00040107 CITY OF CUPERTINO "
�''+/'� p I����,+/'� /�*T PERMIT NO.
r.' BUILDING DIVISION. PERMIT CON.Cb-ACTORI1N11�.1I'Z1 AT+.TY1w - ,YI oA'( �, 07..��0 ,•.
BUILDING ADDRESS: - - sen o tX SANITARYNO. APPLICATION SUBMITTAL DATE
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NERNAME: CP. `_i.JCLL.0N/C 1 CONTRON
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RCHITECf/ENGINCER (r L//' p , s .ULDa101RRMFPINFO
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t+ y LICENSED CONTRACTORS DECLARATION- -
Z w ,1 h reby affirm Nal f am licensed under provisions of Chapter 9(comma dg ..; . Job Description i
w with Section]000)ofD' 3o th,fasn and Profession Code and yline :s 1
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of and effect,, V\\2y\OVN K�V\O1b11\Cy�'. �Cl� fGl� Jzp
9 w o Lsc nae Class pp,P�' Uc N '„ 1r
2Z4 r- Dale a,�ty.ConUecbr `- \ I A N, 1 }
-u.OQ - ARCHITECTS DECLARATION, '`� VA �Q��O`-^Q•I f�� s Q
w 4� 1 unless my Plans shall be used a public records _ wq,�,.,.A IC W�,\� `'� ^'� � 0.
C.k o Licensed!Professional
to ,� - OWNER-BUILDER DECLARATION •• y s• -
1 a I hereby"alio Nan 1 too exempt from Ne Contraem License Lew for Nr - - ' •'
k❑ following son.(S don]031.,.mines and Profession CodeAny city m County ,.
which req permit m Conswct alter, mprove dcmolisM1 rep y swcrne
- S FL Floor Area ' Valuation
polls is Issuance,also regmreh Ne applicantforsuch peemil a File a signed statement q' ,
Neer he ix liunsetl pursuanua Ne provisions of Ne Contrecafs License law(CM1ager9 - Q '
Met
erthan]9o0)aebasisforMfNe.usicoaneer.Anyohacax)m APN Number � ccupancy,Type
SecNet he Is exempt Nuufmm and the beers for be cts the compiler.n.Any il'p an of ..
C.I mo 9615 five
any applicant for a Wt, subjects the applicant to a civil perWsy of +'-
� nos more Nen five M1undred dollars(5300). .s-
• ❑Lax owner err the progeny Cor employeeswM wagesn N'nob......line" 4 ». :Required,Inspections '
sill do Ne work mrx!throtarso,auremrod intended or offend forsal.M.,0014,Business / }
ad Profeseiom Code The Coadenc ors License law deal nor apply to wow.,of
property who builds or rmpruva6 Mission,and who does such work himself or through
'his own employees Provided Nat such improvements me not mlended or offered for ] IIS IRIY1W11� f�
sale.if however the,building mimprovement is Gold wlNin ane yeti of completion the
-
owner-builder will have Ne burden of proving Nn he did not build or Improve her pts
poseofmle.)'- 1111
1,n owner of Ne propert,sm exolusivel'conmac in with licensed contractors to - J U -
onswct the project(ger.7031,Business end Profcssim s Code:)The Conmilles Lr- '-�V-QO
cense La d not apply 1.sn fwnerof property who builds oimprovesthreoh and
whd trees for ouch projanw Ne nnecror(s) tensed pars a Ne Cnvsaole w'LDIA�
s
c me Law '
Ie /1
❑IarysawP Indo u r ,B k P C for this..on "e �, a it •aV7
,�.w.:J
,Q Wraund SnCOMPENSATION DECLARATION r rr -
by ffrmrism a PanitY of peJry fN fill 8declanr i D r6r`^"'�w.,w. ^Y }
�1 Jrr11jj'� .4
thovered 'e for
ecoonBwse of OnL no self su f rWmke aC ft vim.
sit r provided f by,Section 3]00 of N Labo Code:forshe performance of rhe n
wyI h which N' permit n issued.
3;vI5�1 he d 11 mainsmn a perfi s Comps h I franc n qm A by Se tion .APR
Middle Lebo Code, Me Cance fN work for whichN gentle is issued.
MyW 7Compenun Insurance cenier and Po1'ry " e
Tr,• Camer��',^ts '(�Q=Policy No
RO
TIFI OF EXEMPTION FRO R
.COMPENSATION INSURANCE QY_ -
(This netton neednm becfmplened'fnheP rrttitnforone huMrW dollen($100).
Loy any Natrona anyC mmuof Ne cam M1ahthis to tparmot he Woarssued,'Co shall
rwt employ any person in any menrmr so e6 r beta subject w the WorkersColnpen-
'uQiWLawserr Cahfomn Daae '
Applmam 6
' NOTICE TO APPLICANT:If,efts making this Qnifi<ea of Exemption;yeti should
I "hx9me subject m Ne Wart 2s Compenution provisions of Ne Labor Cade,you moat '4 - ,
'(ortM1wiN comply with such provisions or chis permit shell be domed revokedx - - '
CONSTRUCTION LENDING AGENCY
Z,0 - 'Ihorw aRvnthmiodi is..a gin.3nlending agency for Ne performance f
• ,Z,= .Newmk for which Nis penminsisxued(Sec.109],Civ.CJ
Lenders Name y•. ,
> Larders Address - a .�'„ r
W A - I certify that I have nal Nis apolult on and sato Nen me abovemfmmatioin is -
r Cr comet I agree c comply with ell city and county ordinances erd an laws retiring e _
z buiiv con read propend forcbyamhonre prc een�ves Ofthis City 10 Enter upon Ne
above mentioned Property for mapecnon Purposes. ' �• "
IDLir Fr (We)agree a,save,and expenses Rich my in an o ii ru Cupertino against - .;;$ i
V liaConsts,rydnof thecosuard expenses which may in any way teems agvnss evil City f ,•
me Constipation of the gmnuog or Nre pe r
F U0 APPI ICANEGIJ STAN[ ND I CDMPLY WITH ALL NON-POINT
:V EGU IO - e ,
JAit t
Signmreof ApPllcan/Comrscrm n .Date r. a
HAZARDOUS MATERIALS DISCLOSURE
Will NeaPPbcsnnorfumrebu0ding mCap ennrmeorh till hauselouspas '.1 ,Re-ro6fR - - a` +
' as defined by the Coast Municipal Code.Chapter 912,and Ne H M and Safety -. f ..
Code,Section 25532(a)? _a Type of Roof ,.
S :
Will the applicant future building pent keequpinemo deviceswM1i h All roofs.shall•be inspected prior to any;roofing material being
emit baurd , connm nn ax sed by rM1 .YArceA Quality Management Installed. If'aroof is installed without Y-first obtamingan inspection
❑.Yes t--,SNo -; '' - - ,.. J'agree,to remove,all w materials for,inspection...Applicant I '
understands an w 1 Ip
with'all'non point"source regulations.
Will 1h aelse Wind.s mnteals rem u rde Chelan,6.95 of Neck ,
homes Dealt&Safety Cade Sect 2550 25533 M 25531.1 Id[r61aM Nei if e
hui manen0yh as r m s Y pa b'l syr Cody Ne occ- 1I'�alr—sa�1
o N Ieq ellen w h itis n eofapm fie re or Occu y. - -
/ll -� O�(gJy Signature of Applicant Date
Ownrror.amonxcn.,oarn _ D,n _ ,. ', - .
1 1 roof coverings to be Class`:Bir orbetter
".''''OFFICE": .
CITY OF CUPERTINO
I PERMIT NO
BUILDING DIVISION CO
T"�
N -TORYM
PERVE )61ION
BUILDING ADDRESS:
SANITARY NO APPLICATION SURM[TiAL DAL
WR;!SP1ANiE
NIC CONTROL#
BULDING PEkMrr
ARC4�CGIN!Ek 77
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- C. F
NOTES
24E Job Description
EI t:-
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Cdu
L-A
Sq. Ft. Floor Area Valuation
APN Number `0dc6Mcy—rype
Required Inspections'
Z JUt 0 7
z auk
JW
UO
OF0 QjVe
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Re-roofs
Type of Roof
All roofs shall be inspected prior to an roofing materialbeing.
installed. If a roof is installed without k
first obtaining an inspection
1 agree to remove all new materials for inspection. Applicant
ungerstands and will mply with all non point source regulations.
4
i
Signature of Applicant Date
All roof coverings to be Class"B"or better
APPLICANT'S POSTING COPY