00090082 '
CITY OF CUPERTINO• - )' Is
BUILDING•utvtstoN PERMIT CONTRACTOR'INFORMATION:
BUILDING ADDRESS: Plilihl l'I'NO. '
owNCP'rKAME:.18887. ARATA WRT EL CAM ROOFING . 'a'cldh16�s1�!®r1r�008�
PHONE: -ice 1,650 CJ .7TH ST SANITARY NO. rLl��1(H• E�+YrV`.0 r
APITZ,,,, PETER. „
�Z
o o ARCHrfECTENGINELR. • ' BUILDING PERMIT INFO2 .
BhDC [CECT PLUMB MECH
L
LICENSED CONTRACTORS DECLARATION , � ' t'• +� n,y , hscri�
z Nz _ Job:Deption _
1h by II 1'tI d d p [CI Pt 91 more B 1
Gr with Sealoon 7000)of o ",n l of xa and I rfe,a :Cdr,hralr,hr,ra, r- x -
YIa ill d `?al a 1 7 Z
a a- Users,C ..
o o•°
Data % l��o "an
F
at iL ARCHrIFcrsDECIA oN ,, 5 REMOVE 1 _TAR, AND GRAV. :INSTRLL NEW. TAF
w?p O Lic J Pont. at `b
OWNIRBUILIJPR DECLARATION rf, ,
ui=' I h by ff that 1 m ,s tl C t t L :e l Ir the
C 6 fill 8 (Section 7091 5 Bunn:a d Pei Crad,ApY tY ount, a7.
F,F� b laq p tt .t t II mp Jmllh rep ytucmr
Be p1n , I q '' tl G'PI' t1 hP 'tt fl t 'gpd tt m ' • } - ,� -
thatn licensed p tt t p e nn C factors 1 Law(Carrico9 Sq. Ft.FloorArea - Valuation
(a,mmene tgw'th Sector 7000)of D'vis m 30 the Bu,ne umPoRss onscror), - -
orthmhe
aotisleCx 5npphlyReaction
and hark
nnfor
t:uthe nlard
aexciaptifer,
0Ac'yvviolation
m'eltbmaothan are honded dollars(ssoo).
n
APN Number . " � -. � Occupaneyj�_
°I as owns, tthe pnolpany, Yend,le,ce,withbate, Ih nP n. t' ,.' .
IT J Ih k d th structure tintended offered for',-le(See.Baca - -
BusinessI Pror:k Code Th,Confusion L L 1 ply t 3751203-&QU 'ed Inspections
owner of property.Who In Ide tr rapon,es Ihere m soil all,,Joe,sash work han,'If
on bhls.,a roployes,pnovaltoltht sach inapi,eirents, t" t del or
offered or,ale II"'h the building or nipt'is ould th' one year rl' - - n .. '
„mplet n.me,wnerb n nhaveN n"d rpnv�gmtneai atboddis, 5• = FRAME
i nProvc Cor puEposo of. I ) I ,
307 — "INSULATION .
°I p of property,tv . 1 : "r contracting 'NI d t t .m 601 — ROOF 'TEAR •OFF
r,t td project(S 7toa ow o JP f' Cd )TI Contractor's -�, .'t _
uc E dr IpIYt o fp n and bud blp int 602 — ROOF PLYWOOD NAIL'
and h ,Lams.for ch.p j Ys w Ih a nlrael Ir(sl LumW puism n t the - -
o'iI netw la an fi B&rer m'I ,Iaaai 603 :. ROOF. BATTENS. -
Owner Date ' 504 -- ROOF IN—PROGRESS
WORKER'S COMPENSATION DECLARATION, � ,ta • n '
I therebyo Dinflly ofperjuryone ofthfollow g deriaortions, `
•° I have and will'annountain a,CendficatefConsent I elf usureofor Worker's r f" ;
Cou,sai as p I l for by Soriano 57001 of be Labor C d for 1h,
Pronvan conhek1.,whichtl pallaill is issued, .. 6
/v
°I h J will onfirecia Worker's C m,wl,all(t In urea e r qt it d by'se'tima l/
3700 of the Labor Code,for the pe f f the work for h h ih s Per w is - • ,
issued:M'y,W rlw6,Courpon,nallon In unn eCarrier and Pol ey nu pher
G� ' rV' II N�oylx. Pnf Y In.:WG3otTIS -
`CERTIFICATION OF EXEMPTION FROM WORKERS'It COMPENSATION INSURANCE, -
(This wonalartal ant be complas d If the fit,for an bundmd dollars
($1(107or 1 sa) - .. . , ..
.. .,e !r
I certify that in(he.perharoduce ofNcrkfwhich th.pr Itl ted,1 f '• ,
shill not a npins"any P a i n) t hewn .n hi m to no Workers . .. •'yr'
Cnmpena hal Laws of California Date -
Applial I ..
NOTICE TO APPLICAN I If, ft makin,thisCertificate f L ,ti.,y l auld a
m .
bec eubje t to the Worker,C.no,ossaina,maimins,of the Loh C de y Hast -'
Q forth 'nheanp"y with such Poor sons ortl'.pernt shot lforce tedrevoked - ' -
z sy ,
CONSTRUCTION LENDING AGENCY I I r . g,
I h ralv,r,dry f he pertom anion
Cil Fn -of the work for which this p rall is issted(Sea 3097 Cv C)
S Q Led Name _
V O Led 'Address
1 ffYthktlhd IM1': ppl' t -Ltt Nath t f tis
W [�.
correct.I elt IY. 'll 11 citytund berly radial ad snue law,lefulfir, ... _
U In hu ld"ngc nstmm m and herehy uthr erepre.emal'e, ft6s citym ente aptn
r� the shotve mnfoneJ f tx ty .Int P T:..
•Ey y (We)agree In"Is. deandy and keep h rnlus the C'ty of Cupeninn againel ,
H-I Vi
liabilities,1 Jb t. t expenses which any any -"Y against V
U z City consequence of the y i n h p Hie - _ -
�"� APPLICANT UNDER D D"Islr i MPLY.R'ITH ALL NON-POINT " v
SOUR L Issued by: -Date
Ignamrc nr pp icr so soon - !7—" I .:Dine
Re-roofs .-
AZARDOUS MATERIALS DISCLOSURE _ r
wumed "cat future building corrosion. r houndleo- uten,tl Type 6f Roof
mMunicipal
as dc" cd b}the Cupen'no Code Chapter 9 12,and the Health and Safety
,..
Codc,Swift m 25532(0)'1
f T
Ye, icdo
All roofs shall.be inspected prior„to any roofing material being installed.
Will the "I t f t b ,d g pat seagl pm nl devices wuch If a roof Is-installed without.first obtaining an inspection, I agree to remove ,.
'm 1 rzI u. a u m m num m Jel Heil h}the Ruy Area Av Quul ry Mnnagameni _
istriefr — all.new materials for inspection. Applicant understands and will comply with-'
°Y' N all non point source regul tions' r
I k 1 th I d t I eqI emene' n 1 Ch PI A95 f the
Calf .,.,III ffiSafe,,Cnd Sect n 2550525635 d2559g IunderstandNm If
b ld” gd nt mentlYk to t t tl' Y 1 bltyt ify the.
ccupa0t of the re u more.,,w hours I p to Is I Certificate of
Occupare r
I Signature of• tcan[. •, _ ; ' .I Date -
ar.
Y. All°roofcoverin s
to be Class B" or better
Ow er aamne,ed- Data e g