00070149 CITY OF CUPERTINO
BUILDINGDlvfStoN'' PERMIT CONTRACTOR INFORMATION:
f BUILDING ADDRESS . - • PERMIT
.LiV) I t
OWNER'S NAME. APPLICATION SUB DATE
i.1,012',CRINYON 01STA' CT ROYAL , ROOFING 00070149.
ONG SANITARY NO. CONTROL NO.
HOA 1345 VANDER^'WAY 07/24/2000
C K L 'ARCHITECTIENGINLB' ff� ,' BUILDING PERMIT INIsO
(408).279-233G BLDC.,. 'ELECT PLUMBMECII• .
LICENSED CONTRACTOR'S DECLARATION
Ih br Hernia t1 exewa I p .. fc1 pt 7( ins L :Job.Descriphon .
wthS t 7000)of 9 flheBu IP-f fd .�yl I '
is in f Il f t .JJ// m
�C ¢ Lc CIV. L tl �� .. y ,
awS OU Date Cur r
W 3 m fn ARCHITECT'S I Cr S DECIl ARATION I
1 let a ypl "o-nneutel wpbleranm RE'-ROOF HOT" MOP TO,HOT MOP
t+ICoO
Licensed P1 ' al - ..
OWNER BUILDER DECLARATION
1 h ,. (S d 703 rov tb C si t o n' Le "f -
U the
toll g (S f ]mLS B coal besides Csl A Y al county
o'
E�Y G w1i M1 ts 1 I n I pp p men T.1terminal,a I I _: m
3 o 'prig s t t un a 1. Guth.posiou^a ll r. chpermit' fl geld to I ' + k
that he aP I m p nn
' ec I f1 (en'm 9
(ca m�emngw m samtor aan oanne B and Pr re.....n.Code) Sq. Ft:Floor Area Valuatio• n
'or me s aircraft indicant and la,hes for me alleged sm,fround aopr violation a '
,
^ of secfon4ml s ray aaY'PPI'c t f R 1 bee t:me apPl t t �nmhy ,
of not more man five hundred dinars($500)- - -APN Number Occupancy'Type
El 1,asuwne,eflhe prod array employees with wages as th' le compensation. " 's $'1:3600
will I the k d theI t o1 t e d ff red for sale(Sec.9044, - -
Burundi add Prefe,aimp,Code"TI Connector's Lucino,La ,doesnet apply to in,' Required Inspections
fp p 1y Who n IT " p ,e m rad n a n workd If 35626039. 00'
,rywthrough h.ot empty provided 1bar h p mitt e n t'intended or 4
offered bar sale If.however,the building p t'. old'vaidid led y al of
imoplet on the owner Eo Ider will have theburden of pmv ny That h�did not build,r o r "
mprove far air cuticle.). _ - .-305. '— FRAME' : '
❑Ial recon,of the prap tram exclusivelycontracting withlicensed contractor,to 307 — 'INSULATION .
nou'dand the pmleer(So,.7046 Dustiness ad P f ,suns Code)ThCalot LicenseL' J 1 apply or owner pnywhohnn p, -sthc ` , — OFF
cold
-
andI f n p j whb a eom aetoaau a p nt to the 601 ROOF TEAR OFF.
Cont ctorsLicenseL"ve 602 — 'ROOF„ PLYWOOD .NAIL .
O 1 mit exempt ander Sce. B&P C I.,Ill,reason n - '
603. — ROOFSATTENS
owner o=re 604 ROOF IN-PROGRESS : '
' WORKER S EOMI F.NSATION DECLARAi'ION" " � '
Ihereby ifem(unite,penaltyof perjury one if the following declarations:
J 1 have and will maintain a Cenifle of Consent to Wif-incre.forWorker's �i }t � t ,
Comps anima, as provided for by Section 3700' f t Label Carle, forthe EVC:.. -
pFrormanceof(he work far which this pe ais issued, F��� r" - "},- • .r
❑1 ferric and will iota n Wmker s Core pressman Irooduall.looNmend by Section _
3700 r m I m-.Co I r t pnor, f thex r which this permit is '" JuN
issued ADW kersC ni"a's., nl uran arrer a`nd Poly nlxrurc. ., p '., .�'" 4
Coupr xtimrN BUILDING
CPRTI Xoll,,NON PRO WORKERS' ° ..
s r /�� J10,1USATION INSURANCE �� / F
(Tit t d'lot b c n pl ted'f InTeram,is fortune mandool
I centfy lnat in 11 p f a f ffirwmk for which this perlinit is.issued,I c.
.hall not employ'D person in any naliner,so as to h -subject to lM1 Workers
Compensation Laws of California' .Dl s
Applicant - e
NOTICE TO APPLICANT If, f1er making thCertificate fExemption,you should
Z''became, bj.1(d the W k Clar,amorimnp ' f the Labor Conle, a,, 1ttl
Q
forthwith comply with suchp Of lsvrdmtshall bdeemed revoked.
V_
� "
CONS9 RUCTION LENDING AGENCY is
s Iherebyafford he,It ka co,almoctimaletting age my far the pgrfommarga
"eY mo work tar which hisP I':issued(See3097,Co,C)
Landods Name
V z Leader's Address
0 1 tfythat Ih Jthis'pplt d111htd 6 no a -
fi wrr I.I g t I ly with II city d county J tl state lig
�•VmeIding constractionumadh by tl pen ti f this cit t po
�s W e the h t d property 1 inspection i g p
F .y -We).gote, user.indemnify andk p handles,the City ofCapnn stairs,
Z liabilities,judgm t:,nots and es,emer, Irish ra, n any Y accrue against said
C.1 Z City ad ofth ounfir,ofth:pedpu •
A CANTON .RSTAN D ILLC PLY WITH ALL ISSUedb
U EREGU fyl S Ley 1 719� y ' DflCe v' .
T P C°H/A�DOUS MATERIALS DISCLOSURE/ /D 1 '` R0-,GOTS ,
Will the applicant or enure building occurred store or handle ha.addl ar tee m `Type of Roof
as def ted 'y the Cupon m Mun'a p'd Cud CI 11 r 9.12 ul a the Health h a Safety "
Cock,Section 25532(.)1 - Ir - '
OY No All roofs shall be inspected prior to,any roofing material,being installed.
W'1111e plus t fwre-h 'll 6 p i -9u1 u d -es whh
If-a roof is installed without first obtaining an inspection, I agree to remove
mit h d s cont ares as defined by ehe Bay Area Am Quality Morma,m m - ,
Hitt^ all new materials for inspection. A pltcant understands and will c ply with
❑Ye" 0Nt
all no o t source r ations.
1 h .it 'he lacrimal mainirlsy me.T cader Chroar 695 cli
,.
California Halm&Safely Code,Sections 25502 5231 and 25534,I dider,oundiffent M
'fine bu lit tgd 1 rctlYhte tthtt . y .p nb l'tyt- tfylhe ! p:
nwupum of the mgire nwrc whiJt Host n t pn,r in nem race of a Cenihnnrc,f _ +
onaprray. a -
_ Signature of Ap licant' P Date •" ,
.ownnr u,a�maraea agars Date- • All'roif coverings to be Class y`+B" or better,
OFFICE•