05110014 CITY OF CUPERTINO
B UILDING DIVISION .PERMIT .��aC,ONTRACTQ,RI�IIr'ORMt�,TIONce
BUILDING ADDRESS: PORTRAIT HOMES INC PERMrr No.05110014
�s NER'S NAME - PERMrr ISSUE DATE
CUPT COMM HOUSING DISABLED INC1098
NE SA ARY NO. CONTROL NO.
' (510) 577-0294
ARCHITEC IENGINEFA BURRING PERMIT o
BLDG ELECT PLUMB MBCH
I O LICENSED CONTRACTORS DECLARATION lob Description
r� 1 b by a(Ym this I M H¢aorl untie+Prorisiaa+M Clean 9(c,mme g P
i� with Srdon 7(10)of DiW 3 ofde BuiKss tool Rofcassans Cadc.arE MY lkoocu
_��, WraurmaanatBaL r^7 REVISION--ADD DETAILS (2ND FL. ) ,
FOUNDATION FOR ADA
g ARCHTfELTS DECLARATION
a IunMmaW my puoa t>>Vl W urd upaWl,retools ORIG. #04060014
f6u<
e� Lfaued Prol.oal
OWNER-BUILDER DEMRATION
i 1 herchy arr.d,a I am— pq from the Canllacta/s Lkeou Law for de
p O following moon.(Sonko 1031.5,Baanoar aM Preposition Cade:My dry or ommy
3$(L which msdms a pumil W e L Slay.®pore,&raodW,a mpab n1 a ro
-2Y p{arb its lWOML.alta Katon thesPplmne for"It pVmll W lift..,rad LalCmeN
< ,h„heaRconfedP..tWuaapm. o,"or weear.,a,:."l Lt'w(cea'W9 Sq.Ft. Floor Area Valuation
yts• a (eaomuWing whh Sream 100M of Diruion 3 of the But=and Pmf®au Codt)or $94
E R— dui m u.,a thondr.m and tM basv for rbc alllF essmpd.A,liolulm of
Sw 7051.5 by arry appd for a P—It a*Ot do-Wkr a to a c 11 Protally arAPN Number Occupancy Type
not mare dun Rso haodrod dollars($5001.
❑I.0 owocr of Lit pmpmy,or my rmploF with wage udr-h sole ^'w
and do do wort and the ai m Boal Wodcd ortiff t for sae(See.TOM,Suaress Required Inspections
and Pmfesal..Cade The Cmuano s I Law don not apply W ae o Q( q pec
pmpc y who kau)cl.IX improses Lh m and who dou auchwort hlmvJfa N,00gh hu
aw tmplor,=p,oridcd tion soh impmaooata tae oar iornded.radioed foaaak.a.
law ,tim,Wit"&a hePras®oat I,sold within arc)ear ofmmpin theownv-
bu0du will base ttsc bis of poling that he did na hdld or impure ra ppz of
.L).
❑1.a mw or ds propcny.w aolm"cmaaaing with llvaud amuaaots W
cooat x the pm}ea(Sec.10M.fl a rd pmfoLtim Code)Tle Coot acmes Li
awe Law oleo am appy to ae awmu of ProPutlMo h,ild+or imposes Wertm.sod.
who
d p
cooacu fm sal poJeaa with•mnbxwp)devuaasunt W me ConuanaYa
L
C] lan% aw.
❑ lam eaemp vudv Src .Bl PCfa tido mu+n
Dau V
WORKERS COMPENSATION DECLARATION
1 hertby sBUm udIcr peu(y o(pajmy our a tie following A�
1 bs.eand will maintain a Ccfif of Comcm m x1f.lasmc fawn .Conpcm
udoo,u pounded fa by Secdoo 3700 a ibe Labs Code,fm the pufonnaa.a d tie
vola for which thio panil u tmaca
(]1 base tad NH maotain WateYs Campawba Iwma,u regdrN b/Sadm .
17(10of tine Lsba Code.ra We pafamaecc ofthe w for ah"this Prail u lmed
My Watara Canpnasdoo 0m ami.od Policy
Cartier:�, �. .
CERIT}ICATE EX—ERM,INFROM WORKEAS
COMPENSATION INSURANCE '
(I'hu seNm seed ms bemmpNed Hde permh u faonc tmmrd do0us($100)
a kss)
I mtirr shut in dto pufanmus¢N to,.orit for which itis p h u Ivad.I stall oa
cvpioy any prmn m toy oto w as W b vme mbfas to Oe Wa 'CampcoWim
of Cal(omii Due
NNOTICE TO APPLICANT:If,.ler making Lids Cmrf of Eamption,yas stoaW
tx v aubjat W We Wmtefs Crmpenodm p Wow a do Floor code.you moat
Oronhw;W comply wail snob proviamu a Wu p t shall be loured mv1e4
'Zy CONSTRUrnON LENDING AGENCY
I tembr aRitm don tM.u.arta.. i l os.p^uy for the prforro.a
a> do srurlfor whkh Lida puma is inteA(S.3097,Ch.C)
QUndoes Num
Z Lader.Admra .
U0 I mdfy that I hast road this applicWon tad,tau this Lie amsc Womadw la
[s.- corm 13gme W caoply with all city and cavy arci and a•a,taws mJsdog W
O buildi,eanaealim.and hucby aahodae seprexaudvn al Nu eltY to al -pm det
W abmecWndi.eE pio'c Y Tor inpcdoo purpoos
(We)aeoe W nm Ivdrm,dly rnd tap harmlen tie City of Copenbm Simon
IiNilidafWgmeou.eons and e:pcoas which.uylowynya galutsaEGly -
UZ Ing q.«,.of We gravuog a thio P L �s 2'O J•— .
^ APPLICANT UNDER ST D WILL COMPLY WITH ALL NON-POINT Issued by: DateL.
SOURCE�ECULATi
�J - /ror
^Re-roofs
Sgm.of Applioan trtoarof ApplicinU trtaar
om—
HAZARDOUS MATEIUALS DISCLOSURE Type of Roof
Will We applionta fouuc bdlthne aaupanl atomabandca ^^w^nuuW
Idented by de Cupenlna Monkipal Code.Chaper 9.12,and the H dr and Said,
do.S d.2503ua)T All roofs shall be inspected prior to any roofing material being installed.
❑Y. �Na If a roof is installed without first obtaining an inspection,I agree to remove
WH the appliam a folium lsdlding oavpan use eadpmud a dcvlty which
Mil to ua ar cmuminanu a dct�by We Bay Arts Au Gaudily Maxtq m all new materials for inspection.
❑I hast rW tie lantdonsmuerltu rtquhenenu adoChpu 495 oftieCdifona Ha1th&SafayCock Soave 25503.25533 and 25531.1 u aaa,d thmHdo Nrildiog
ce ml caiMy Mse a C tarsi that it u my vporSWILY W miry Lie ampam or tieyabc 1 Wi�aanaoracadnneor Signature of Applicant Date
All roof coverings to be Class"B"or better
awi Mrod.cent e-