01040017 CITY OF CUPERTINO .,.
nmLDING DIVISION PERMIT CONTRACTORLINFO"ATION::',
`. BUHIDING ADDRESS'. - ` I • ,• PERMIT NO. n -
�p/ b . ' ' " WATERPROOFING 'ASS CIATES 01040017
APPLICATION SUR DATE
. .975- TERRA„BELI_R 04/04'/2001
SANITARY NO. CONTROL NO.
O.8 (650L937-1.299
G,p zo ARCH1'rEC'fIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH '{
.F L.� • 'i . JJ IBJ � '
oi
F: t LICENSED CONTRACTORS DECLARATION
z 5 g - Job Description-
4
O z ❑ I hereby affr n th t I I :d'nd pn n. I Ceapta 9(co n ne g .
P t-w x'IdS t 7000)of Dtvvon 3 or the Brain...add P f..or,Civil,andnry l' en.cc - ''_ - ^
is it,Illfr sand �q� � t
�ya�a< Lle rCl . > L x X486 T/0=B U. R. W/GRAVEL,
X 3 a F Dat ^ C nI 1 n
listARCHITECT S jam"A' ON ADD 'B. U: R.
so1 d t' d y pia ''hull he used l tbR Prion nl' 'I` '
5a w 'U l.' 2;1 �F3.6
a d oC Licensed P f::noon .• - - ` t -h -
nOWNER BIJILDF.R DECLARATION
_ 1 worry afirrad Ih t I arn the Contractor',Uklood La.fill(he
fall 6 (St 70315B ! d 11 fil I,Code'Ary id, f,runly
'cal wh I 'pIt t o II p d I'.1 p- y structure
a3G pn: t l I. 9 'tl PPT II hp tt is 'a d t0nen '•'..'f' .. .
-Ica h I p t l d provisions if0 t Central Business L L (Cc AterY _ Ft. FIOOr Area - '
(rt wit h 900()ofhe ba nI of fortedlhgd' dProfessions aCode) - q - -r Valuation
or Semhat by say fnnland
o,,basisforthe I the
npu .Ary violas on '
of Semen 70115 iv ivy hundred
oll Cor a p t. hjem.the nppl t t i.il penalty - '
ernor nore man Etc ht nerad don.Lia fssrnJ, - APN Number - .Occupan)ryitl}ml
❑ .ax nwnetnnhe properly,or my employees wartwages as lbeireola mmpansation,
wdIl do I k l the tore m intended or offered f (See 7044.
Business and Poll :Code In C o.erode License Lee d I apply I n 3272002ta(C Red Inspections
Lip p Jy Whoh II: p '. tl I h 1 1 work . If
owrm gh las own uniployecs.provided thh'roproveravars are notine Id
effect!f I If,h r handing r' proven t Id 'll y f
etplr r n harder iit]hurt,tn nranofpnvnathat he did a.[hold r 305 —. FRAME
`tpprnrefor Tumn�enr'ama _ ',307 — I NSLII_:ATI061
El f Do propert,,out exclusively contracting elth licensed' t t 'I-
alulanter th p J t(Sac.vera B d End. -. C m)'Tn c t- t 601., ROOF ,TEA
R OFF.
liw Gpu),f 11 p ly it bald rP e'th
and n conraem such projects with rrclicensed to tire 602 ROOF PLYWOOD3 NAI L'
CentrartorsLcetseLaw.” ;4t ❑1 ,d candriller, B&11Cfor this reason E03 ROOF BATTENS
'..
r
-
- .
owner Date - t 614'.,— -ROOF IN-PROGRESS r
WORKER S COMPENSATION DECLARATION s1
I harcby anion under penall"if p jury one oflha fellowins daelurmin'n.c: _ _ ti
° Ihave I 'll ' t ' C,,fifi,irc of Consent I ,If' : f Wk 's. .'FINALED
Gmnp i p 'd J f by Scat 3370() t' Lia Labor
h rc C Ne,•for the
pert anw of the wo kfar which ml'[h.rmn n small -
have and willnnznt nWorker's&al, 't' 1 inner,as reglad hySmtmn
39(10 oI tire Labor Cod for h p f lattice of tie work fit,which dr,per ft is
iasl ed W kc C FC n Insurance and Policy b r are
Car e- .'�-�l POIy"'
- CCRTIPICATIONOFP.XEMPTIONFI20MWORKLRS'
COMPENSATIONINSURANCE d BUILDING,
15100)0...
' -
ton nrcA not he complcocd't tl v lar nn is f� h Bred dollars .it - - +-
' legs), -
I certify that in the'perioriarrhL of(he worn:ler which this per ti t 'isided,I
shall noLempiny any person in any dander so as Io m
fccoesubject-to the Workers' • - .I '
Cnmpensmlon laws of Cnlifernio.Dine
I , _
-NOTICF Tn API r
z becone subjectto IheWorker's
Ip I LCt p k'a'tt r Ernst adds o
Ce I f of the f ELabor
Code.yo
ode•youshnomulsdt
fonhw'Ih wmidyw th I lknnsnr thisuhall bedeclared
'
rcvokal r
CONSTRDCI ION LENDING AGENCY '
I thereby oH that'diduld L,it consurancIlLad lending agency fin e'the perfermanre
o"he nrk ter which!his p rmis ,sued(Ser 3097 Cis.C). - 1 - ^
Lender s Name 'v
.a7 z Lend Ad I rl,,s s -
hV 'k this application ldiahtllboI certifythat lh Initiation -
W
correcLI g t ply m Ilc'Iy am ly 'I' d II ) II g " '
V wh 'li 6 't t adh rcbY uthp 11 .ce of city at et,upon •3 s
the t dlsoleralf :pn pm . ' •. ,
try d (we)a6memeuu, ndmnnify,nd keep hairless theft of Cupertma againstl
y
Lia V] I'ah I't 1 dg nl',c .I:a I pens'cswhich all,In any way accrue b'inst.said
,V z
City,an cg north 6ra.tia, tfthis.e 'I.
APPLICANT UNDERSr1'Rpl'St D WILL COM1 PLY WITH ALI NON-POINT �,. : Date
SOURCE REGULATId VS 4 Issued by -
Signat of ApplicenUCoada,l ''Date Re-rpofS e=
HAZARD( S MATERIALS DISCLOSURN. ' - _ .•
Will the"li'am found building ec'urand r4av(IT handle hadart laracrial Type of Roof-. - .
as delmcd by the Caperfiiie Municipal Code,Chapter 9.12,and the Heahhatd Safety y
Gale Selo en 25532(.) ' - -
All roots shall be inspected prior to any=roofing material being installed.
wII to pr t r t nId'I g e p' t ylrp 1 d ea n. n- -
.If a roof is installed without'fi'rst obtaining an inspection;I agree to remove
emnh I I can :nmdohe l3ay Area An Quality Managentem _
District,. all new materials for inspection. Applicant understands and will comply with "
°Y" all non-point source regulations.
Ih' e readtl IaaN ' 't - I gcotll d Chapel'fi5Lithe
Calif ll Ith&SafctyC 1 5 h -2550525533oil 255341 larderaindtht -
fthn 'Wyl I currentlyh it,turna,anni ,toyov,ponsibilaytnlfylhe
to
�1.4�o�.
C a f'he lu ti 1 ul
which nl h t p a,issuance f C rtlficm f 7
"Cepd Signature of A plicant _ r: ., Date;
—/
owner or da,horii,,
agent - - Date - - 'All roof coverings to be Class "B"or better,- x
OFFICE