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06030164CITY OF CUPERTINO *�n�T�"+'��,{ �t �t�,�/� BUILDING DIVISION PERMIT �T!�. "�C+�1\:'l Qlt it�J<'04�=�ja� ON • A; w•. 'T'912 BUILDING ADDRESS: PORTRAIT HOMES INC PEAMRNO 06030164 10092 B OWNER'S NAME: PEanar lsueoATe CUPERTINO COMMUNITY HOU N DI 0 SASTTARY N0. CONTROL N0, 510)577-0294 ARCHRECT/FIlGINEEA: BUILDING PERMR fNFV BLDG HFCT PLUMB MECH LICENSED CONTRACTORS DECLARATION Job Description 1 bcraby afro not I ro ltco, d wticr pmviaiaae of Chap19 (ammaebg aridi Satim'1UW)NDivbnJof lbc Btmrras and Profs' mCadc,td mY lkcnsu in mu face td afrw-. : _. REVISION HANDICAP RAMPS AT CLOUDED AREAS SHEET _ o' c�,m�.eat� ORIGINAL PERMIT 404060014 ARCH.CrS I#)EL TION I uoui, surd my plau shall b tttud u public tcmrN Lksttsd Pmfatiatul OWNER-BUILDER DECLARATION 1 hemby Afrum not, 1 em a pt from the Canlr Ws Lkcme Lar for Che i folbwln[ ratan. (Sinton 7M I.S. Boli. tout Pta(c . Code: My city or coumy which c9uirta a pmmit to anarocC, aIle. knpmc, detoMbb, a tepais any swnwc - prior.its i.uatom.aburcquira the applkantrottach P"ittoaktknd-.1 I.. liar 9 S FI. Floor Area q Valuation $0 Nat M u Ikcnad pvvaant to no, praviskoi of the CotmstaY (CMptc (educing ar,b Soctim 7") of DiW J of lbc Bwtinasa and Pmfe .Codc)or Nat ba b temp amdrom arut the burls fet.tbe alkLN a mtfnlon. My vlalativa of APN Number cupancy Type Section M31.5 by any uppllam Aw A pormh fub}ecu lba aPpeenl to a mva p "Y 0 am otos than aK bvodmd dollar' ISM 35907010.00 \` 0 L n owner of tha prvpM7. a my—Pkym rut wages u their wk—Pam lea, Required Inspections q0 w dodo, .6- and wn amulwe h out musae a aaeed fa tm(s�-7aA. Buri. ad Pmfutlmo code The Cuntramols IJ=a !Aar doe not apply n an owns of daaamcb.,art Hm,- rot Lundith h a prapaly arb bullduaimptoaet tbveaa, and arb ora amployoy provided da aaeb udmo teau art tnl baedad aaRrrtG row ale If. r boar . the boildinL abapo+momt Is told widiin oney. of.Pletim, me Wilda w fl h n,a ft bnden of paving that he did int WW a impmAe fa purpos of ak.). ❑ 1. u ower of Cbc popany, w =bauvciy oonoaab[ widi licemed acorvaa on catmoua de pt,*a (Sec 706x. Butineu add Pmfetuans Codc) Tic Caaucda Li- . Laar don sot apply n an order of pope" wba Wilda a bmpoaa the tin. . wbo eanlnrLL ratty pta}aN with a ouauaaur(t) Ii d pvrWanl to Ne C'mNaen. t ❑Itmaamp,a S .BQPclwtblapman DauWORKERS COMPENSATION DECLARATION 1 hmby affirm vdcrpnalh• N pnjur, me of the faBawittg delTint. 41'lbas ad will maiwin u Canura ofcp to aelf-lamn,(wWoraYs Comp - .quo, a 0o ded fa by SCCIan 7100 of de Ltaba Coda, fa h performata of We wink for whkb Nu pawn'. laved 0 1 have ad Will maintain Worke(a Cope m laautna. u oyttbed by Semlan . 3700 d the labor Cade, rot dao pvfarttatta of de work fa wbkb thin Pewit IS lmo My Woke( pmwtn Wmarta n and Pulky naaba>R: Carriu`: -.--_..-PN1ry No_ / 6 -Q 2- CERTIFICATE F EXEMPTION FROM WORKERS COMPENSATIONINSURANCE�� v (rids sham red tin W.Pkad U Ne Puml Is foam batdmd dumas (3100) a lea) I m that In die Papainase. of We wv1dC fa which dila permit u iaaed. 1 shall tw cmpbry any pawn In my mamvw aa w ¢ wbject to to Waken' Compeodalm � of Calirum a Dan Appl{om NOTICE TO APPLICANT: If. anti mating Chu Ccnirtat of EmmPdon, you should berate aobjm to Ibc wok . Campmadan povimma a the Lobo, Code, yw mus Z fo,,n i,b mply widi.cb ponivav a uta pc hWall hdautd Cemlxd. D n CONSTRUCTION LENDING AGENCY 1 betaby affirm Abu dicte la a mmrucuaa knLin[alpn In, die pafarmana of , > de watt fa which (bus permit Is I.Ced (Ser. 7D97, CN. Q _ udola Matte dt Lossless Adm Z 1 conify that 1 haw rt" tbu appT . atW MW drat tb abote loulmomlun b tom I aloe b comply with an it, and eawy adiwcu tad mu Ian m Win[ to JbuiWin(Wt) baannity arimrtplumd.eaof Chucity pwdic Lu ibom-tredoad pmprty for impenion purpo Int to as upn1i. (We) riot to arc, indemnify and kap harmlea Abe City or Cu bull s a[tiet rZIiabilwq,jad[to upas rut. matym un)'nyatpue agalmt aid Pry timmm.aad Z In aaucganca of the graalnt of that permit r. APPLICANT UNDERST DS AND WILL COMPLY WITH ALL NON-POINT (sued by: Date SWR�•�Ect�y� - �I —//f �/ sir - — - `/!/I�© JRe-roofs Type of Roof Signuvm N Apoicm tram« Dak HAZARDOUS MATERLA.S DISCLOSURE WN dte Np,mu a fuwrt butbang attvpacttto o a hulk haardata matetial u leaned by tk Cup:nind Munkipal Cade. Chapin 9.1; and the HdN and Safay taco CY.'�SJz(')?� KH_ j 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 tin uppliam p roam building oaawa as waipmat a downs rti;an a w oa an, conuarniumn, u deattd by the Bay Arta Air Quality Mar Coat all new materials for inspection. Mwiml 0yn No - I Wain msl Ile hiniduu twmdab aquYcncw omkr. ChiNtr A95 of Ne Glifa mu HulN&Stfay Cade, Ser 25505.25577ad25534. 1udaanW Iballlthc bi-It dip tIX Lyre. hath.' a 1CINl dW a . my RtpJnGbil4y. notify the o..panl Or 11te manumtebn J°manaefacadaa,ear Signature of Applicant Date All roof coverings to be Class "B't or better Owns Chavrd aLcnt Ih .