnm
3`b pr rtt t also 1 piapplicantf d p urs fl asigned ehapter t
mato Ia Ipreua,t d p ,r n, fm c t nest - Law..noCer9 Sq. FL Floor Area Valuation
(cum clogolattheren,000)ofDividon3d theforlatedcssand Pn,fAny iCoed ,
copilot he i,31.5 b thcrca'otn and the hneis un tM1c cts dilated c applicant
Any din natty
ofS to...]031., by any vp dol l for npermit wbj^nstheupplinmt wacivil Penang
of not,m,ro mai five hmmrcd dolma rssnol. APN Number Occupancy$'LXpe
owner uI the propenY.nnnY untpinyce,with wagcv'ax Ihtir,ale conq,cuwion,
w Jn thewmk,nail the'"con"' not fmm�ded or dread far sale(See.Wolof.
Ra ,and ran 'nd'ens^rb cowmemrx Liaanse Law Joe,nit apply n nn 3',:647040. quired Inspections
.woof propcny Who failJ,nr in,pro ca thereon,nail who docs end,work M1imxelf
or Ihn "L his own mupinyer,.p.....Jnl that such impmoeinente u d not intended or
offered fnr,vac.If,hnwcvcq the building or intprnvcmcnt issold within enc year of
,mldedoa.tire ,o
e osver.hailderul base dna burden of proving mat be ata not build or 304 — ROUGH ELECTRICAL
uu0rovo for pnmneo of ewe.l.
01.o,at bid topro,aid aamsmdycontramur, ,in ser deommcmr,to 501 — FINAL ELECTRICAL ENERGY
L,nmrtwt he ponder,(So,,704L Roane„and Pmraecmne Code I the contractor, 505 — FINAL ELECTRICAL
icense Law docs un apply loan owner of property who builds or improve Iherwn.
unit who commas fill such projects with u aoatnemr(e)li1ou'vd Pursuald m tire .
Conlmmnrs L¢un
oIwo Od:lv._ _ - H&PC hit thio re .
)wnor _ �//�O�
( t r. IR!CL i/
I curhy aftinn emit -
pmtulty al pcjnry one nfthe GJlnwing Jcdnrntiwu: FINALED
❑ I haw and will maintain a Cenilica d of Comes to,elf-inoure for Worker', -
Conlpen,mion, rteprovided for by Suvnn 3700 of the Labor Cade, for the
pctf odaraa„ftbe ,),kfnrwhichtai,pa,rraisissued MAY 3 0 2001 ,
❑I hoot and will ne.inwin Worker',C^mpvn,ation Insurance,as required by Section
Tial of the I.nnor Cori the Ledo manna or the wad fnr which trio pemdl is -
I,wcd My,l9orkcr',Cnngaytmtion Insumnco ird,ner and PNicy,rube,area
earner, policy No BUILDING
CLIRI IFICAnON OF EXEMPTION FROM WORK17RS'
C(IMPCNSA'r1ON INSURANCE ,
(This section need but he cnmpleled II the permit is for one hundred dollars -
ISIallorfor,I
- 1 daily that in Jae perfnrmvnee of the work Far whth thio permit is ,arr 1,1
shall not employ any Iperwn In any nwnner oil as m becont eobject to'he Wo ord,
Contpmnstufon Laws of CUllfumin Data -
Ai pllama <
- NO'rICETOAPPLICANT:ll,after muking thikC✓ulwale of Exemption,you should
recent subjttd n the Wo too,,Compesuuon provfslono of the Labor Code,you loot
O kulhwlth cantply with such Prov kla io or this pemtit,halI he decnmd revoked.
COAST RUCTION LEN DINO AGI!NCY
a Thereby waffinohich that Probe is:r csued(Seenlending agency for peti,nnance .
N f the dor',N for which thh penult is „use(see 3099,Civ.CJ
C. Q lxridcr'x Nana
Z Ia�nJcr'e Address
U O I county that I have read thi,aPplicalion aM runic than the above mR,rnattimt is
W �i correct,I ugme to comply with all city and county ordinances and state law,relating
O rJ m hullJing consnanlon,and hereby aulhordae representatives of dais city to enter upon -
the nbove-mmtioned pmpeuy Ibr inspection pumo,as
Wy rwa)aSree to save.indcunflY and kip hamdm,the Cityol'Cupertino against
rV] liabilities.judgmm..N,max and Lapin, bah mu in any way le,ow against said
U .Zi City in most ,of the 6rmting n- IsF� ,
APFIAI or Effh, , Sd N' MPLY LTH ALL NONPoINT�/]r/ ISSDedby: Date
SOUR �1 r I 511 ///
"Isnot eufApplialAZAi a air r 1 t Re-roofs
IIA'"/.AI and Mding acALS DISCLOSUREhandle
wn tw e Cripart re lute ipal Co accordant r9 12,bindle meamoan mafedal Type of Roof
as de, tca is ata Cupctim M1tunicipal code.chapter 9J2,and the Health and S:irdy '
Code.,eY”25532In)9
0Ye� "^ All roofs shall be inspected prior to any roofing material being installed.
Will Jtvappllctm or nc future building occupant , equipment ar devices which If a roof is installed without first obtaining an inspection, I agree to remove
mnw
tit havanloo,air conintmt,an dallned by the Hay Area Air Quality Managenem
Di,tri l? all new materials for inspection. Applicant understands and will comply with
0 ye, El No, all non-point source regulations.
1 have rend the baaatdous manuals rcquircme,ne under Chapter 6.95 of the
Cullfnr lv Health&Safety Cn le.Suction,25505,25533 and 25534.I r cold; d drat
If the building docs rrcnty huvcvtm n.th;u 11 le are a.'hllhynnmify the
ttupanl of .a,which eau. Inez pr' ,1 n Certificate of
oCe Signature of Applicant Date
owe" u Due All roof coverings to be Class "B„ or better
451-huT,on agent
OFFICE