00100146 .CITY OF CUPERTINO -
BUILDING DIVISION pEgM"jT CONTRACTOR INFORMAT}{IfON S
B JII DING AODRBSS: + - y>N C PERMIT NO.
6 ,
OWNER'fi9S,(Nf�IZI ' - . - APPLICATION SUB DATE
` SMITH- rig , 10/20/2000
PHONE:-RICHARD, _ - - _ SANITARY NO. CON'IBOI.NQ
` C?
QWua •ARCHITECT/F:NGINF:Gk: - - BUILDING PERMIT INFO _
- ter h BLD ELECT _PLUMB MECH
y 6 - ' J • L .I LJ
`z to
h by
LICENSED CONTRACTORS DECI ARATION ; : Job Desert tion -
p sad d p " f Chapter9 b, b . - v p
CLF.Wwith Section700) fD' 3 fth11 Iprofession,C deandmfRense
-' sin fullf -e nJ + c - �,�('
« -7� / 0 3 5HRKE. TO TILF_. �'rG�'w� ! 1'
d
3 a Dal (cO c nrannr &JS _ +
ARCHI'1 ECI"S ULCLAR ON
l5a5a:t�'qtq D N Iunderstand Y plansshall be usnl Is Nli coPit/ 1/ ] •'/
195p0 LeJProfesstml rt \ �•l�(%DX
°� , OWNER BilILD6 .CLARAIION., \ I/
W M to to 1 thereby ff thin1 d C eco( L I' formal .•
Lj felt 1 , t5 I 7031.5p B . or
i P f :C d A Y Y county
acquiresaPermit tI 'I II r demolish, wpai,anyt ire
a3. ,,f I t .0 c a[sr,narrow,the d"heard farhp II 11 in Lstatement
that he is licensed Pportion I tho,owition,of tire C ara,mats,L - L (Chapter 9 Sq. Pt. }�' OOr Area • Valuation
(cu 6 11 Section 7000) ITU 3 f IM1 B : 1 P f: Code) • v
or that hpt Ifidef .,ad let basis for Jac alleged etareption,Any violation 12100
of
'
af5 i 70315by yapplicantf p t LJeo,the applicant hi civil pen'dty - -
tfn t mea roe area delta,,S500) - APN Number'' "' - " Occupancy/Type '
❑1.;is owner fthe property,ormy emph ccs with wages n their sole compenvtion;
Busn m w k i n ( I r (intendedoffered r 'r1 (s 7o a ' ', •' .Required^Inspections
Business and professions C le Th C I t L'e n Law been t apply to an - _ e. •• - "- ,
rather+f properly Whoh 'IJ .p Ihetr. n and who J h k himself 1, • - -
orown 01 that such improvements not intended or
offered inr.saleif,however the building or improvement iIsold xlhin s yen,of v 305 — FRAME_ ` . _ _ •,
impletion,dee o el'dulder will have Ne burden arpro,ing that he did one
build or - 7 'ION -
veIle purpose " 7 —. INSULATION
-p pn. ) ..r Qt
oldsowner ofthe property,amt.emsi,elyennfmctingwith licensed contracmtsto 6431` — 'R00E --TEAR` OFF ,
_ Liconstruct the project(Sec.7044,Bu,nes,and I'mae....as CtJep The Connector's -. - -
cense_Lawdxvan,applytoanownerofPropertyIIIhoursorimprovestheir., 602' -+ konF PLYWOOD, NAIL '
And whoc t'f : mmm
h p jeCle"with u mo(s)I ursuant v:the
licensed p - -
Comn
ractrnLceeLaw. - 603, ROOF BATTEN
°l an exempt order See. - .B&P C In,nn:reason 604,1.: ROOF .TN—'FIROORESS'
Owner 'Dm, - -
WORKER'S COMPENSATION DECLARATION - - -
.
IM1arnby aflinn ander pmevhy of pegnry one or the following dedvrvfares: _ ..
oI have d ,R nalnu ,a cen fe. f e l or Ir bit Win Ion',
Compensation, as prodded for by secret 3700 of me Lalar Codd, for run
pert ofthe kl h'hd' promil d le-
I he, 1 ll labile Work,,',C I f Inarruwj..1 reBUInal by Section -. - ' • - �
I'he Label C 1' IM1 performance f IM1 k i which thisp I's '
'csucd My�prker pet. Y finaru ie aid Policy anothert : O
Cmr er �•2'..�d Co.roheyN �,`J''✓32002.3 97
,• o
C don ICI- ATION OF EXEMFPION FROff WORKERS'
COMPENSATION INSURANCP.
(Ths. tion need nrtdccaapland'1'the ponnt is for unelindred dollars
(5100)or le") ' h -• . -
I certifythat' the P,f (it the kfor whichth permit if issued,I
shall not employ' y pfo,on in any fortiori so as In become subject to the Work ,' i
Conry. . ionLaws:fC If rte, Date er -Applicant T.
-
i: NOTICE TO APPLICAN P If efortooking this Certificate ofE.moptton you should
Z become abject to the Wcorkri s C p,mat p -'ftha L.hor Core,yen ound r
Q forthwith comply with,such provisions or Ih. term(shall be deemed revoked.
r I
z..
CONSTRUCTION LENDING AGENCY
A 1�
a ~ Ihereby which
Ih tpe issued
lend n8agency for the performance
of Lea kr limn I ' asnw(sea.3nm c..e)
Linder, Name
Lenl 'Address � - r - - , . . ,. ` r•
V.�
Iso V l athat 'dlhI. py ' J state 1 o 'lI
torr .I those I ,,imply h Ihi and ordinances l state laws relating
'"
to buildingdn foehmpo,sa wnvewof hvelY to e......an
the above aroundyt ,insp .. • .
M. (W)a".t fy dk pth 'th CtY fC perlin.against \ -
V1 liabilt Jul net t d 1 ses 1 h at,o ,any, ) cru .,alms(:'d
+ once of thegrit of Q
V City c O
APPLI ONDERSTAN ITB All NON-POINT + I
'SOU �cuLAT1oN Issued by Date 0-
JO-zv'-oil
SI Appr anJ� Leen, Date Re-roofs' ,
/ 14ALARDOIJS MATERIALS DISCLOSURE. - -
/-
Will
rl building pts rhandle hrnadn-sm.eedm Type ofRoof ~` '
as da0ned by the Cupchi n Mun copal Code,Chapter 9,12,and the Health and Safety
Cal S ( 25532f) . - • - -• ' ,
°v ,f All roofs shall be inspected prior to any roofing material being installed.
wnme ppr' ( n b c p t qa'1 t d 'ohich If a roof^is installed without first obtaining an inspection, I.agree to remove -
Dilat tlous.ream au'deh uJ by'dle Huy Atea A'r Qt vl ty Man.,emem
Dt.nt`to Ye. all, new-m• rials for inspecti . 'A llcant'understands and will comply with ,.
all no
of source r gt tall
I hoe rood the I' trial: 1 ns nnJ r Chapter 695 of the ' - I - p.
CvlilocaH• h&Safety Cnde Section 25505 _SSA3 and 25534.funJernmddthal R
iftI but ng locx mol rntaenl�1,1hvd,,tvrmr.stcor,1 emspons 1lty.mshairythe
tandhat a J��.�����"
crop
t oft •reyu nmectela e n„Ismr t emmfieuv of - • ,
oa me
�o_ZaroB S' ature of Applicant • . 'Date -
or.mn�rl..edugeln - - Date -ATI roof coverings to be Class"B+'or better ' - -
OFFICE r n.