00090140-CITY'OF CUPERTINO `; , ' •..
r
""" • ., . < ...
,r, ,
"
`BUILDING," VISION-', PERMIT
CONTRACTOR INFORMATION:
1•
BUILDING/DDRESS " •'
w.,
�.,
-. r.
PF.Rh11Ith0'
`i
- •
,
RIG
'r 0901'40 " ,' '
OWNER'S NAME-
4•^.
APPLICATION SOB DATE' r
n
PHONE c: Fl R 11-, I }_ _�
N r -
SANITARY NO. + CONTROL NO ,.
4 ARCIIITECILISGINEEN.
BUILDING PF.RMII'INFO
r
-
'BLDG. ELECT 'c, t PLUMB MECH
I� t✓L., I� ISI`
Z LICI NSLD CONTRACTOR -5 DECLARATION
Iheron affirm l d d
ce Ya -p ICn,par9 (acts nevese
- ,.
JobDescri tion.
P
y wdnoreandor D' mJaqFlhe B, n dP f. tiC de,o dnYl license
;' ^
in full
hoe full and Bet 3 1 L H �. �) 9 4/
[)are C n —1 Jf O
IT,
.r
SHRKES TO<SHRFCES-' ..
ARCHITECT S DPCI ARXTION f✓; eAU FIN
);-
Ja,ae�manam ai panEc recons
YLicensed Professional
OWNER-BUILDFR DLCLARA9']ON
1 nemhy affirm ibal l am attempt thin, ha G,mmaRe's Licenm Law for the
I
y following reason. (Section 7031.5, Bensons and Pont ... fana Code: Any eny or CountyIf
which feel apermit ( st tahe,,nTovu deillipho, harbor any., mum
j Prior 10 Itsiss,ance also rect'ms th"pplwa for such Patin o file asymd sawnent
t
- that he . licensed pt, [lie provisions of,he Comir l' Law Chapter 9
• Sec, "
Sq. Ft. i'IOOI"Area '
"_
Valuation
(commencing with 7000) of Davis 3 f d B e d P f : C le)
orthat ie is ewhrprpt therefrom multhe hasis for the allgedexemption Ally violated,11
.'
1
of Section 7031.5 by a, y Trldl t f permit "Itacts theappl nu civil penalty
_
APN Numbers OccupacY' P.e , ,
nr„toalfledltlIf,$)
r
Ed 1, ratiop P ty v ply allwagesa m I l .ton
-
Ofd thek and th t t fintended offered far ate(See 70,141-
Business -and Proes,iom'Code The C t t . License Line cities( apply Io in
.- �� -equired Inspections .
w r of property Who b Id p th ry t d h k I' e"If
_
- n •'
or through his law it cnpl yees, providedttrta h improvements are hot resultedor
IT
afraid par all. If, IF w thbauldna, at improvement is afld within am year of
305 =: FRAME
`o npl t tl builder ll ]in;, burden of proving mat ho did es bu ld e,
np' m,Parle"cid .lc,), .. (
307 — TNSI.11_ATION
-
El 1, as roofer 6fin PPY Y g,W I'e:d tact:i
..
601 — ROOF TEAR OFF' '
e nhP al (Sea 7144 B .1n prof . C d) Th Contraction',
License wie , p, n owner oflacipely builds r improms theater,
-
'602 — ROOF FI_YWNRI__ a
and h contracts for such pojects with a aparaco) cd ut,ant the
canLicense La
•603 • ,+ .
— ROOF 'BATTENS • .,
❑ I am xem,, ,It Sea. 11&PCi This reaso"
60A '— ROOF IN—PRObRESS -
Owner Date +
(' .,
WORKER'S COMPENSATION DECLARATION
I our hY, I(Y i P I Y o f ll i f
_/ ,.
imakerp enM1
ElIh t ItI t Cardiff frot
sir f W k
Coop , t p dal f (( 9 3
ni t
Fd [..bar Code f the
VR/y,.'/
f
parlor c Rl - k for this 70(1
p m t d.
'
J3Thchadvold1,a 1 W k C P t ,Iimanapar, ,, reNmeedhyS t o
F, 37M(it 1h Labor Code, for the paloortance th,thework for which this Two Is
L
�• �� �L.O
[[[ ��4 -
ssuelMyW For Cn
at\ Fault re(ulad Pti rather, are:
�•.,
f. .
(p�e)'f
Carrier5%�r(�i r VN1) PlicyN %-a ST0�%r(31'I.d
CLRTIPICAPIO—&EMPt ION FROM WORKERS
O'. .,.
• '
COMPENSATION INSURANCE
. -
This seddim, need hot be completed of the Ter n t to fors v handrail dollars
'
is 100) imless.)
)a
1 clarifye tin he Iscrourprome fthe whilkfrwh h this permit'.' ad,i
`shall hat employ any 111hat 11 anyrte hl a t ,h W kaon'
-
sa(on o
aCClfk 'I ��Z�
Approach HIT
NOTICETOA ANC if aha parking (his Cenfete of Exemption, you shouldforthwith
p the Lobar Code, you must
- -
or,lnn
comply with
fotlhwi,h comply with cath pro ;inions or this Persil( snail he Assured revoke.).
such provisionsfin shall
CONSTRUCTION LENDING AGENCY
I herany afl r n 11 t them a construction lending ages y for the perforinterse
'
- of the work lar Tothislsootl is issued (Sec. 3097 Cv. C) t
Lender's Nome
-
' Lender's Address
+ e 1 certifythat Ina l this 'PPI 1 d same ,171 he office of region is
a .• ,
correct.I agree to comply with all city, and cry armarchance and.m(e Tbw4 rogaing
�.
mht IT g construction, andheavily alalmom letaWwomfi ....f this eiy m cote, aper'-'
i.� • T
,he all2 t ,ed property f inspection n purposes. '
- - -
(We) agree t. ,, a, hadearmilyandAph d.' the City of Capeck no against
'
liabilities lrallanal cast, and espouses which may in any way I, ue ignored vaid
.City in clameNtopeop, of the ilearting of l his Tern(
APPLICANT.UNDERSTANDS AND WILL COMPLY WITH ALL NONfPOINT♦�
-
��
SOURCE REGULATIONS'
ISsued by: Date
Signature nF,Applic .- Data .
'Re -roofs �
AZA
HAZARDOUS
RDOUSMATERIALSDISCLOSURE'
_Roof.
W ll,h .......r furore a lmmm handle lar1 : hera
Type Of
defiuedthe Municipal Came Chaptmr912. md,ha Earth and Safa,yC,de,
'
-
Section 25532ad?-
°Ye - °N
'meapplramorrnmren�ldnd
"All roofs shall be inspected.,prtor to any rooting material being installed.
- will
ur,ha,araona.moon(aminanlanetdaunadnrmnenyAraannQanh,rMmmgei»bot
ctheBayaab artAi tolyMthrLewnew
If a roof. is installed withouthrst'obtainin an ins ection I•
g P agree to remove
oia,^ma.
❑Yet ❑ o'
n. .., .
all new materials for ins ection. A beast understands and will comply with
P PP
all no -point source regulations. f
.` 1 mor, r W The halladmiaanaluddis requirements under Cheaper 695 of (h
Calipartia
_- -
Health & Safety Code, Sections 25505 25533 fuld25534 1 understand that
Tyd c try lh a
who re- nl , y .p ,
•- /) ��AA
the
fretful,f I e eq n t I'ch must he (prior ,oissuance of a Cen'fwm
of
oaaap' y. -° 4
^'= ��M _B '
n
Signature.ofAppbcant f Date
��of
b i'!
.. - " n
•AEI roof coverings to be'Class "B"'or better`
Own mmr_'ud ng t t ate
1
ul
o