00080207 (2) CITY OF CUPERTINO .
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
RUILDING ADOR ISS: `//_� ar^ /�/J PERgIrr No.
OWNER'SNAM1I Allft
/�N�//�S AI'I'LICAItuNti f -G
SHONE: JENNIFER /pSANITARY NO
p C Z AIiCHITP.CI'IIiNGINEER: Ur BUILDING VERMH INTO
mOW
O IILDG ll(T 1 wmli MECH
QLIW
G�'��, LICENSI?Il CON'rBACTOR's
DECLARATION Job Description
I hemhY orlon that I a it licensed under prnmsions or chapter 9(mnmeacinp
F=-� with Section7(XX))nr Division Jofn,c Moire,and Profe.oiam cnde.nnd my license .
Ewa, i amu brace and dr' -
�Cw_ iccoeclu,sfb Lic.p ��
X- d 1.,ac - n,mnci TENANT IMPZ/O
T
a ARCH]I ECT'S DECLARATION
I J I' 1 try 11 II h soli P nl 'Ax
xN /
la w I lcc J print by 'I a OWNLH NUILDIiR Ill CI ANAI IfN
w 1 1 Fy ff n,,h t l p, Ili l t nn L L w for,he
Fir folio 6 leant 7Un5 t, les J I I : li e d y ly arcounty 0
5^O ,i eM1 , Permit, t talter, min demolish. nany structure,I
a. park t [ ubimy 'm ..plc ,1 - ohm us,, t1 fig h vr,
bar he, licensed isSee nit m ter ' ,., 3 c ,rah.111 L w(cnamen9 Sq. FC Floor Area Valuation
or that he in,is exempt Sedan oNla of is din,3 0l Inn Rasmex n d Frans m,lade)
or that he is31.5 htherefrom and Ilio arms for Inc alleged the exemption.Any l violation
s,1 non merciless.
e it s. try any ninth,
red don for a permit nunjap,Fe applicant¢,u civil fewlry
of nut n,am man live hundred dmans astgu. APN Number Occup$ii-op,�E,
❑I,as owner of the front lit my nnploycm with wage,a,their sole cmn,ovation.
will do the work,and the structure is not intended or offered far sale(sec.nus.
3].605053
aurone„ono rrorea,lnm eminrn,e co,nma,o,s uanxn Law dieu ran apply to on ROlired Inspections
r of property Who build,or improves thereon,and tubo dies such work himself
ow
rvthrough his own employee,,pmvlded that rico inipmvemens are no,imm,ded or
uttered for sale.IL however,the building or improvement i.,.sold within one year of 101 — FOUNDATION
nnpinion,the owner'nwlder will hth
ave e nnnlm,lirproving that he did not build or
improve for purp o,of eras,.). - 102 — PIERS
❑I.as owneroftheProperty.ameacaxb'elyconlowingwith fianscdcontractor%no 103 UFER
Limxtruct the project(Sec.71 .1lmirco,and Profession,cods:)The Contractor:,
-1
License Law die,mmspin,tranowncrrrpo,pcnywhirnuild—,iinprom,meteaa. 404 — REBAR
and vino cmnracu for such projects with a conmsontO licensed pursuant m the
cmmmnmrs Li'moc Line. 105 — ANCHOR BOLTS
❑1 am everms under Sce. .IIA P C fonts,mason
1.06 — SEWER R WATER
net Dam
WORKrR'SCOMPENSA[[ON OECLARAl'ION 202 — UNDERFLOOR PLUMBING
I hereby affirm kinder penally of pvoury one of following demoration,: 203 — UNDERFLOOR MECHANICAL
D I have and wiu maintain a Certificate or Consent to,elf-imam for Worker, 204 — UNDERFLOOR FRAME
Cotnpea,otion, is, provided for by Seed on an ) fir lie Labor Code. for the 205 — UNDERFLOOR INSULATION
pednm,mnee of the work far which this permit is issued.
0 have and wimm�imain Worker'.Compensation lmursnce.aanerirodbySmdon 301 — ROUGH PLUMBING
,1700,of he team..code ror she nenormana or me work for which ter,permit i, 302 — TUB & OR SHOWER
nsued,lily Worker's Compensation Insurance carrier and Policy miniver arc:
policyNr,i 303 — ROUGH MECHANICAL
CIiR'OFICATIOK OP EXEMPTION FROM WORKERS' 304 — ROUGH ELECTRICAL
COMPENSAI]ON INSURANCE
0 his section mail amt wn,inplmed h ore permit is li,r enc amdmd dollar, 305 — FRAME
(slanorle") 306 — HOLDOWNS
1 certify that in the performance of the wore.for%hien this permit is issued.I 307 — INSULATION .
shall not....piny airy Pcnan in env mt"mnr so as It,become subject to me Workcn'
pcmauon sGalliumia.Date 308 — SHEETROCK
°herrn, 309 — EXTERIOR LATH
NOTICETO LIGAN'1':Il:alt muA mCanillcute nf . nip,ion.You should
cnmc,uhjecno line Works/s C mpense,ion pmvi,iomaf,l- tb,'CNe.You mal
O O fnrtn%amnompnywith,usn,pri ,ion,orI,!,pnr,dt,hauwdaim-d revoked. 31.0 — INTF_RIOR LATH
z n CONS'IROCI'IONLENDINGAGENCY 311 — SCRATCH COAT
a > Ihemby affirm that there it a construction lending agency for the performance —
onhe wink fist X1,111,this I,nrni,'is i,sand(See.3197,sic.C) 31.3 ROOF NAIL
O Lender' niishic 501 — FINAL ELECTRICAL ENERGY
vO nannyma,Ihave madmrsapplinadonand nic has ihenbireinfomarnnis 902 — FIN LUMBING ENERGY
emn'ild Ig conmcomplywishall city andcounty ematives,and,cite to enerupon
O U mbuilAiI.,me uc,ion.and hercit it,adcomey,achovmof,andacme11-1erupm 503 — FI AL ECH CAL ENERGY
B,cabovcnueneoned property for imlecdon l,mpo,n,. 504 — F ,NAL I.I I_I . IG ENERGY
t}„i p,
(We)agree m save,indemnify and keep harmless the City of Cupertino against
m lonilni .iadgineins, and eslen,es wwrl,ii„ir in any wav name,igamsi'aid 505 — F E R ICRL /
City in consequence of the graining of this perm,.
APPLICANT UNDERSTANDS AND WILL.CpMPLY WITH AL1,NON-POINT IsSUed by: .rl — - Date
T ONS le
Siynak ofnpptennv ,ntmclor —/F-Il1JIfi� Re-roofs 507 — FI L PLU ING
It tnanaus MnreRln DIScl.osuRli 508 — F AI_ MECHAN I CAL
wiu ran apphmmm,u,a wilding i,mup,im aumoninmla ntuaidom„e,ndal 'type of Roof
n.Aslined nyme c"pemm"Monici,n Core,chapter 9.12,and the Health and Safety 509 — NAL GRADE
Cale.Section 2553200?
Dyes ONo All roofs shall m lr@pw, es7aj ¢ylo ap1_WPIIAaregMNmm@mtt�eeyriiaa�l�bfteing installed.
Willits,applieam on future building ocwpen use sa,mpoen,or desire.,which If a roof is InstaIPl�*ithotFTf rgjjbt:ptUlgLq b s WOV rTf'a�7 agree to remove
coni,hwardnn,an cunuanin:ratsas defneil by the Bay Area Air Quality Management
Di„ricO all new materials for inspection. Applicant understands and will comply with
13 ye, DNo all non-point source regulations.
I hide,cod,he hmurdoux ma,cnals mgnimmen„under Chapter 6.05 of the
Uhtornia I leulih A Sofery Cuda$vainnx 25505,255A nnJ 255Y1.I understand that
'tithe building dies not currently have a tenant,that i,n my rcsponsibilily m nmify,he
erPan,of,he mqulmmmn,which inns,he mu,prior m i,sroule of a Cerlfen,e of
c°pa” Signature of Applicant Date
C
of aotm,naaai - o/e PO All roof coverings to be Class 'B" or better