00060024 -'CITY OFCUPERTINO - -
Batt INO mvtstON PER VIIT CONTRACTOR INFORMATION:
' BUILDING AOIlRESS:' �� ^ ' - - PERMIT.NO•
21143tCHRISTENSEN' DR PETERSEN—DEAN INC00060024
WNCR'S NAME t e " ,. APPLICATION.SIN DATE .
CHANG 'DAVID'M Ali6hSCISANNE' L 7980 ENTERPRISE' DR 06/05%2000
PHONE', SANITARY NO,,' CONTROL NO.
Is
. (510) 494-9982
M VQ C ZO ARCHITECT/ENGINEER, r .. cr •. ' TSU ILDING PERMIT INFO- -(
NLUC hLUCI PLUMB MECH
ZS Z 1ICFLASEDCONfRAMOlt SI) CLARAf10N " ]Ob Description "
11 by RrtthatIa I' e d d p fCl pt 9( g p
OZ ❑ tthS t ]Wlp fD t' 3danB It f:c Ctl end ray I,' y '
I.c teilFrl 5'aee L a /� SHAKE TO SHAKE REROOF
' pat Coal
CS On ARCt11fF.CTIs DCCLARA310 5 _,f•, ( �'. .
sa�+�i� d '1 d YPI lull bcm Ipnl' niN ,i
'ul�p0 yUeranedPrf:'mal -
n' NIR—BUILDER DECLARATION
to 1 hereby affirm that I arn scenipt froor the Contractor's License Law f thel r '. } '• .
C < foll g (Section'1011 5 B and Profession,Code Any 4 ty - r
f.tF0 which 11 p it .t r ❑ tap c J I:h p' y t I -
t�i�732Pn t t I q " .th ppl tf SuchP n 11 'g dtt m
math licensed pt to the provisions oftM1 Connector's Lie ' Law(Chapter 9 .'t'. Sq._Ft. Fl1 11oor - _ Valuation"•
(conTnnel ag with SuAnn 90(0)(if Dv'.' i ftl B . aJProt ..' :Code)
onhat he's c "mpt thereforr.ad the b.sis battle 11g d c opt Any t'ob t un . " °'.
of Scent 7091SM1yany applicantt periffit,tbjtt.le the applicant ldevil peals `
'nrnet a0remanrten i-data r,(Ason) �» 'APN Number '- Occupancy,Type
do oftheprthny;annye is ,,it eserdlor offered
final air mmpenw044, 7 7
y will d the k d n, b t tit led fl aw air lass 57044 - .. -
Bn' d Profession,code fh.o t t L e w,, act 1,hill 'Required Inspections '
w f p p fly Wh h W' - p tl d 'h d -h, k h 11 >,
305 — FRAME'',� i l
or gM1 sa we er, p d d tl t 1 p ens: t t dea ., .
offeredf . I .If,h the building or hiprovencrat is.oil within now yarn( 307 — INSULATION
em pie the bId ill hmulcM rie fprnv'ngd thedtanotbond or ' --
Impr,ertrnnme,em. I ). _ •• 1 , 601 -: ROOF .TEAR- OFFS' ..
❑Las ox tcn,nhn pr pert) luk ly t i :m I¢nd nt act to
t
L.astord din pojehl(set,7044'Ba,fiass aid P oles,t0a,Cadt)The Coneretrisf, 602 ROOF PLYWOOD NAIL
tc L tl t apply t of p'iperty abrUn IJ pri Ih - .
and 1 t t,r inch projects wtm.a contractors) l m d lrha t therk 603 —: ROOF` BATTENS J' '
El e,ip,tide,Sed B&ICPit his r u - 604 — ROOF '41',17-PROGRESS
OwnerDad` Iib„ - ., -
/ WORKER S COMPENSATION DI CI AkADDN
iherchy affiirn d penalty efp Try ne fth following d I i � e �
'❑ I h and II mans C tl t f Consent I ell [ W k 4 t h
Co penin : p d d f by S t n 3703 f th f h L d 1 ih
pert mane f fh k C h h tl'-I u al. a - ''
I h d II w W k .C ,o 1 1 p - d b.5 t �/�
3700 of the Labor Ct 1 for thepe f a f the work for whichthis pernat is
doped My irkcrs nawasetion Insurancecarrierand Policy numberare -
Caner:�� se+-=r^—`.�n�Pol'y
CERTIFICATION OF EXEMPf10N FROM WORKERS",y
COMPENSATION INSURANCE
1
(This section need not he tomplwed 1 me par ti t is f (died dollars ' r
(A 100)or less) rJ,, ,
1 craft,that'it the pserficAnatice of he askfor whch this p 't' .sued I s, 't
shall n t era,loy an,tk n in air,annall: hi beceirse labirld 10 its Worker"
Compensation Lee,of California Dred
Apploreat - s •`
NOTICE TO APPLICANT If, ft eking this Certllertenf Essropiii you should '
Q Omnecoe subyecno the k C . t p p : if the labor Code youmost
foBo,kcomplywith:richPocimain,or this arostshal l he deconal revoked„
CONST RUCTION LENDING AGENCY
_ < ,
e
^a y I hereby affirm that there n'Ir f leading aye y I r the peifm
nrance
Fr
if the workfor h'ehthe mann,, rvuetl(See.7097,Civ.C) 1
r,.
Leader's.Na to
5 Leader',Add
UO Iready flirt lhave readthi ,h t and late that the dave' f i' tt
correct I agree to comply with all city and' tY d' _ d tat ws rel.t 6 a
V
in,building construction,and hereby.ttbore representof thiseatw enli,vTorr
the sho,,,-rachlitandpnnhais no,nor,pri,ptsid.
Fy py (W)agree to save, d dy andkeep h 1 .tleCty or Caperton g t A
V1 lithilitice,junbatents.costsI expenses which atay to any way tga tst said -
V z City - nsTUNDnit fitg of thh,DWIp nut, r - V/ f
APPLICANT UND TANDS ND WIL OMPLY WITH ALL NO POI ` ./
i'soukeE RBcuI oes _ �. S Ov Issued by: Date
'.St,carad ifAp hvahUCm amr ” - Dae, •Re-roofs• -
HAZ MOUS MATERIALS DISCLOSUREh„a .n
t
wunee appiiwm r t bodkin, P t r m a:orth anterial 'Type of Roof,. .
as defined by the Cuporfno Mu t gipal Code Contact)12,and the Ilealth and Safety
Code,Section 255.32(a)7
°Y All roofs shall be inspected prior to any roofing material being installed.
Will d ,,I t f t I 'm' g ecttpaat ate ctry'p t d `hOr If a rooinstalled without first obtaining an inspection I to remove
'mit h d co ride is t' lefired by the Bay Area A one IlY Manager ant f is pecagree..
District)ores all,new materials'for.inspection. Applicant understands and will comply"with,
all non point source regulations., -
i I have read the hazardous to`Is requidereents unde CI pt fi 95 orthe t ' '
Calf Health&Suf ry Cad S :25505 25533 d 25534 1 d 'm 1 th t -
.4 if the buildingde5 of currently have tenant,tl that Y p nityt notify the �, rt
Leap t of ryire o wh cI moot tp erro ss n.ofeC n'Ret f' •' 1, - Ott '
LS
OLcapan y. ' Signature of Appllc^nt :' - ,' Date -
L, 3 oV
U,,wro� umortoced, t, .. 1.
, - . - Doa '' '4'%, -All roof coverings to'be-Class,';B:'or better -
OFFICE