00090115 cl Ut.mDIVISION cuPE
BUILDING vrSION sto" PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PTOMIT NO.
OWNER'S NAME: API'LICA'I'ION SUIT DA'I'H
22211 }SITTER OAK ST 000901. 15
'HONE, SANITARY NO. CON'I'Rol,NO,
CHAN ANDREW K ET AL 09/1.8/2000
� Z AIiCIIITECTIENCINGER: BUILDING PERMIT'INFO
u O FOF BLDG ELECTPLUMP MHCII
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Nzm L_I L-1 C_.I I 1
LICI NSEDCONTRACIOR S DICT ARKHON
11 hr fr "I I I l eeasee p - l C I I )(a"ne.r s Job Description
OZC� wIIS r 7000)If i oid,,Broinel,I Iserict,sior,COI license
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II IA i
�lei Liu Cla _V L C H
O a D Ilam G� . _O. Cnmmdnr
7TH SRC141 I'EC'1"S IIECLAfAAWA
14adenaand ray liars shall led as"thrc,cood, 22211, 22221, 22231 LITTER OAK ST
dyoo ueaasa.Prae"i'a,al REROOF/ CENWOOD TEAR OFF REPLACE WITF
XX OWNER-BUILDER DECLARATION
al= I "'Ohy aff,ar Ii,,I a clan..fmrn the Coni mc4.r's I"'eo"I.rw It,,the
�Z Q hollowing reason.(Soon,9031.5.Bnsinew,nn l 11 1 ..(a,Cade:Any city ar,,ardy
`Y O 'hien nynlrui a Puonlr In wwrnr,n,ane,Improve,deirakh,or repair any arnnnrc
c4 c, PRII OilI. y IN ppli t ba heat
a a_
(11.11 he lLcerh011 parsr.oa I nhe PrOVIsilahs Ordle< t- t Li I (u'p"1) Sq. Ft. Floor Area Valuation
(c1, l, TI S-floor 7000),11 Ullil1 of11 ciliates haril "' Codc)
o ([It[lptd ]hit hu f the IIb lc pno, A ) tol:r,1
al SCOI01L 7031,5 hyttlyIpl -a[x ,'t.tlyel:I11v-4plc.0 to 11 a"I pemlly
or , 1Ill.h JddJ ,.fs51m APN Number Occupancy Type
❑1.as ownend IIIc pagmay,lar my carploycex wish wages a,mcir sole eampcnwrmn,
wdl Jo the work,and dm elorcnae in not he led or offered far sale(Sec.7044,
woorsO rmd „m
11 fen,Cade the Caalraeor"uaca.e Law cine,, I,,t apply to I Required Inspections $14000
ellica 1,l Se"c"y Who hall,Unnrp..er,ncc,con,and who does lath was ort,,11
.I through]as 1,'n ernpluyce,,Pm.III Ih4t such iurpravemcnH tu'c not Intended or
libeled l(ar,ele.1f,ho—a. the holding or nanmwcmam 1,sold"'Ilan 011e year al 32651 01.9. 00
tompledor,the awacr-handw er will face the harden 1,f proving that he did ant hrld or
orpent,Us pamo,e of,ale.),
❑I - f tl P tY I . el, I f g LII J hacho, 5 —
t I d P_ I I Is 7044 B d r C )'1'0,C director
30,a FRAME
LtI e I lllrt II p 1 1 .11 1 Ir1e" 307 — INSULATION
lad Neo co (,file
mI lane prlrel,wm a r, afr (a)l,[:ned Ptrdate,to lie
cammetor,License Lot,. 601 — ROOF TEAR OFF
❑i c ri exemplurdn Sec. ,B&P C harm:,renma
O„rer Dnte F-02 — ROOF PI_YI,IOOD NAIL
WOaK)RI COMU NCAnON DILLAIRkd ION 603 — ROOF PATTENS
I hycnan trader penalty ofpni v Lare riIemE yl .l. .raa„ 604 — ROOF IN—PROGRF_SS
❑ I jiave call %sill roortria a Catificate oi Consent ill sell aisle f -W k ',
"l I r l I I - by S t 39Uu f 0 Labor C f the ��
pert !❑ l,l h a m l I I. .
1711 1 I t Wrist, C I I required t' I, 0
E9(lfl 1 0 h G f the P 'f Irl Work l h tl'. P.. I'u V6
and.My We I ku,ConpcIs40,1 I I s1rsre arrc dI,Iay aIII hva I I:
Carrier: Policy No,: /
CERTIIICATRJN OF E%EMP'I ION FROM WORKERS'
COMPENSATION INSURANCE
if his smlan m,cd nn,he cnmpl... If the pcnnit is fm ono flailed dellars
is 100)or lits)
I certify that In me performs lace of the Week for'hleh Iit,permit i,:sand,I
C.......
t ICIf r Ut
NO1 t
NOI I.c I I 1 ANT II mk g :C t o PI yo.,1,1,11.
M u ll k C .'I I he
I I Y
O � r'�,nwthel,IllyWm,Im,p11,c,1,11.rrrn„parrtt,nunedec»ruraaakla 1,t.
7 h CONSTRUCTION LENDING AGENCY
I nerchy amnr that mere is a C1,a,lrncres loaning ageiey far me peri nnanc
W oh the Nark for which his permit I,:sold(Sce.3097,Civ.C
OLerdcr's Nanta
a z LenJer's AJJrv.a
nydatll dda, piPli-floo and ashe that fter, inlialoatirseis
[y ' I'6 t Ply rtl II city 1 �se Islate mfdmg
Q [) orrh'Id'Ig cal,t-et i1,1,, I octet,aaNa^iter...... m:Inst,,lar this city memct Orissa
y WW4 the ahave-meathared progeny for iIs[)CC oo liar POWs,
0. fwc)agree it)save.halcoarry trod keep hnrmlcs,the Guy al CaPelino zgala,t
Vl 11411 judgmenra,rusts and expenses which 1114y in any wry"ware against still
eira,
APPLICANT UNDERSTANDS AND WILL CO
e grnulag of this pear /J V 1
SOURCE REGULATIONS, COMPLY WITH ALL NONPOINT Issued by: Date v
Slgratme of A,sclrmrcanrzucmr Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or fmnre head'rts,recl)am,Iare or h4adlc h1,,"alias 111aleda Type ofRoof
%dcf,red by the Cupertino Manicyal Cade,Chapler 9.12,aaa the Hctddr sad Safely
Cone,Su4ioo?55d2(a)f
El yes 0N All roofs shall be inspected prior to any roofing material being installed.
Will the u JACant Or Brmre h4Pi'rnt,acapam Ise caulpnmrn,,deals,,lath
r If a roof is installed without first obtaining an inspection, I agree to remove
In na4am1,a,Orr C1,m4n11a4at,aned lar the Bar Area Bir p4may M:rntrgernerrt
,Iriel, ,darall rials for ins ection. Applicant understands and will comply with
El yes ❑N
i all on-poi source ,[ions.
IoH tl `I 1 t. CI r)s citta (�/-.p'
Ithe II 'hh k51h)Cd S i ll, I 5533a I SSil l .r IIII ��� ��
'fm h I gd I IY 1 III 11 y-.p 'pI fey the
TIP p,r�'/ M1Nhah lndh clot toistr art Cerrl Gteof
GITI p.,y. 'CiSignature of Applicant Date
1 w „I rart,a."d,Ela Date All roof coverings to be Class `B" or better
OFFICE