00070008 I' CITY OF-CUPERTINO ' , '-
,. CONTRACTOR INFORMATION:
BUILDING DIVISION . PERMIT_'
. '. 'u `- .
RIIILDING ADDRfSS'.�•, �. � � PERh41T NO. -
. ` INF 0¢I07000e
OWNER'S NAME'. - ' ` - •c Yt,Y, APPLICATION SUR DATE. . ,
SHANn RD 07/05/2000
HON[:: , ! SANITARY NO. ' CONTROL NO
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I ez ARCHITECT/ENGINEER: 't"-• ' - UI LD INC.PERMIT INFO
REDO ELECT. � -PLUMB MECII '
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`F❑Z LICENSED CONI RAC FORS DECLARATION ' Job Description
�� q Ih by R" nthtl d d p - f(Tpt r) g at,
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F,mEra ' hh Sel t7G0) fUl, 30fdEd BY n. and Prot xCode,and mylicense; t - • „ r d +
Io Ill flus and I N t33A"Z . - 'L+
SHAK 70. tLFETIME AMBASSADOR CELOTEX
at la`F auto / 4/ C tmdor
'IY 31+w L T"' AttCHIILCT'S DECLARATION ' -
C .'I and...mvd my plans shall ne used es public meant, t ..
u1�00 f.c Jp f .l - A /-
aj OWNER 0sso DLR DI CI ARATIDN O _
Fri�� I h M1y R that70 (heC I I o L I nt t -
1=�¢ toll g .(S t 70915 Battles,' dl f:: Cd AY 1y re
t�q
which y permit I 'I I II P I LM1 p y.l structure ' • O _
a 3 m trio I I I. 9 'tl ypl^ f ud p r Li l .L -
-
that he licensedp II m p rth c railer,� L (cn'pler9 Sq,Ft; Floor Area Valuation
(co 6 with Section 7000) fD" l of Business d Professions Edo) -
rnr that h opt Ih f tad theb f IM1alleged pt A yi n
ofS i 70315 by Yapplicantf I Isublects the appl mfan civil p tally'
of -I oamanfivehundred dollar,0S5W1. • - APN Number OccupancyTypea
Cl 1,as owner of the property,or my employee,with wages as their sale compensation„
will d thek d t structure tintendedoffered.f I 05 7044
Eu and P ra Code:TI Contractor's L Law-a I apply to.t - - . : Required lInspectimis _ I.
x fproperty Wl b Id' ti 'll d h does. 1 workh' II
throughor1ply .p edt I "-p I - tintended 30 1 r FRAME
offeredf :al If,h II nudeng p eni Id 'n one year of, , '• .
omPl l the fin"lde will l e fp-ovilsbe,h did an,bu'w n' ' r 307, — INsIlL ATION'- - y
lap f p m f lel - - n - I
p l a. t f theproperty, I s Iyconnecting' th licensed administers t
601' ROOF TEAR 'OFF
an Iraal thep I(57044 R . e a Pm" :Code)TheChain I 60P"_x' ROOF PLYWOOD NAIL
License 1, doesn tapplyl all owner of property who bt Id' -tp vwthrec m s - - ,
and h tis r h Pm,, with' lar I I¢).licensed p '. tat to the 603 = ROOF BATTENS '. ,.
Camanam,License L -,
tr ❑Ia,t exe npl under s 'E&Fetor lnt.'rea,,,n •604 — ROOF '.IN—PROGRESS
Owaid 'n;t z.
WORKER:S COMPENSATION DECLARATION.
1 hereby a1Rnn under penalty of Nrryq ote of the thousing- d lufmlonv: { - -
] ep � d II I Cn'C t IConsent i If f Worker's - y -
'n teen:au n p ded f by Sr u 374 f d Latin, Unle_ for II
Pero rm'mce of the k for which this pe n t d pound.
1, 1 -
q rvh' 'I
O 1 h' 1 will u i I Worker's Compensation Insurance, reached by S I n "'
3700 of the Lahr Code,for the.p&Ecr nonce of the work for wh ch.this permit is
st ed.My Workers Comps canon Insurance carr er'end Policy number are: - - -
Cerner • Policy N.,: I'•�' ' .
CERTIFICATION OF EXEMM ION FROM WORKIiRS' - A,
''COMPENSATION INSURANCE ' t ,
(Th I' need net be uhr,U d f thep is f hundred doll u i , /, 1r
($100)or lues) N. I r
I certify than in the perfor Hance of the work for which this Pa 'x n eJ.I i -
shall not employ a p ) to� n : hj I I th'W k '•
ou�,fo�p
Connective pLa I a a Dat -. v'•- Y'
Applicant]G•l d•- i -
NONCE API I12; [ fl k' gIM1 Cnf t fI pl YmshmW - '- _
becomesubject t theta A Compensation :of th Later Code,yam unit
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forthwith chat wit, h p or Ih s permi(shull h J an d ked. i . : r ,
F y CONSTRUCT ION LENDING AGENCYt
I hereby which th t d I t I d s Co.
C Y f the perform h' r r
Leader's
work for which th p I issued(S Jf197, .CJ n'
LendersName
ra M1
U.Z. Lee .one ^ .. .. - .. ..
I certify that l have read this application and state that the above information is i • _
-Gti F carred l.,me m comply with all cay m l my lain...: and late I .nalming
nobould'tg armonclan.and hereby•uthl' 'pm,cttaivcxd the city melnutpon ,t t
the I o f d property f - P tiP P ,
jH.W (W)"me I 1 'fE Jkeep i late deCty Chprpa ag vI
nr Vi liable jag t: I A I. which 'y" anj eabtnl J -
V City n mneeyuence of the g,ding of Ih 1 ml s. - / �� -
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT / +^ 1
SOURCE REGULATIONS - .�lssued by: l Da[e
t1 SIB I fApplcam/C I' I '1 ,• Date Re�rOOfS
HAZARDOUS MATERIALS DISCLOSURE _
Will th pp1'um futon bu hairs oecupatn score er handle h,Nous palatial -Type.of ROOF
is dehned by me Co,cl no Mt ic'puI Code,Chaarei)12 and the He.dm'md Safety -
Coto.Section25532(.)'!• :1 s - ' -
Ell ye, _ o'No - Alltroofs shall bei nspected prior to any roofingirnaterial being installed:
Won par t By � bond s p luseen'Ipm al deal,.,wn-up If a roof is"installed:without first obtaining an inspection, I agree 90 remove '
quit d and!...a,cam ffia,de and by the Ray Area Air Quality NE groan
1,Irira all'new materials for inspection,. Applicant understands and-will 'comply-with.
eye, ON. all `non-point source regulations.
I have road the haroodux mate_t I lu r nems under Chapter 6.95 of Inc
California Hidrhh&Safety Code,Sections 2550525519 and25534,1 understandthat -if the building does not currently have atenant,(hat it is my,re pnne'bllly n)nary the ;]s •, - ;c' - '
ve p' t of the regi r I. which most b one pier m ala me,of a Canine t f i n r
°i p y- - 'Signature of Applicant , jv Date'.'"
t'
14
Owner orauthorized agent' laic a '., 'All roof cove'r'ings to be Class "B" or better