00120134 ti I CITY OF,CUPERTINO
m.mnc DIVISION. pERMIT' CONTRACTOR INFORMATION:
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BUILDING AU4H{,yS
c-�t39 AL.0 FLDr k IZD H AIR
13/4 `
�JCItb1017p ' - PPLICAll O 'SUOWNER'S N M ( �r c T
/1=k00 45317.10 11\1DUSTRIAL DR
:PHONE a a, w ' SANITARY NO, CONTROLNO,
(`'110) 40-5655
C Z ARCHITLLT/LNCINLLR '
BUILDING PERMIT INFO,
",y• BLDG ELECT PLUNIR LCH i
Z HON z LICENSED CONTRACTOR'S DECLARATION .� Job Description `
Z-,q 1 tirleby dill a, her I am le"o'eJ muter Pmvl,ma,of Chapter 9 nlooIn,emm.g . .
K�FU, with SCCma711001of DI.I,Ian Sol the Brame+,and Prof ee,;..a,Code,and my,license - RFPI_P.Cr 80' QI17.1Q1, FUI?,NfaCr .
,4 5's nln full tone nnJ {leq„_ I I P .,
y55y C NN6 U I,cen+c cl�,., •_�d4 L,e»yl� _
tai 5 u.N Dale Cunvacrnr_ '
AV. HI"ILCI'SDFCLARA 10
1 under„and my plan,shall M:need n,pubh,11
„ !.
Lnensed Plofe,+l;mal ... , .
OWNER-BUILDER DECLARAI ION ' t
1 hereby a0irn.that nn,exempt nom Ile Contracm..s Leaor,e L.,w far Ile
mach,ngreams (secant"T1315.Bnsmnm nndvn,l demo+code ear etly Dl cnnmy ,' - -
$$ q me rcgaircs a pnnw m ninamcl,alma Improve,h inns,h,nr mpall any stmcmre
tai 's pnan.as n,mmcgalcolcyn ue,ihcnpphcanr l h each Pemnn Ian,.,gr.(Ch Pae9
teal let,IlcrnseLl rSttela a 7thePmvnnum+nl the heBasnesskins..Lew(Clemn0 / /
(c..mm her, wnnscams-Bran,]the ..
.... o,Paneensure,+and rrn Any In Coral Sq. Ft. Floor Area .- / Va71 On '
" or Dint he n..hero IM1arnlrom and ilia hers Inn Inr ell..•ed racm tun An Lmm�
PL b. P Ysi.
or ad air a Bran 6y:my dpplleml lora permn'subjeck the aPPLC;mt to n roll pen:dty -
..f rem mate than nee hnn,hee d..11.n,($5nn) APN,Num e �'c, cjY T'pe
.•14iRtu'�1�33. C1i�
s a,.,it,of,he propety,of my employees with'a"s m then sale nnnpcnswmn,
'Ill do the wnrk,tool the..[..nano,I,no,Intended muttered taI ,ale(Sec ]1141, ]� �re�-I °
Brame„and,,I,Who°nni;i`:1;r The cnmrme�.......itNinonae,,,oleo"u,akharelf � 204 — LlblDk�{4uMOW119cl��RE -
n pmpery mow,
�:Tortilla his n'n ho.1seee,.pm,med that loan loon, %aid.I i not one or 1 RC11Jt:H RI_ rwlB T. lG
or llalld tar,.da If,'Ilawe.e,WebudJmg or ardeeve,; ,that wllhm one yedr of 31,?I L1 h _ . ,
cnl,lplmm�;Ise ex,ICr-nmmcr'dl h.ea a,a Women mpnr Ing tnel rte:lid net norm or .
Itltpra.c larparpn,e nl,4le>, ` - •303 RCIUGt-! 'MECI"IAtdICAL ' .
°1,te,r,aea of theprorertr.aa,exelas od,a,mracaa,eithhcenud.m,tmmnr,to v14 — ROILGH El rT�"TRICAL l
L..namct hefell.,(See 7044,11mmes,and More,smn,Core l The Contra ct...., .505 -.. FINAL rL.EGTRICAL .
men,c Law does not apply to a,,nwnel of pro,ely x170 bead,n,m,pro.es thereon. . r
and''h,canna,to do inch pr,oa xRl a emm�eea(s)lineman pmsonat m the ,r- — , '
Comracmr's f."ense Law. : 1171'7 F;L C NFL. F L.IJp11�.I hJG
°I on eaetnpinek,See, B&"P C half"tensile _ 508 —, FIINIAL :MECHANICAL. .
o",nr Dare L51 !i — 1=•.TI\IAI '1=rllltl_IC l'J�JRKS
u WORKER'S COMPENSATION DECLARATION , °
1 hereby afinn Linder penalty'of perryry ono of the olhe,In6 dc<Idemmr,.
❑ Plane it will n room...a Certificate of Consent I°self-Ia,;ae.Nr N'mker',
Compcnsaaon, rte pr..ned for by Seeuan ITX1 of the Ldtiar(Cede, tar da, 1y ,
rode ne'rao Lit Ihe'xmk far uhiah,hie Ixnnn n owed.
t.
°I hoe and ndl marmarn Walk,,'>Cnmpens;nrun Inaa.mce,as Ie,artl d by Secaan
"3700 of the Lahar Cnde,far the pclpvmansc of the'od,for%fish this peumt Is,
,nwe,l NIy Worker's Cor"att nne la'aaaee carrier and iseley,nnmber are
s c�'z`S —
.. Cnrncr 1'ehcy No f +�
FRTIFICATION OII GNEMPHON FROM ORKERS' - `%
COMPENSATION INSURANCI? '
The, ,,I a need not be completed II the pears n It,,one handled dollars
L eertdy that Ia he Mdetmance at the It ow
r whLell ,I,penna;e ed,I
shall not crnplay any person m 5'manner wiR�eeyye ytbuel b are Winker, \ ''
Cnmpenmtmn L�g�
Apphcanr ¢ - r t
NOTICE TO APPIIJJ((jjiiNTlf,after making the Cenilica,e Of Exempunn,you dmulJ
[serene,sablce,to ttl(Nbdrl\C°mllereavan rl ase one of the Labor Cora,yon mull }'
z0'Q forthwith c°nlply ,ah wch pto.I,Ien,oI thI,per...I nhwl be deemed revoked
V] CONSIRUCIION LENDING AGENCY:
I hereby Little,fill three is a cona tin,t n lendritg agency for[lie(afo naaae '
` w n�.t of the work for whmh this per w Issued(See 3099,G, C)
7Q Lender',Neale .!
•Z Lenders Addle„
C..) I eerily that l have rend this Tiflettnm and,rote thw the utawemfeniz,ne.is
rnrrcm 1 agree to comply unh.,It any and eoen, ohnaa,e,and,fore Wu',a.•la el, _ . : • . .
Q V to budding cbnentet died hereby au,houzeaeprmrokonool the coy mentef upon
,the ab it i,rapenr for Inryechan parpo,e, •
t••I 6^ ly\'m agree a.Nee;nalemnrfy and keep h,ende,a the City or Capenrna agaanl - r -�1 , . ..
Lr. Vi habarne,.judgments.,nab and esto nses winch may In any only ncerne agna,l all '
.U City in consequence in the granting of this per till[ '
APPLICANT
RFUL TRST SANDWILL COMPLY WI;�; N-PO�INI Istaded by: Z-• /-�ILJ70hc.�'C;.G Date .
!!
S1, Mme Appneam/C°aaaetm note Re-roofs .
HAZ,\RDOUS MATERIALS DISCLOSURE
° red,e.,ppleanlarfamrehuadles,vctp.na+lirembandyha,ardea,material TypeofRoof ' . . .
:u defined by tlie Carrillo.Mantaipol Code,Chdpler 9,12,and the Heallh and Serey - ° $
' Coda.Sectim,25532(3)^ . y •t
❑re, ,, E]No : . All roofs shall be inspected prior to any rooting-material-beitig installed. '
was the appncam aL anme nmmll,g aee,q,al„ma egnlpmenl n.ne.nrz xm,'h If a roof is installed without first obtaining an inspection, I-agree to remove
II_ emu naerolt n,av eomdmrnanne,it,recd ny the Bay Area Air Qaab,Y,Mdnegemcm
1 'Dl+tnw'^ . :; 'all new materials for inspection. Applicant understands and'' ill`comply.with
°\e' 0 N all non-point source re'gul'ations.
1 have red the Irl'adnw e n male legmrcmmI'ta under Cie ter 695 of the k:
Califnrmu Health&Safe[,Code,Semmes 25505,25sD orad 25534 1 undeiaand that
it the bmlAing does nn,mmenlly havca lenan,l haln n,nyre,preatdny to noal'y the f t -
°ecupin,of the mgmrcmenis I%n eh Intel he tire(poor to I„uen.e of a Cenrrcate of
`° '"y ^�� e.
de ,Signature of Applicant Date ;
Ce All roof coverings to be Class13, or better
ow ��/dm rc
6nnd agent . ,H:nc g .. ,
OFFICE '