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02120056a cd Z 1400 R P 9< Q 0 U 0 Z Z C 5 :D Z U C U;Z CITY OF CUPERTINO BUILDING DIVISION PKKi4IT' 0 BUILDING ADDRESS: CUPERTINO KITCHEN DESIGNS PERMIT NO. 10180 BYERLY CT 02120056 OWNER'S NAME: 10562 S DE ANZA BLV APPLICATION SUB DATE LI JORGE P AND MARIA Y 12,Z.1.3/2002 PHONE: (408) 257-4900 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing Job Description with Section 700p) of DivisiwJ of the Business aaProlossions Code, and my license is in full into REMODEL KITCHEN/BATHRMS C License Lic.# Date Contractor ARCHITECTS DEC ION . no . records tnd, ridA�?Z A%id as pu c records Lice2Wnilessional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 703 L5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area $ 7 5 U90ation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of be Occupancy Type not more than rive hundred dollars ($500). 0 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, andthe structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of 102 - PIERS Requked Inspections property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale.. If, 103 - UFER however, the building or improvement is sold within one year of completion, the owner- 104 - REBAR builder will have the burden of proving that he did not build or improve for purpose of sale.). 105 - ANCHOR BOLTS 0 1, as owner of the property, am exclusively contracting with licensed contractors to 106 - SEWER & WATER construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon. and 202 - UNDERFLOOR PLUMBING who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. 203 - UNDERFLOOR MECHANICAL of am exempt under Sec. 8 & P C for this reason 204 - UNDERFLOOR FRAME Owner Date 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING I hereby affirm under penalty of perjury one of the following declarations: 302 - TUB & OR SHOWER 0 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the 303 - ROUGH MECHANICAL work for which this permit is issued. 304 - ROUGH ELECTRICAL 0 1 have and will maintain Worker's Compensation Insurance, as required by Section 305 - FRAME 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance ca mI et and Policy nu b7e are: 306 - HOEDOWNS Carrier . 57� 141M_ r Sri 1.7 Policy /0 — 'r? 307 - INULATION S CERTIFICATE 6—F ExEMPrioN FR6m WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK (This section need not be completed if the permit is Intone hundred dollars ($100) 309 - EXTERIOR LATH orless.) 310 - INTERIOR LATH I certify that in the performance of the work for which this permit is issued, I shall net 311 - SCRATCH COAT employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date 313 501 - ROOF NAIL - FINAL ELECTRICAL ENERGY Applicant NOTICE TO APPLICANT. If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must 502 - FINAL PLUMBING ENERGY forthwith comply with such provisions or this permit shall be deemed revoked, 503 - FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of 504 - FINAL BUILDING ENERGY the work for which this permit is issued (Sec. 3097. Civ. C.) 505 - FINAL ELECTRICAL Lender's Name 506 - GAS TEST Lender's Address I that I have read this information is certify application and state that the above 507 - FINAL PLUMBING correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the 5 5 1 FINAL FINAL MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against 9 FIN FI liabilities, Jud nts, costs an expenses which may in anyway accrue against said City 5 " q1 N ingn q ceo the granting of this permit T U D�E APPLI R ND AND W'11, COMPLY WITH Issued by 1 WORKS Date SOUR AT N , woofs Type of Roof �4i ofApplicant/Contracnor -1 HAZARDOUS M IALS DISCLOSURE �r" /2,ng po Will ft applicant or future b i ding occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? 0 Yes No All roofs shall be inspected prior to any roofing material being installed. I/ If a roof is installed without first obtaining an inspection, I agree to remove Wilt the applican t or fur or fu building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 01 0 Yes uko 1 have re the hazardous materials requirements underChapter6.95 of the Califor- niaHealth See ns 25505,25533 and 25534, 1 understand that ifthe building =Can- does not c - tenant, it is my sponsibility, to notify the ore P t of the require iss7ofaCiutificateof cc oo� _A iv/'Z�WZOII 55VV_ Signature of Applicant Date All roof coverings to be Class "B" or better JF`aao;1zed /bate'* 24 a Hoc U F i 2 w6 D, w3W I. Y. O HNaE to no 6Xm� � ?6 ESp F 6'1$ ./ Oz z.. a> W 0 UO_ O F- Fa Uz I CPPY OF CUPERTINO —1 CONTRA CT,ORINFORMATION Eu1t.Dmc orvlsum PERMIT BUILDINGADDRESS: CUPERTINO KITCHEN DESIGNS PERMITNO. 10180 BYERLY CT 02120056 I!R'S NAME. 10562 S DE ANZA BLV APPLICATION SUB DATE LI JORGE P AND MARIA Y 12/13/2002 PHONE: (408)257-4900 SANITARY NO. CONTROL NO. ARCHITECr/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o LICENSED am CONTRACTOR der p DECLARATION I hereby affirm that 1 am licensed under prnvis beers of Chapter 9 (commencing Job Description with Seairn7(X 17 of Diviri lrf NC Business Professions G,aC. and mYliccnw is ld fml n,re err «L new' U REMODEL KITCHEN/BATHRMS F'�AL�"® License C Lic. x Dmc Gmracma ARCH ITELTS DEC Jc ad In II d as C RION /.ute c ra'ordr APR 0 9 2003 I.ICC nlcxsio,al OWNER-BUILDER I am BUILDER UECLARATION I hereby .(tutu that 1 exempt from the Contractors License Law tin Inc BUILDING reaso following reason. ]Instru Business and 1, o Code: Any city or county er it I which requires a permit m connmct, she', improve, improve, de demolish, h, or or repair any structure poor m ill issuance. afront to the the applicant for such permit w file signed Chaps em h farmait t arcing wit pursuant to provisions of the cemmnss Sy. Ft. Floor Area $75�'fltthtion (cane (commencing with Section ]land of Division J nd Prwlaom, Codtn9 Business and Pmfcssions Code) or of li and Ire basis for the al alleged exemption. Any violation of Nat he is exempt tang ubc Semen 7031.5 any in applicant for a permit subjects the applicant m a civil penally of -14 be Occupancy Type not more Nan five hundmd dollars (g50% five redll 0 1, az owner of the property, or my employees with wages as their sale compensation, will do the work, and In structure is not intended reoffered forsale (Sec. 7044, Business and Professions Code: The Contractor's License law item not apply to an owner of 102 - PIERS equlred Inspections progeny who Wilds or improve tt ment. and who does such work himself or though his own employees. provided that such improvements are not intended or offered for sale. If. 103 — UFER hrnvever. the building or improvement is sold within one year of completion, the mi Wilder have 104 — REBAR will the burden of proving that he did not Wild or improve Car Pugmw Of s'I`) 105 — ANCHOR BOLTS 0 h as owner of me property, am exclusively convening with licensed contractors to 10 6 — SEWER & construed the project (SCC. 7044, Business and Professions Cade:) The Comrenor's Lt. WATER cetee law does not apply to an owner of property who builds or improves Inciter, and 202 — UNDERFLOOR PLUMBING who contracts for such pmjae, with a contraaor(s) licensed pursuant o the Contractor's' License Law. 203 — UNDERFLOOR MECHANICAL ❑ I am exempt under Sec. ,B &PC for ressom 204 — UNDERFLOOR FRAME Mr Data 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING Ihereby attrrn malt, booth t yat 302 — TUB & OR SHOWER ofConwmofl6eh,uowlarWorla',Co: 0 I have and will for by a [ion 37 to of Cam abru Cadc,sum [or Performance ce of,h- sation, ar provided for ny senior s]Iat of flue Lan<,r clove, for the perfermatee nr tut 303 — ROUGH MECHANICAL work Car which this pemit is issmd. 304 — ROUGH ELECTRICAL 0 1 have and will maintain Worker's Compensation Insurance, az required by Section 3 05 — FRAME 37100 of the lane' Cars. for the performance of Be, work far which this Permit is issued. My Workers Compmwtion Insurance carrier and Policy nu Mrare: 306 — HOLDOWNS _ Carrier. �i W F�UIiPrrey 307 — INSULATION CERTIPICCOMPENSATI4NIINSURANCE ORKERS 308 — SHEETROCK This section need amt he completed the pes,n is forma hundred dmlarx($100) 309 — EXTERIOR LATH met.`.) 310 - INTERIOR LATH e ccnity that m ed Performance any or Ns monk for which this the Workers issued, I shall not Permit employ any person in any manner w as to become subject m the Workers' Compensation 3 11 — SCRATCH COAT Iawr rtsSbromla. Da" Applicant 313 — ROOF NAIL NOTICE TO APPLICANT: I L after making this Ceni fcate of Exemption, you should 501 — FINAL ELECTRICAL ENERGY become subject to the worker's Compensation pmvisiom or the Labor Code, you must It in comply with such provisions or this Permit shalI W deemed winked. 502 — FINAL PLUMBING ENERGY CONs'rRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY I hereby aft or that there is a contraction lending agency for the paI romance of 504 — FINAL BUILDING ENERGY fire week lnpermit r which this per is issued (SCL. JVi], Civ. C.) Lender 's Namc 505 — 506 — FINAL ELECTRICAL GAS TEST Addreaz I Cattily that l ham read this application and state that the alcove infnmantown is 507 — FINAL PLUMBING corrects bcorrect. 1 agree to comply with all city and county ordinances and Slade laws relating m uilding Construction. and hereby authonve representatives of this city m enter upon the 5 FINAL MECHANICAL a nave. mtnemnedpmperym dnspemmnpurposes. (s ju agree m tam, indemnity and keep nay in an the tidy of Cupertino against liamliucs,jud nts, costs and cxpcnwt which may in any way accrue against mid City 09 — FIN E N G APPLIy cc o Degramingof this permit APPLI U DER ND AND WIL COMPLY WITH ALL NON.. P INT Issued by51 WORKS / SOUR AT N . Date sec's oofs can of Appli_I`Cmnlrannr FrAZARDOUS M RIALS DISCLOSURE Type of Roof W""1. pplteam or future h - ding mcupanumrc or handle his Maas material its defined by the Cupcnino Municipal Code. Chapter 9.12, and the Health and Safety 'ode, stoic, zssBZla)] �YCt N,Nn All roofs shall be inspected prior to any roofing material being installed. will the applicant o lustre Wilding ottupam use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove Coil hamrdous air contaminator as defitmd by the Bay Area Air Quality Management Dimrinp all new materials for inspection. ❑YCS 9N� 1 have read the hamrdnus mmmrials requirements under. Chapmr(.95 of the Califon on llcann& fn GNC .Sccoinns2.5.N15.255Aand25514. IundersmnJNaifobe budding Cn Jas nod II have n Imam. I,r my rymribil'ny m nndily Ibc atop I of Ne rcyuire are =nmms+,a�/.,e �„Im7cfacntmcateofacm � �� Signature of Applicant Date All roof coverings to be Class "R" or honer amWrncd agt, I Dade a a ITY CUPER,TINO CITY OF CUPERTINO PERMIT APPLICATION FORM 0 60111110 Fee Description Other Appliances Bw—ldiAg Addiess: Construction Tax By F— R -Y JC omm/Quasi Jer's Nam e: � ,AAR on C. Tax f or Contractor: _RQZone Hotel n--1 Motel VIII =41 ME Constax — Resifflobile BELEC1000 Elec 600V <-- 1 OOOA Applicant/Contractor: 0001 I 11wal I a 'iling Permit Info: Elec Svcs 600V <= 200A • 12219121 EnergyAdd Multi a fee Sq.Ft. floor comm. g Fee all) 1:-Wv1vvLCMv JR�e. HousiRg el Architect/Engineer: _MAFee__ New Multi-Family Res Valuation: MAU IN'L-New Multi-family-Res Type of Construction: OC cupancy Gro I of 3 r ' Fee Description Other Appliances Meal Construction Tax M" JC omm/Quasi 1 KX on C. Tax f or Prins _RQZone Hotel n--1 Motel VIII =41 ME Constax — Resifflobile BELEC1000 Elec 600V <-- 1 OOOA Elec 600V > I OOOA I 11wal I a L'. 24��� Elec Svcs 600V <= 200A • 12219121 EnergyAdd Multi a fee comm. g Fee all) 1:-Wv1vvLCMv JR�e. HousiRg 1--1kvw1xvvkv11wj1vj�, _MAFee__ New Multi-Family Res MAU IN'L-New Multi-family-Res 116.1 1, z I We SHUT I 'ECTRICAL 1 -.3 LN I L4 Ov I a I New Comm Mechanical -'ET I D 11, twes kyj New Comm Plumb I of 3 r ' Vmw HO-A 30N3(]IS3N E)NIISIX3 01130OW321 IIPPV bullapoLugH fijjaujqL3 Guy X90NUN011YO01MILL UOISONM31010ul 8 M 62 j O Z: too Z� LIZ: toll z J., Q Cal U-i U, 0 APh �,giftg hij h! N M 'M H HUI NIMBI ia mZ `tip Q Cal U-i U, 0 APh �,giftg hij h! N M 'M H HUI NIMBI 11 *SSW THW MO=I 33N3®IS3N ONIISIX3 Ol 13®OW3N �> W�suo I!ppV . Buppowaa. Pulauquo auij" o n o ID o w W N7 }d NOIlIlOW30 8111(18 SV u6'sGPN3H3lI}iouIja8dn3 = 9 x � R fu , 8£ Jul „1£ „LL lli 2 S ° \ ( W C p iI g, jr 14 ! 8L t1 s - ---- w fi 1 v I a ml �a 0I ,,%cot Q.. E% I I - � O 091 iI vv 41 UO3 33N3GIS3M SNIISIX3 01 -13(3OW31i SUOPIPW." 6u"hapo'W'98 ISO NVId N0110 ....... A - - �PN3H3JLj)jouijj9dn:) Fl- m YjAi 4— 7 2, I 4!f l'i 4r ZI 7 LLI V . file ~ Hi- ILI JL 11P P i1i 7iiii ", All 1 17 9W I lit X to Nit at �fa b- alow a I Jill MEN Lrffrj1(1 N0A3ONR(11S3H0N11S1X301130OW3H NVId HS11411d ASOMHUDIOugJadno 41 7 T - -4 1-- 1 — --- --------- - - e> 1A m js < Ir Ail, U HU 7L H it L ---TT io 10 z NJ is S p is ----------- fli F1 0! W! Jj1.'jt "N' Mh J O'n i I'7'S2Iw'8•aw ,a, >,m��m�$ NO-A 3ON30IS3N SNIISIX3 0I13 (lOw3m suolippy 6ujlapomau.rtijaulgepaui�" uMHOID1 unieft SNQUVA. ` l3Mtl'Id d01 t131N(10� 113NI9tl3 v {l 5 ( ._ _ _ _� m � Y` r� �`$'✓i, 'S/` � ,7�t � ;' I I i I Rr,� �o I M' <, Eli it i I �s p � $. qI 1517, R 11 � `yyll � M ( = a C 1{I zl l� e 11 y4l, a I r IgI � I g$ f$E I EI I I 9H I I€ �� 8 ae & 13181F8 3 IUp = c m $ $ Z.-2 r u = 2 £ -w C1 42 eneF, zoo, I 1,9 0, 39 I �s p � $. qI 1517, R 11 � `yyll � M ( = a C 1{I zl l� e jjPPV . 6ullopowau . zloulqeo aul MOJ 33NMIS3M ONIISIX3 01 13GOW3N suol SNOLLVA3l3/NVld dOl u31Nnoa a3NIW ASOMHOIDIMPOOM mI k sd 7EM y mu er" � f� c 61- OTAI, 41 x N k sd 7EM y mu er" � f� c OTAI, x 2L i fs Ak '2 Boo ril ]IN- 11's8w 110:1 30N3GIS3H ONIISIX9 01 13CIOW3H )Glgu,qF sanuoaasaaa URSONMILDIOUIVIDIUM Lillie, I Is! S M 21 A P -6� Z 3- vcn �:Z ,.. cafrY A .3 = _ Yo sE 4- 4 T �tI T" -s' 9 2—V -Is Gill 12,33, g �wmni E p4 It oz fr11 Rj� 'M z &-v v as 5A I z TA I ki p 9 r G T T Mum I f is g-jg I i z! S l ;i 9s` is It H T w �zn A E sI is N- ig�W3 el -Ez i V V p 4L5 eE5 �2 x.0 A 6 19 5 E 12 m� o 0 ki p 9 r G T T Mum I f is g-jg I i z! S l ;i 9s` is It H T w �zn A E sI is N- ig�W3 el -Ez i V V p 4L5 eE5 �2 x.0 A 6 19 5 E 12 m� Hoc U F i 2 w6 D, w3W I. Y. O HNaE to no 6Xm� � ?6 ESp F 6'1$ ./ Oz z.. a> W 0 UO_ O F- Fa Uz I CPPY OF CUPERTINO —1 CONTRA CT,ORINFORMATION Eu1t.Dmc orvlsum PERMIT BUILDINGADDRESS: CUPERTINO KITCHEN DESIGNS PERMITNO. 10180 BYERLY CT 02120056 I!R'S NAME. 10562 S DE ANZA BLV APPLICATION SUB DATE LI JORGE P AND MARIA Y 12/13/2002 PHONE: (408)257-4900 SANITARY NO. CONTROL NO. ARCHITECr/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o LICENSED am CONTRACTOR der p DECLARATION I hereby affirm that 1 am licensed under prnvis beers of Chapter 9 (commencing Job Description with Seairn7(X 17 of Diviri lrf NC Business Professions G,aC. and mYliccnw is ld fml n,re err «L new' U REMODEL KITCHEN/BATHRMS F'�AL�"® License C Lic. x Dmc Gmracma ARCH ITELTS DEC Jc ad In II d as C RION /.ute c ra'ordr APR 0 9 2003 I.ICC nlcxsio,al OWNER-BUILDER I am BUILDER UECLARATION I hereby .(tutu that 1 exempt from the Contractors License Law tin Inc BUILDING reaso following reason. ]Instru Business and 1, o Code: Any city or county er it I which requires a permit m connmct, she', improve, improve, de demolish, h, or or repair any structure poor m ill issuance. afront to the the applicant for such permit w file signed Chaps em h farmait t arcing wit pursuant to provisions of the cemmnss Sy. Ft. Floor Area $75�'fltthtion (cane (commencing with Section ]land of Division J nd Prwlaom, Codtn9 Business and Pmfcssions Code) or of li and Ire basis for the al alleged exemption. Any violation of Nat he is exempt tang ubc Semen 7031.5 any in applicant for a permit subjects the applicant m a civil penally of -14 be Occupancy Type not more Nan five hundmd dollars (g50% five redll 0 1, az owner of the property, or my employees with wages as their sale compensation, will do the work, and In structure is not intended reoffered forsale (Sec. 7044, Business and Professions Code: The Contractor's License law item not apply to an owner of 102 - PIERS equlred Inspections progeny who Wilds or improve tt ment. and who does such work himself or though his own employees. provided that such improvements are not intended or offered for sale. If. 103 — UFER hrnvever. the building or improvement is sold within one year of completion, the mi Wilder have 104 — REBAR will the burden of proving that he did not Wild or improve Car Pugmw Of s'I`) 105 — ANCHOR BOLTS 0 h as owner of me property, am exclusively convening with licensed contractors to 10 6 — SEWER & construed the project (SCC. 7044, Business and Professions Cade:) The Comrenor's Lt. WATER cetee law does not apply to an owner of property who builds or improves Inciter, and 202 — UNDERFLOOR PLUMBING who contracts for such pmjae, with a contraaor(s) licensed pursuant o the Contractor's' License Law. 203 — UNDERFLOOR MECHANICAL ❑ I am exempt under Sec. ,B &PC for ressom 204 — UNDERFLOOR FRAME Mr Data 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING Ihereby attrrn malt, booth t yat 302 — TUB & OR SHOWER ofConwmofl6eh,uowlarWorla',Co: 0 I have and will for by a [ion 37 to of Cam abru Cadc,sum [or Performance ce of,h- sation, ar provided for ny senior s]Iat of flue Lan<,r clove, for the perfermatee nr tut 303 — ROUGH MECHANICAL work Car which this pemit is issmd. 304 — ROUGH ELECTRICAL 0 1 have and will maintain Worker's Compensation Insurance, az required by Section 3 05 — FRAME 37100 of the lane' Cars. for the performance of Be, work far which this Permit is issued. My Workers Compmwtion Insurance carrier and Policy nu Mrare: 306 — HOLDOWNS _ Carrier. �i W F�UIiPrrey 307 — INSULATION CERTIPICCOMPENSATI4NIINSURANCE ORKERS 308 — SHEETROCK This section need amt he completed the pes,n is forma hundred dmlarx($100) 309 — EXTERIOR LATH met.`.) 310 - INTERIOR LATH e ccnity that m ed Performance any or Ns monk for which this the Workers issued, I shall not Permit employ any person in any manner w as to become subject m the Workers' Compensation 3 11 — SCRATCH COAT Iawr rtsSbromla. Da" Applicant 313 — ROOF NAIL NOTICE TO APPLICANT: I L after making this Ceni fcate of Exemption, you should 501 — FINAL ELECTRICAL ENERGY become subject to the worker's Compensation pmvisiom or the Labor Code, you must It in comply with such provisions or this Permit shalI W deemed winked. 502 — FINAL PLUMBING ENERGY CONs'rRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY I hereby aft or that there is a contraction lending agency for the paI romance of 504 — FINAL BUILDING ENERGY fire week lnpermit r which this per is issued (SCL. JVi], Civ. C.) Lender 's Namc 505 — 506 — FINAL ELECTRICAL GAS TEST Addreaz I Cattily that l ham read this application and state that the alcove infnmantown is 507 — FINAL PLUMBING corrects bcorrect. 1 agree to comply with all city and county ordinances and Slade laws relating m uilding Construction. and hereby authonve representatives of this city m enter upon the 5 FINAL MECHANICAL a nave. mtnemnedpmperym dnspemmnpurposes. (s ju agree m tam, indemnity and keep nay in an the tidy of Cupertino against liamliucs,jud nts, costs and cxpcnwt which may in any way accrue against mid City 09 — FIN E N G APPLIy cc o Degramingof this permit APPLI U DER ND AND WIL COMPLY WITH ALL NON.. P INT Issued by51 WORKS / SOUR AT N . Date sec's oofs can of Appli_I`Cmnlrannr FrAZARDOUS M RIALS DISCLOSURE Type of Roof W""1. pplteam or future h - ding mcupanumrc or handle his Maas material its defined by the Cupcnino Municipal Code. Chapter 9.12, and the Health and Safety 'ode, stoic, zssBZla)] �YCt N,Nn All roofs shall be inspected prior to any roofing material being installed. will the applicant o lustre Wilding ottupam use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove Coil hamrdous air contaminator as defitmd by the Bay Area Air Quality Management Dimrinp all new materials for inspection. ❑YCS 9N� 1 have read the hamrdnus mmmrials requirements under. Chapmr(.95 of the Califon on llcann& fn GNC .Sccoinns2.5.N15.255Aand25514. IundersmnJNaifobe budding Cn Jas nod II have n Imam. I,r my rymribil'ny m nndily Ibc atop I of Ne rcyuire are =nmms+,a�/.,e �„Im7cfacntmcateofacm � �� Signature of Applicant Date All roof coverings to be Class "R" or honer amWrncd agt, I Dade