07080228 Q 1 PERMIT NO.
0
� T `1080228
o �EgMIT pERMlT1UEDATE
C;.UFERTIN CONSTRIJCTION
,rTX
OF pMEGA 27 2 CONTROL NO.
BUILDING DIVISION
DR SIT A SANITARY NO.
JI_01NG 4 LOCKWOOD 451 FENLEY F VE
BUILDING PER PLUMB MECVl
IwNEKENJI ARITA (408)243-
p4O4 BLDG ELECT D
tNE: Job Description
ARCHIT'ECTf ENC'iNEER: in8 W'[TH
COPPER INSIDE HOUSE
RATION G
dC1 ORr P oviss'I�anChaPtc Ike—Is
REPIPIN
LICENSEDC•,cense GA
PAID FOR BL
affirm that 1 am f the Business and
I hereby of Divist
Uwith Section 7000ffect Lic.#
vin full force and Contractor RATI N
y License CLA cords
CTS DE
O Date C Tl b used as public rc Valuation
u' nd MY Plans shall be
-� t understand
RATION w for the
U DECLA ontractors License,.laor roomy rea 2 O O p y Type
S Professional OW PLEA BUILDERcty Ft Floor A ecu ane T e
wLiccrise that 1 am exempt f rUmd ro Professions Code:Any stuce
o< or repair anysu"CLu e, SO
} 1 hereby affirm. 031.5.Business an demoiish• 9 r
reason.(SCCU on 7 almr,impr°"c it to file a signed
1.41 following it to conswct• licant Cot such Perm"
s License Law LCCA)or
uirrs a Pen" requires the apP as the Conuac sand Professions
which req iscuaMe.also visions gusirics ,rjotatitm°C 0 4 0 P� Num e
1 w prior o its ant to the pm . ed exemPnon.Any 3 4 2 2 9 d Inspections
Z a that he is licensed p° on 7000)°[Division 3°ealleg licant to anvil Penny of Require
$ccti basis for Ut c�the apP
(commencing wilt refcon! t for a Permit subje
3 that he is exempt as apP 5500)•
Section 7031.5 by hundred dollars( as their sole riot B4usioess
than five Perty or my emPloyet with weed for sale( 7 'owner of
not mora d or offered air
his
0 1 as owner o[the pro Law dorx not apply to
or
and the structure is notintende s suchwakhimselt or lhratgl�U.
will dprofessiCode*Thu Contractor's License or offered to sale
who dce
and ons a improves tlrereo°ovements are not iear of comPletiat.theaof
Property loyr provided ib rovemenPm Rtadheid i not build n OOC or n one improve Cor Pr'R°ce
own emP tiding o cp Of Proving 1a
however,the bu
builder will have the contracting with Neale C s U
sale.). owner Of the property t m e clustvmess and Professions ds Of I
coWettheinoicSec to an owner of propertys)Ihtanhesed pursuant o the Conrraetofs
ns Law docs not PPIy, with a contract
cense g g P C to chis reason
who contracts for Stich Pr°lects
License Law• under See. Date�,
0 l am exeropt RAnON
S COMPSAI ION DECLA
Owner WORKER• Dile of the following declaratlorrs
under penalty of perlury re forworkersCom�
Consent to sell-ins"los the PetfOnnance
IW 1 hereby affnm a Cerditcate of C°n L bor Code-
1 have and will Mm Section 3700 of the
J an
Toch Otis
for Y_ ued. cane.�repaired by Seerr
Sefton. provided is ntttt is tss
work for whteh rfr Pe Workers Compeof the
or which tfus permit is
Q d willC t���e Pcr[ormancc of the +Jl�
[have err Ce ca
and Policy num r
3700 of the labor non ins No.:
MY Worker's ComPensa Policy OM ORRERS•
Carrier. C CATS ENSAT110N1ON
N INCE dopars(Stf10)
COMP permit
is for one hundred
(fltjs section raced not ce comPletcJ if the(e d.I shall riot
unit is issue Vnsaucn
or less.) a work for whicrhrto diie workers Com
Performance of w become subject
I ceni[y that in the Per manner so Id
emptoY any person m any manExemption.you shoo
Laws oC Caldornia.Date making this Certificate o[ Labor Code.YOU
mast
after visions°f rhe
APPlicant O APPLICp NI:If tion pro
NOTICE T WorkeVcd-
r s Combs or permit shall be dcemcd rev°
become subject w rhe rovtstons or this pe of
forthwith comPly with such P ENDING AGENCY afire
RUCTION L agency for the Per(°na
CONST Construction 1cnC VgCI
O I hereby affirm that thcres�sucd(Sec.3097.
H.-+ work for which this Petro
it the above information is
Lenders Nam' to chat the relating to
La �] lication and state res and state laws Date
a Lenders Address d Itis apP ordinan is city to enter upon the
ntat 1 have tea and county
Uz L certify all city
Q agree to comply with autho[i�e represcntativcs o[ mine against
r• correct.i a8 coon,and hereby
to for inspection Pumoses. less the City of °Pe•
LL E buildin8c°nstrrr cry c harm a amstsaidGtY
(� indem• Y a in anyaccrue
POINT Issued by
W above(W e)agree to save. ^if rases wtrich m y way arc A L NON
mcnts.costs and o[this permit.L COMPLY WITH
E liabilities.ludg a tinOf
AND Wl Re-roofs installed.
Uz in eonsegircnccVNthDERSfAN Type of Roof rnaterial being
r-t APPLICANT LAr(ONS. Date roofing to remove
SOURCE RE _ OSURE ected prior to any an inspection,I agree
1-WXLSDISCLahandlcbaranim"dS2fdy shall be insp t obtaining
rgrtature o[APPh HpRDOUS MA ant store d ehe Health and$aC All roofs firs
°ccuPa to 9.12.anstalled without
WilllheapPljcantorfuturcbuiadCode,Chap If a roof is in t10n•
Cupertino Municip is for inspect
as defined by the l web all new materia
Code.Sectionmentoro ment or devices
e'up a rifle'
tt rebilding occupant use 4 alityMa°gdcftncd by the Bay Area Air Q°Willdie appl11; orDate
emit ha-1ardnus air contsminan u tCc r• „B Or better
Districtl rChapterat9hatofft buildi.Z s to be Class
Dyes uircmcntsundc e of Applicant covering
atcrialsreq d25534.1undersmntheorxttpantof Jtc Signator All roof
ha�ardrKrs 25505.2553`annsibility In-ti" Y
I have read the Secuor cc C CefnCicate of
niaHcalth&
Safety ly h°hea tcnartt.that it is mY
docs not cots wthich m be m l poor o f
CITY OF C-L PERTIN 0
�� /MAIN SERVICE
REPIPE/ ~
APPLICATION FOR
OF PERMIT
�n APPLI(.
CUP EI�TIN Date: Z O
APN#
Building Address: �`�n � Phone#�
CX�V�DD(A V "`�`
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-�)
Owner's Name: _ — — License #:
Phone'
� ,�J
Con i'. � J v/ Cupertino Business License#:
Phone: L, rte„_ �L
Contact: � V JJ
Building Permit Info:
Elect ❑
Plumb
Bldg ❑
Job Description: PA
�� �►"-'�
Commercial Li
Residential �_
Cost of Project: Go
Fee Grou
Qty. ifFee Descri tion BUILDING
A plicable Fee ID Bldg. permit Fees PLUMBING
BpERMFEE Gas piping System Fee
PLUMBING
BPGAS pinbing Permit Issuance PLUMBING
PP FEE Re i e of Fixtures pi IT
BPREPIPE Pblg.Fixture PLUMBING
BPFIXTURE Main Water Service PLUMBING
BPWSVCS Sewers pLUMBING
BPSEWER Sewage Dis osal
BPS EWAGE BUILDING
Business License
BUSLIC