00070043 CITY OF CUPERTINO
BUILDING DIVISION "PERMIT PERMIT> CONTRACTOR"INFORMATION:-
BUILDING ADDRESS : PERMIT NO
10365 AI—PINE 'DR i:. �., t^ 00070043
OWNERS NAME: - - -' - APPLICA'tiON SUB DATE
VAI_LE JOSEPH AND CECEL'IR 07/10/2000
PHONE, alta- -' Y SANITARY NO, - CONTROL NO
" .1a0� 'ARCIIIIECT/ENGINEER _ n - 'e <- : BUILDINGPF•RMIT,INI'O
` • ' -' BLDG ELECT - PI.UMif MECH
�' LICCNSLU CONTRACTOR S UCCLARATION •A. ` It
>5„a I hereby e o tl a I ' :d I P t Chapter n g' ,Job Description
5Z4ig with Se'I ]One) rU s nAorlhe l3u' _ dPoffess Ce -aHyl ,. _ a _
�a a is i fit]forcemeat affect. « REROOF/ASPHAULT
0 V Dal e -v. G once"
3 a ab ARCHITECT S.DECLARATION a • 9tl
ItndenoienAtyca „ hall 1x.us das fabric meonl: _
s ¢4
i DO Licensed Pf. 'I _
OWNER-BUILDER DECLARATION A
1 hereby ffp that 1 to I,1PI from
the
Container's
cl L f ,h e f ,` a - I I Is ,
�6 foil 6 (S I 7031,5 Business d l r os :Code:A Y ty carbonate M1
FC
which q ' 1 I I u asural l alf armhole, 1 hrain,' 3 t ,
Adm pr t , 1 :0 PP1 If h(n. 'II fl g d Il t - - • -
that to I ' :_dp ,I IThe or—mr-ef (bami License Law(Ci' d Y ' S Ft:.Floor-Area Valuation -
(cmmwcngwith Section 7000)ofDu - l of the B : dl .
I : s' Chile). - q'
orthat h wm f the se 1 m ned tw A-) on' e .1$1450171,
ofSection 70115by no,differ.,f 'rp n,sublce,the applacent to,ciclp alty, -
of t n trcmat fee hundred dollars($50th, -.. :APNNumber _ . OcdupanoY Type .
❑111
3261511.0. 00 I skh P P ry Y PI y enh ,
d II ask,and II , r t t d i ff (S ]
toBusinessgrape r: cA Tn Content c Law
d I pp1Yto:r.
n a "I . Regiiired'•inspeetigns
fir p w Who bonds 'mpn a (hereon, 1 h d n workl Hadi "a
.FIIIir Sirhispl ) p adttom,hap. . l intended r ” 305 —• FRAME t
Fired I auto If,n m b la' t pn of , 1a ,thiny or 307 - .INSULATION a r-
n plr ,.me owttarn 'mr uutavem n lenlrprot nen ,h de Horn ua or ,.
• vainescirpurpose -1.).- < - 601 — ,ROOF TEAR OFF t
°ias now net ofm p e ty helvconverting `,Co nr to 602 — ROOF PLYWOOD AIAI,I_`,
u l,h p J ,(S ]014 0 .' d P ..' C d'J,the contractor's
Lic nsa Lano d t apply(can owner-of 1ompon, 1 hadid,...ar,rod,matter. 7 —
atm who ecmnm.flr.rtn pointers w
ter. tn omremtrtA)lecti prporm In the, . . -,603 .'ROOF BATTENS
Coordinators license l.rw' 604 - "ROOF'.' IN—PROGRESS
El I din uxe tpl under See. Rn&N C rot this raison
Owner
" .WOR 811, c0 PEN ,TION DECLARATION - ' t '
Ihereby lf n do,p IIY fpeJ Y fm following J P 'I
m'
° 1 have d will In I t k
Compensation. a 'headed fby is
pr 7 h
I ' y
A p
piaborent,i,offhe wt k f M1' ITh':pernnit is I....ad.
111 have d will behation Worker's Cour,orfalion lostioreag,a,rallaired h 5 I n ` T� •
3900 f theLabor'Cad for the pe f f thek t which this p r n'
issued.My Work,,',Cat,somaitorlia,mano,c candor.,ad Policynumber arc.. - 1 't - W
Ca a u
Policy N . f - r V .
L.CERTIFICATION OF EXEMPTION PROM WORKERS' i
- COMPENSATIONINSURANCF. it
.,
(This Italmener not be completed if the parnt'sfor one hundred dollars
($100)orloss) '�.• �' -1 f.
1 certify,far in the undonintrog off work for eilank,this lormit is issued,1
shall a.,on,loy a.,p yma as to examine object to the Workers
Cc p :rf L nfC l'f .Uurenne
A, I am ,
NOTICE TO APPLICANT If fl k' gm.Certificate.1 Examd I,you should _
hoacnic sublecno theta k Compe ation poeidomoftheLabor:Code,you ust t
_z � Aorthwtlh anttPly w ITh: h P- dons drab:p t I shall he 1 doevdkea
F^ r�.n CONSTRUCTION LENDING AGENCY - _
ITh by [hon lhm lh re c t ale rte y f ,1 performance
, °p
IT4 of,h k f h cb thisp eard s vwe (Soc 31H] Cie.C 1
a (� Lend Name .. .. - t
Landon',Address j
,U p ' . +
I cen'f)that l l r 4o 1 ,11"lication and;nno In,,tire abovef r
`�w Fcorrect.Iagree msotlly withIII nd,and myordito,a d state laws cltm8 'S -
'� U .,o budding construction,and hereby authorize represanatives of this city menta,upon , -
WQ ,heabove-mentioned P P ly f :P ci purpose, '" t '
0. (wlabe I J rY antikeep l l .II Cil fCp Inc og t ;;
V Z City nxegU
•6" APPLICANT UNDD ERR STANDS ANOD WILL COMPLY WITH ALL NON POINT - `: �\ 1
SOURCE REGULATIONS' � � TSSDed by �� ° � 'Ditto i►1VCI J -
Sie dire df ApplicznUConeractor a - Data Re-roofs .' -
IIAZARDOUS MATERIALS DISCLOSURE d - '
e
will the apN cans or metre building occupant store or handle hazardous,m:, al' Type ofrRoof: .A.i
aa9effed by be Cutieda,Maec,ilcode,Chumer v,11 red me Beam a_td sett, -
Code Section25532FIC• .''' ' '. - -,e
El Yes °N All roofs shall be inspected prior to any roofing material being installed."
w 11 fl 1 pl I f l t, dim,ut,abpard.,a riii;mrule I' If a roof IS installed,5dithout first obtainingan iris ectlon,-1,agree t0 remove
tntith ab mm , If dhr th ByA aA Q IIYM '6e n p fig _r .
D.ar t + all'new materials for inspection. Applicant understands and ill comply with
11 °" all non ntsource regulatto s. i
IT h xd"tba h d materials eta t td Chapter fi 95 f a
Calif Health& ,y Cad Sections 25505 25513 d 5534 1 )1 1 u that - �M1
if the b Id pd e I I t tttN///JJJBBB...RRpRI yre 'h 1, t Id I - t
urP tol t• 'e t M1 htn4 CetYlca r, ,
oCe p n`r L4 Si tore o pplicant ` Da
Ow vNoagent - D„o {' ;All roof coveeings totbe Class `B”or titer '