00100052CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
null.DlNG AooRHss:
I'ERNII'INo
OWNER'S NAME ;l
].9845 BRYWOOD DR
WAGNER ROOFING CON
IrDA' f
�i'�{�I f��F'f� i1VC00iNVTklS
PHONE: `
A t NO CtIN.tI ) NQ.
��N t��L RDI.I /14�./i:Q100
" MOFFETT
].rc4C SARATOGA—SU
I ARCIII'fbCT/IINCINIil:12:
BUILDING IIFItMI'I INFO
H
i 4'12.18 ] 7% '-8331
PLUG ELECT PLUME MECH
z, LICENSED CON TRACTOR'S DECLARATION
Description
I hereby uffinn tha I um Ecmo..I u..d" nrf..trs a Chi 9 (cunmancmg
.106
ly with Skchna 7000) of Division 3 of In, [I massa I Ploe"im,s Coda andmy llernse
—! all lull fo¢r and rftr
— lar .ilGSe
ARCS Ill O4
be sita...it,
I:r I ypl ncI Left
hell
TO SHAKE
®�
Licensed P1.. 'I
OM NI It NUII DI It Df CI or
f d C l I I for
I I by ff ,n C dee
y II g (S ', 5 E ,r d l .' L Any it, r ' ail al,
6_,,�HAI<E
not O 1 'll 1 y_Imcl, ae
,I I' n
ry�il
innn.,s cs a s, ale, cyu'cs III upll wnl ba s, hl "-,iia file ung ed 4hramcnl
p
St' Ft. Floor Area
Valuation
III I, kensedpunuanl lame polluin�,e ofmCConvacrvra License ,(Cma
Ica t n90llUm no of line nc,eand Profession, Qlel
,ia he is Onvorllhcae, meilia hasia fufile eflegol Al
au.
l,
ofecia7031.5 by any inpdlfrmxubject''heaindlena'1'aled puinally
nn
nrrl rtm char, Ie<nddollmrS(ssol)
APN Number
Occupanc�e
$ :i3Ti� 10
EI J, is o, nontf Ism pmpcn%army aniveldt wages as,Iran "s, cl.npcaeaion,
n
will to the k I li I 'l l'intendedoffered l al (See. 7044,
He d l f :.' C I fl C , Y '. 1' Law, J , pl l) to an
Xe d Inspections
rtfn1, Wnon Idspn�v 11, mlwclJ,work hil
d
..-_.
III hs oven chiral rr, drdmL impm nnI all or
.p
offered lar sale. 11, ho a,Iho building n nn veld onkit e yna of
wove
tb�rlan
frpiclinn,menwnrr.baim.-n wdn,wra,e '.�prt, i��E da:., bkdid ��n harder
�,',ptnnr
for parpnsr nrculr.).
305 — FRAME -
e finaa.,laiiVrly r9nlrama, vel ,It beard confusions m
❑1,"( .... I,,'OflhVly,al➢
('�
2,0'+� — INSULATION
na,rarl ala prnlrrl (Sea. Awa. Eakin,. , and Pror.inaa Cnde.) I Corral
6VJ ]. — ROOF TEAR R OFF
I opnsk Law does nor apply lean ownerurproperty who thri nr rope—es lhcrenn.
a.mo
will) nrtnelh For .ach pntjeets still a coni aanrca) license([ ptar oath the
n
cm
121' ' E — ROOF PLYWOOD hl
NATI
.1vnl Leeaee Lanto
-
❑ 1 can e.mnry atrde, Sue, ,EffiPC rn,ml„,aeon
603 — ROOF BATTENS
ow"ar
804 — ROOF IN—PROGRESSWORKER'S
Iola
C(1A11'ENSA'I'ION DECLARATION
I hurchy aHiou trader penally of pr9ury One al We following declaraion:
❑ I Lave and will Taiilon a Curuf we of Conseil In for Worker's
nelFhi
Cmnpensafmn, os .....vital fm try Srcrinn 3900 of the Labor Code, for the
Iwrfmmanca.f dte work fnrwhich fnk panni, k Joetad
❑ I have end will maimain Wnrkrr's Gmymm:niun Insumncu, ac required by Section
3700 of .he Lnhnr Coon. for the prrmrinaral of ole work for widen III puna Is
ooled. My worker/.x`Cjnlnp limn Ilrmmum eanmrwd policy anlnner are.
Carrier':_ VA
4
rIfIC TIO PSicA1Pl l�ON RKOEROs'
ormil1NSAnON INSURANCE
(II,Is'eatam need hill be completed if fermi, is on one hundred dollar,
(Y1001 or Ives.)
I certify that in lie raf,nmence of the work lila' tell tell this parnix Is iorn d, I
shill III mnploy any lion.. In any Ilan.... m as to III efrhi to in, Weaken,
C(...,eo,lio. Laws of Calihnnal D:ar
Appllclanl
NOfICIP I OAPPLICANT. Il;almsalc iag.nlnCml bcaleof Hell you shnuW
bcmmc sables, ln,he Workers Coar lion provisiom of the I.nhal Col you n.ref
fonhwifh comply wuh noel. pmvinions nnir, III shall be deemed revoked.
] CONSTRUCTION LENDING AGENCY
I hereby III that III s a consvuconn lending III for the performance
orde work for which Ihic perm'I is ir�amd (Set. 3097, Civ. C.)
i lenderls Naim
Lender's Address
I ...lily ,ha, I nave mud fill, .application and slate lhll the ahnvn lnfunnalm, is
t 'CCf. I agree,. nm.fly all all pity lard .....n,y cl inanres ani'arta Inws'if'rag
Abbanking
con,reellm.. and hereby m.mnriee repremmw.vrs of oho ally to coal open
the above eunn I'd prnpaty mr inspection pmposec
01 ngive to ... I. indan,niy wW keep h.mde" rhe CII, of Ch"'n o against
] Hairline , judgments, costs and exfenes which fray in any way accrue agannol said
1
APPLIy in CANTUncenfl PANDS A of I LCC
APPLICANT
Issued by; Date
EGUATIONSNDSANDWILLCOMPLYWITHALLNON-POINT
SiemIl,are ATIlleal,tlConnallnr
Re -roofs
HAZARDOUS MAI RRIALS DISCLOSUIi F.
Will fit, apfllCum or lan.ml,audingnanpair .Vlore nr:;Odle haionleae lnwrrlal
Type ofRoof
as defiled fly nick Cupertino Municipal Code, C'hapavr 9.12, and the Ilcalm and Safety
C ... w. SO,d 12553200°
Dye, 0 N
All roofs shall be inspected prior to any roofing material being installed.
Wib IheII C..m nrbid tire haildifile OCL alse I con cgtIII ator(1, ise5,vInch
If a roof is installed without first obtaining an inspection, 1 agree to remove
emit cocallous air coma re look at tic lSnot) by ,he Ray Arca Ait Qnal fly Managrmem
DiMrislp
all new materials for inspection. Applicant understands and will comply with
❑Yate El No
all non -point source regulations.
11 Ili don, thileafl, reellininients under lr ofthe
_
Call H and lW 41 fyC 1 S a' 5505 25533 d25534, I I --p d,Ial
T.h hi b l , dy l l t title )- p 'b'I'I) H sof fY lir
to to
�� Q �00
of me arq, ,. n n which a st he mr, fell' to lonanea of lI Cembnmo of
6
f"Llicall
c`a"Inas,��Signature
of Ap iamt Dat!�Ow
All roof coverings to be Class "B" or better
I',neOnI axt agkn. am
Vrr1i.0