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06030130t�z ,o�Fo Z Iqi )�U eLL� �aC g�S 0. z. !Y WI U i U<E U� CITY OF CUPERTINO ,,' BUILDING DIVISION PERMIT .�CONIRAgLgWTN'TFURMA.TI©1�I ?.wte. '+.�'Aa "� 4 "A"c wua�.,xa niSepd .-i BUILDING ADDRESS: t "S B I PERMff N0.0 6 0 3 013 0 10977 ACACIA WA NERs NAME: PERM ' 65(IE DAIS HOMESTEAD RD.LP 395 DEL MONTE QT_ 41�3 05/19/2006 P':TONE: SANFARY NO. CObmROL NO. (831)274 -2518 ARCHITELTIENGINEFOt: BUILDING PERMff INFV ELECT BLOG PLUMB MECH /Description 0 LICENSED CONSRACIDRS DECLA A7RON Job 1 hvcbY affkm iY+i 1 m Bawd udtlm prmisom of Cbapmr 9 (nmmmcing wtN Suctkn tf180) of Wvitfon J of Nc Bmirua and Prafcukm Cods, and mY Ikcnsc V infwlf«a.ndcfloc 099 REVISION- STRUCTURAL THROUGHOUT D,m �mg�,aar a ORIG PERMIT #05090182 —NO NEW PERMIT " ARCH=S DECLARATION 1 m Denim° my plan adll be uacd u public rtcordl liernsd PmfestloaJ OWNER- BUILDER DECLARATON 1 bemby air. that I Im exempt from Ne contractor's Liceve LIO, f« NI follovd., mums. (Suction 7831.5, Bud. aM Pmfcuiun Codc: Any cloy or cmrhy , which mgWru a pmnit to cmuncl. IM. Apo w dcmWLsh. m rOpur my avwum pin, to im its.. Wu roci. tbc+PPlkam for such permit to fik a alined roOcmau l cont li Ua (Chain.9 Sq. Ft. Floor Area Valuation $0 Net be is liccnacd P., to the ptcc .(the wes vc (cvodarcing wild Smlon 7()[11]) of DivWcot J of Ne BUSheo end Profusion Codc) c I Wu he V etcmp thenfrmn W We buffs f« We allgcd o[mpdon Aoy "ad- w APN Number Occupancy Type Swims J031.5 by my appH for a permit ndbjwl the IppHamtO a. Pm11tY Of °m mart"'° nw brmdnd dolhn (I10B). 32602066.00 0 L u order of the ptopmy. m my co ploy. wbh wag. u their aok ampauado, Required Inspections q P wHlmN,w°Lmd tt amta.Is notm� teed «"m`d m'aale csa. 7 u.Bud. Im Pm loud. Cod. TLc COadracmrs - Law d am apply n m owner Ofd pavprny wbo Wilda mimpmeathyme, em who dco such wok himuffmthmugh bu . onpk)en, provided that such beprowmou ve M bradcd araffveE for silo ILA hwcwr, Ne bW ldiag m hnpannn rU u Sold 61hln ode Wr of cmapkO -, the ---', builder IoB bla, Nc Wrdett a pronne that M did m WW Or improve r« putpoe _ i 1, u pwnv of the pmpny, lci Bared n \ a (Se. "Oad. B tod. t ad Porft". Cod e) Te C antoOmrs S . . LI r , l os « apply m ts om a pmpny abo bolds or hapn Wermn. and. c Wort contracts (m tad projects rhh a cmnuaaa(s) .. vn p«ment n We Cmrnors Lice. W. l un eawp udtdv Sec . B k P C for Ihu realoa Date WORKERS COMPENSATION DECLARATION I krOby III. miler poahY a( per}my are a the fallowing dodmdtons 1 mK and r H m '.. n a Ceninom dCrowns m r f -roan fm Wortds Compo- a w. u pr *d fw by Swum 3700 d the Labor Cp . fm the perf«mtna d Nc work for .hich Nis parch is mmc,i ❑ 1 bar, and rib maiown Wootr z Compoazoon Iamvt¢. as nquln i by Section . 3Wt of ft Labor Code, for Nc p.f". of de aerk for vbich ibia pmmh is Wed MYWmk,(��a Conpenutim huuuncc anim and Pniky numbs ere: Darien Jrft F.SNb PangNo_2%4_06a0o_1V0 . ` CERTIFICATE OF EKEMPyION FROM WORKERS COMPENSATION INSURANCE mO, IccUmt msd Sot be c.,ktd if the pmmh ti for. haMrd doutra (3100) ork,t) 1 anify Nu M Nc pcfurmuta of the work for which Wes parnit Is uott ci. 1 mail M employ ary person to my mmucr So U to become Sobjw to the Wire Cmnpmmulm Im of Califo.e;• Duo Applicant NODCE TO Cminutc th EuW you uWUk APPIJCW B. worn,c=ti IAbm code, you mart pm.it" of Co become bj m sloe W C n pr 1c farNwitb comply wiN Inch pmvitimm «Nk permit fltwl wdcarcd mot,Il h co., ch pro cm or Otis y CONSTRUCDONLFNDINOAGENCY 1bor.1Iffdm Na Nom Vswmncri3 for the prf«mar¢of ,apcoq a Ne f « which Nis perrrtls 4 iumd (Saw 70ff1, Co. CW. C.) d es c lrndcli Ad l � Wdrfa Addraa 1 catifY dirt I haw rod Nu applkvian W ma. that Nc Ibosc Infmmabun iI corm. 1 IS= to comply with all city Soil county ordloan t I end awe Im dclauag lo eanocd Pfc W Fcreby mNorin reprtruuu.es of NU ndy n arcr upm Ne bon-( d popaty for kronify show -d(We) l(OOP h the City Capnim IS and tag hay (We) IS= tO aw, mt,l d City u. eosuand upensurhich maybmYray lame a3almtdd City n OI r in m o in of Z, A APPLICANT a(tDUST NDSthisD WILL � APPLICANT UNDERSTANDS AND WLLL COMPLY WITH ALL NON-POINT Issued by: Date SOURFngcy} fNs. lJ�9�Diy Re -roofs Type of Roof Sigwme pf A,ppll�ioo— VCmUaav �e HAZARDOUS MATERIALS DISCLOSURE WHI de appliavt «futmc bolding oavpint aton m hmdk hnatlan materiel u deflred by to, Cvpmloa Municiral Code. Chlper 9.12• W Ne Hkahh and WOY r.• Seaton 25532(.)7 ❑YUNu All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove win Ne Ippliont or mwm wilding acvpaot me egulpmenl or dcrkn .hkh cmh bvurdnu err cmumimm a dcftrcd by Nc Bay Arta AU Quality Mmaicdocot all new materials for inspection. D.uk' `1 ❑ m )(N. Ihavemad Q U pim 6 if m- oIffNe c &SLFOyCok-n25505,25533WM34.1undo W hulkling N doo, WIIWA a aiLhM y rMpmNlhYWm(Y e ata Date qu �/ Signature of Applicant All roof coverings to be Class "B" or better -� Owrcr «etnharvW ac t Doc