05030169r CITY OF CUPERTINO
BUILDING D'VISION PERNIAV �
BLILDINO A6DR0C,
TF.SL�+NS--C ELK 131 V n _
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PIIONE:
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L IC DPATOS [ IaRATION5ECONT
I btrcby affirm thrt I am Iircmcj under provisions of Chapter 9 (cummerwing
tth S.-ctvm'tJfltfl of Divisbn 3 g line Business wd Ptofculum Code. and my license is
n '�n Pa11 frvtt and effect
v. �s _
L.Kente Coat - Lie.
F ,c Day cdn art«, 4
rah W ARCN(TECTSsAAT)ON
k✓st l .auand raY Plan � tlfE�it slide
to Li:ktucd Rafctaionil
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< ;E l hereby affirm that 1 am eaemo frym dte Cotivactoh License Law for the
n following rcaxut (S-Nen )(1:11, auaineu and Ho(cssinns Code: Any city a county
w 2 which !,quires a pennit in cautfuct, alter. improve, demolish, or repair any ttructurc
prior kt its trio{,,, ain't ra circa the ap)dkant ra such per.nit to ftk a signed staicm znt
., ` %, spat 'ac is IieenceJ puissant a the provis.ane o>t tint Conunctur'a Lkxnse Law !Chapter 9
•r � r,.nemencin; wish Section T000) of A•itiw 3 of the Business and Pmfrssinns Cndc) or
Lis that be ,romp( ticrernxa wrl Use baste. for the %Meted exemption. Any -rnolat)on cf
Section 7031.5 by say apphcam rut a per ih tahjecla Use applicant to a civi' pensky of
nor more than Bve bundred dollars (M),
I t 7 Las ow w or Ct propeny. a my ,fork yas with wagea a their auk ccsmpcnsadun,
will de the work arid the structure is not b.tendrd or orraed roe oak (See. 7044, Business
and rrofeudrmt Coe: The Ctraus:ter's L)kYriae LAW owl not apply to an owner rf
pmpeny wbo builds or Iranlosea thnoon, and wbo does atrcb work himself or throe jh his
own empijyxs, prwirhsd that rsch iminuo ,menu n not Inrrak d or offered lor We. U.
h_tver, tlx building or improvement is sold w?thin ate r-u of complet"- the owner-
bvitd�.r w:9 have the burden of proving that be did atw build or imptem for purpose Of
f7 1, as owner of the property. am ekciusively coavrttirtg With licensed contraction to
cons,,tact the pwiect (Sec. 10{n, Burmese and Profesuors Code: ) Toe Ca•tww's Lf
ccnse I AW dos trot apply b Ia owner of proputy vitro Dodd{ of Lnprova IFcteon. and
1 o cuntracta fa s1w:b prov
projects with a conatnor(s) licens't' pvvAnt to the Contrr.to/e
a,rttee Law.
l Ll I am exempt under Set. _.—.�_- , . B A P C fa skis me"
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WOFKERS CCtMPENSATIOIu UECLARAT70N
L hereby affrm under penalty of perjusY see of the rollowinp declarations.
.] I into, aril wtB melnui9 a Certificate of Consent to self-taiun for Worker's Co npen-
ation, as providod for by Secterm 3170004 isle LA" Cade. for IPe Performen:e of the
vork for which this permit is i;aued-
] I love uteu wirt maintain ♦.orkxs CoMpersatiun Inawsna, as cx)uited by Section
1700 of the Labor Code. for the perrormance: of the mit work for which this peris snort.
sly Wafer'{ peMuioo Insurance terrier and Policy nurm+�bis am' 4
�s4� Policy No.: Z -
;:gorier: rlF) TrN% E— poi c FROM WORKERS'
COMPENSATION INSURANCF
(pus swkwi need not t•e eompkled if is permit is foie one hundred duifan II IOU)
or k•�I
I eerily that in the performance of the work for which this permit is issusd. I shell inn
c^•ploy any person in my Marinello n is become tu�*l to U e Wo trti Cump nuU sit
Lttwa of California. fuse •-- -
Applk—
NOMIR TO APPLICAN L If, aftn making dru CenifxeLe a £xerr pi on, you sho'aW
beconw {uhkn td the W,:ter's Compensation provisions of Use Labor CDde, born musl
forthwith wm,+17 with w;h Provitktce or Utis Permit!bail be deemed ",coked.
CoNSTRUC`nON LENDING AGENCY
l hereby affirm thatthere is a constrocirm kndink lgenty for the petfermancc of
the whwk rtx which tilt txnnit , . d (Sec. 3097. Ctv. C I
-•--
I cmfy that I have read this application and stale thou the above infomtauhm is
correct I agree to comply with all city an4 co uuy ordi:tau r t rd sa c lums relating to
building cautruetion, ant hereby authorize rerrese n tativt t t,,. y ,o enter upon tlr
ahove•metriitxrcd plop,:I%y for irnpertiow prarpor s.
(We) agree itsure, indemnify and keep hara:less 0t7 t-r,y ' 'txc o against
fixDili,aai,}udgmtnts,c�i4 andexpcnaca which orgy in any wry.-riic a= ut said City
in con equcnce of tham)ng e grof this permit.
APPL tcAK-UW*A3TA1gD3 Ak4 WILL COMI" Y W . ' AU ' 1N-POINT
--1'r 4 -
yDale
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HA7.A J.9ATERIALSDI. _L-t:PF.
Will Use applicant ur future building %:cupant',sorc .sett.., r' ^dour maicnal
as tkfined by the Cupenino Mmicipil t'nde, (IupScr 9.1 "'I"- I.h wj Safety
Cxfc, Sccuut 23532(a)n
O Yes fJ5 Nu
wit{ the applicant or frown t wttmg oca,pans use rgwpment or devices •,h" is
emit narardnus r.r eontamomnU Ps Arfirhed by ohs Bay Arita Air Quility Maragcmem
D,mrwo
1CTOR INFORM_ N: _
1'EkMITNII.J5030169
-- I PERMrrISSU£t3AIE
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I SANITARC No, CONTROL. NO,
BUILDING PERMIT rNFo
BF -DO ELECT PLUMP Midi
Job Description
TI-FULL INTERIOR REMODEL
HVAC/PLMB/ELECT/MEC:H
5/18/05 CHRG 24.80 FOR COPIES OF COMMENTS -OUST
Sq. Ft. Floor Area — Valuation -�
850000_
APN Number Occupancy Type
�lteduired Inspention s— — —
Issued by- Date
R.-roofs
Type of Roof
All roofs shall he inspected prior to any roo ing material being his ailed.
If a roof is installed without first obtaining as inspection, I agree to fzlnove
all nely materials for inspection.
QYcs Nu
Ilive csJlhchanrdwsmurrialarcyuircmcntsantkrClvper6.95oftheC111"" j
nu lic:i+h 6 Sgftt� Cndc, 5ci'w'N :551i5.1557J ud 235�4.1 undent.,nd dtatif die hu+idtng
dory not :afro n�tl,%�� a wn"6 u my msptav,lt lity ho nwty the oa'[upant „r the -- --"--" --
rcy»;runcy�1rr11CSmutlbemrtpror'A i;SanoxofaCcnr'.utcofthtupar>Ly. _ f Signature of Applicant Date
__� ���1j All loof co�ersngs to be Class "B' or beitel
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