06030148 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ;*CONTRACIOR INFORMATIQN
BUILDING ADDRESS: •rpEA)Iff,4�o
21845 ALMADEN CL
ER'SNAME: PERMIT LSUE DATE
ENG KENNETH K AND WENDY Y 1420 EMORY ST. 03/27/2006
PHONE: SAMTARY NO. CONTROL NO.
(408) 489-6044
ARCHTIERYFNCINEF3L:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED COMRACTDRTDECLARATION IbDescri [ion
1 bmm thu oby affirm 1 w11" undo Vom
vids of Chaptar 9(mmn
m ,coDescription
f� NSmdm)000)of Diriuov l of Nc Budrw and Praraslan Code.and my Ikenx is
mnrar aerr«b INSTALL BATHRO ii11II !!mPACE .
amu:
i ipq DNans Clw con.-
3� ARCHNECTS DECLARATION
X73 Iuvkrvandmyph.etWlbouxauPublic rccmCr MAY �} 7006
�au
d ars
t; Licensed Proltsou ul
11
OWNER-BUILDER DECLARATION
1 bemby aRrm that 1 am uempt from Ibe Conon &.Lkwe Lav for Nc
00 (olbwin j won.(Smtien 7m LL Boli.and Pmressf.Code:Any city or county $7500
$11 hi myuires•pmmit to[mprnc,.alk!.lrn m ,dcmcEsb,or rcpoir troy urucmm
prior to i ,also mauim Ne applie for such pencil m Isla Ie a tigrc aulem
-? BUIL ING
< its 4>turtm
dual be islitt.d pumunt to Into podirdmo of the Cm>ractor,Li,,.law(Chapkr 9 Sq.Ft.Floor Area Valuation
It (cmtmeminy wily Section"I")of W ion Jar NC Busircas and Pmfoaiam Coac)v
.- that k b adopt Nucfmm and Ne bash fm the alkj�eaempdaa MY rk Wi'on of
.3tz-yj Egg go
Se on 7031.5 by any applicant for a permit wbj«k the.pplfcvtt In a ri i pmNy of um r Occupancy Type
Ipt mord Nan riw burtim4 dollars(5500),
❑1,u owns of Ih F^DmsY,a my empbyces riN vayn u Neo a,cmnpdnsation,
and
Nc volt,utd dm al s Comb tot,oadcd m omesed r«sale(S«.l(an Busioeo
aM Nofutiou Code:The Canuamo n,umva lav Goes not apply lf an ownrz of Required Inspections
Ra=rhoddMs clod dnwtaimn.and vim dmstuchwartncafttarNmujh bV
awn wployms,dovidrd Ims mcb im I.sol•wit ase mtimr of,,moResM for tile.If.
M<wr,the Wilding m vngoaemmt I.sola ridWn am yeu or mmmk for am owmrf
"k.). viB haw Ne btvdm of proving Nu he Md nn bully m'vnprow for fAWos of
uk.).
I,u a of Nc prnpcmy,w escluivcly comncdn¢NN Ikcoec l tlmdaeLo,,m
< mrouun doe projaa(s«.7044,Bwinca dna Pmfe u.Code)Tba Coavacsurt Li
mese law does nm apply to m.of pmp,ny who bu1We m bnpmwt Nertan,and,
who cmtnck for such plolew with a convLaat(a)dented pun a mi w th Condamara
L .lay.
Olson.. Bh PC fm d,hr m
LZ z DaR
3 z�—
\ COA SAT10N _ _ RATION
I bemby af0lm uMer pasolly W pmJmy_041"rolbrmy d«Iala loos,
p1how andida for
nmiioo Siete or d,,,I, b.eB-,fordoc W,orma Compem
u f c provi In fm by Seelm 3]00 of the labor Code,for ttr porfotmanm of the
vrort fm rbkh Nit pemlt is Itsuel
❑I love and will maintain Wastef.C.Pordsban Inver .as Icgmmd by Sccdm
3700 of the labor Code,for thd pdrformarae of the woo fm v Nu pctmit iskwed.
MY Warters Compemadon Wma se usrkt and Pdky nmob,r am:
Cantu: Polwy Na:
COMFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(ILU xNm mN vol Ee mmpk¢d if Ne prrmd U rmam htmN,d dolhn[51001
m kat)
Icudfyoutin IM perfmmaamdIbc unto fm rbkh Nu permitYnsTrlIIW ort
employ ulfoom"nuy mann. ounb®>ce whj«Im cWmtr4a'Campeafllm
laws of Cilir-' 'tltDaic —
NOTICEt „„PaTT1Lf }
NOTICE TO APPLICANT:l< ftcr Wing NV CCni m of Eawgimt,you NmW
bttmnte,object y 4 .1b ra.Canpemadon aft laborCode,Ym nmR .
,JO forthwith mmpl/vWauch proviflvumNu permit small ba ammea mvakN.
z"' CONSTRUCTION LENDING AGENCY
�-., Ibemby alNnt Nat lbcre its mesumdm lmdirt'. cY for NC Pmforrom.a
lY> tfr wet fm rhkat olds pumit u iume(sm.3097,Civ.C)
Wpw A Lt,ndcr.Name
U C) 1 miry wt I love testi this appl,adon and auto that tho dhow ormmation is .
U.�,^ conn.1 ajrm b comply with all chY arW mmtY aNiunmf and tote laws mlatiny or
huildine cow ction.and bcmby amhorie mprcxnkllwe of Nle city to cmcr upon dm
OW. abovc-mcntimd pm
cpcny for ituc
pcction purpo
(W,).gore to save,indemnify d 1O
,Op ancp harmlesthe s CIY of Cupertino.Sams,
j.h I,bilities,jodjtmno.colla dna eapcns«r I,b may,anyway acmucfjaluttaid CAY
UZ inc oflbe yraruinjof Nifpcnnil-
^ APPLICM UNDERSTANDS AND WII�COMPLY WITH All.NO
N-POINT Issued by: Date
: Date
R T N9 / —O
l� Re-roofs
` Sipwure of AWIkahVC - Dak
HAU A ISCLDWRE Type of Roof
Wi yuapplkantm fM.n1oi l yuxup p4Rm hutak bamdoud Saf.y
u defined by de CupeNm Municipal Codd,LLPmr 9.11.ted tM FINN anti Safny
.Smdm 25532h)7 - All roofs shall be inspected prior to any roofing material being installed.
El Y. / Na, If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant«room,Mtildiny oavpani m, Idp.1 m deviva ahkb
.mil haraNaus air coni.as don by Na Bay Ara Ail QnWity Manajcmem all new materials for inspection.
Disuka7
0y. i
Ihaw mad Nc Wn mamda4mquimmcmurtd:rChapw&95oramCAlifm-
rva IthhSafny Ceh,SaUau U505.35s33 uW25sJ4.1 tmkmvd thatirdic build,, .
doesto
Y haw a,man,IIW it u my rmyowbility m body do uY�rpfnl of Ne ,
mycihm ,met saaanaaracmilwamofa 2. Signature of Applicant Date
r All roof coverings to be Class"B"or better
Narirtdaycnl Dam