06090271CITY OF CUPERTINO'
a
BUILDING DIVISION PERMIT
,COINTRACT1 RJNFO,RiVIA.U,
BUILDING ADDRESS:
PERMIT NO 0 6 0 9 0 2 71
20916 ALVES DR
OWNER'S NAME:
PCRAfff LSSIlE DATE
MUSETTI ROBERT A AND FRANC
S J
09/29/2006
SANITARY NO. CONTROL NO.
ARCHITECT/ENCINEER:
BOILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O D
LICENSED CONTRACTOWS DECLARATION
Job Description
I bmcby afllrm than 1 w lien— uNar Ftarivom 4Cbeper 9 (sammucln9
with Sution 70OW ooi a 3 aft Buctcu and Pooraimu Coda, anal my 1' u
i full ave errs a b3 o'l'io
CONVERT SHOP TO BEDROOM 224'
CaatD
Dam ConotaECIARATION
ARCH
I �m Wu shag be upm 14 uvxads
1'dP1t�€l.So W N.ST
l
/
�9
L�d Pmra,iow
DECLARATION
OatIam
mo fr the C for me
1 hr, 11. comp f .: A"
an y o
f nP math.. (scam 70 1.5. Btul. and td. C
. (Sr oo case: Any aty m roomy
tbizh m corrins,. ober, i m I. dcrwli
which mu; . h, or mpatr arsetme
$2500
. alto ds.ppiunt Tac suchpmmltto 0k a slgncdananemrnt
iu t rmve. h �rot od
that
Sq. FL Floor Area
Valuation
Oaddralwmgthtm
dtan ho ave (Ch.pm9
ccmnJ lataant hods povukio sof
Btacmrs Prat
orno,
(canmcocing with Scctiw 7000)aDi.vion3of the Bust^ -.•and Prorcviau Codc)m
'
thll he u aadp undue . ansa the bels for the allepE vempdoo. Aar •klx{os 9r
r
Occupancy TyPe
Semon 7031.5 by any."Geant for a permit mhjecv tua.,llunt m a ell penalty a
eat mac man rive hwdmd dallan (I l
❑ I,uowar 9f Na, popay,amy empbym with wagp utheb,ae aaopmuon.
Required Inspections
will theeawlaamrt 1CcIl BaLaKL
RaLam apply
mIIaI ILiu:medm Ia w
and PrmCoda: Thc1mn s actto a
Property who W ik, m impose, tivma,astl whodoa,tah saint hbmrJf m through hu
assn emplayr prwldad than, im,,, m u art not InteMed aalrod fm tale If,
bcwesv. Ne buildin, Or vsposaoat I. told w11Wo me yar of omnplodaa, me owras-
buildm w have ma btauan a poling than ba did oat baiW or brpaasc fu Furan¢ of
ak.I.
❑ 1, u vete of ds popercy. am aeIuiv y cnnur cling with Hamed mnuaeton to
cumtrat ds psojca (Sec 7(A. Buddneu and Pm4ssiwn Cada,) The GaaPamOrt U
cutis law dna not apply u, an owtam of popsy Wm builds Or imposes thermn, arm
who cmua v for aueh plot.=with a canvanarp) 8retued pam.nt to the Coauanar,
Lka law.
❑lath aemp wdm See .BkPCfor thH mason
am
Dam
WORKER, COMPENSATION DECORATION
I lcteby.Rbra usual PVattya'dury One Of de rnlb zdalarad c
Iba.e aad will mainuie a Caufow of Catuem to Wfasuar Tae Worke,;Corn c
atlas, u prov for by Section IT00 a tua Labs Code. fm We Pvfumarcc Of the
.ark far whkb this permit U i," '
❑ I have and wdl mao,ale Workers Compvu rdm Imarx , u tyWrad by Scam
3700 of doL Coda. rm the pufsmuncc able wart for wbkh tair PCrrrlt ubuar
Mr Worteri Com pema ion Inuuvtx unix and Polity numbm arc:
Casio. �— Patly Na:
CERTIFICATE OF EXEMPTION FROM WORKERS
'
COMPENSATION INSURANCE
rlbu semkn reed not bcc Ialml If lbs prmlt Is fararc hmbad dullaor(Sim)
or kss)
1 aruf• that In Na, xrrurma of tho mart for which this p it u issuc4l shall not
cmplvr.nypcuooioay manners abbe c abpct m the Walken Compcnwion
laws of CSIi Da
Apphm ^x �-
I
rCAN {
l U. aft r making mp, C or Elempion, rm
NOTICE TO�s`
u moue
ar the tabor code you Imus
or iai Ona. of
baRmc wbJaa m the WarK
r mi..Cuanra�ndauum par0
forthwith amply wim wch pmsvimuatti, parmit,halltrdacmd mmtcd.
ION IFNDINGAGENCY
CONhOo,
4a for Ur pmrorrnanat til
IIverI than Nave usarwamim
hth .Crtg.gcncy
the wort ru wh4h W, pumit u iuta<d (Soc. 3097, Cir. C.)
Lcndcrs Noma
mower, Aadroad
j1 ¢n Br that 1 hast rm mu "Basion and .1d mu me about or.oui , l:
C. 1 at. to rnraply with At ady antl ccumy ordlnana, and,utc Inn matins to
building emuwction, ami hemby authada: r<premnuti.ea o(N, city m mnar upon tua
for inspcuoo
U aho.omentioncd pruu ny purpmcs
(wc).stee to ase. irdemndy and keep harmless ma City a Cu,.ou.gsimt
r4j liabilidm,jWgmutu,cmuand apmm which may in arty ny...{.Imt,aid City
7 to cautoot e Of dad trantlo{ of this Prrmlt.
APPLICANT UNDERSTANDS AND WILL COMPLY WrTH ALL NON -POINT
.
Z '• - - ✓
Issued by: Date i Y Dom+
SWR U 70
�—� —�'
Re -roofs
Type of Roof
Signatuma Data
SSCLO
HAZARDOUSMATERIAIDISURE
Wi0 ds applium no rotorc hdkmtg uaupu,m time or Nwlc haaNais masmial
u derated by Us Cupnion Munkiral Code. auper 9.12. and the HWth and safer
ode, k0u.'t 1553207'
All roofs shall be inspected prior to any roofing material being installed.
❑ Ya
'If a roof is installed without first obtaining an inspection, I agree to remove
Will the aPpllum ar futum hooding.'., rte egtdpmaot m uaakcs whkb
.I, huardom air amumWnu a &Tim by Ra, Bay Atha Air Quality M.napemcnt
all new materials for inspection.
0Ya 0';
1 baso mad the huaNws materials outuimmcau umkr Chepw 6.95 amo Callfor-
nuHnslN& anW 255X.1I WTI lr9,c
ol,hiadc,Smimehu5it my or,1oriv,
dsc, na cumnth n..a.--•„thunu my tmponcNlitrmmdrr thaa,wmnrtha
tegaltmnettl, hkn ame_ty� Via, �ar.cmr.maoatw•rNy.
Signature of Applicant Date
�4-
All roof coverings to be Class "B” or better
Ownm or wthai>m,pnt Das