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00120118 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACT_OR INFORMATION: BUILDINGA „ .+" PHRMITNO ,. Ctj'(TONWOOD I)R EAST"MRN CONIRACTTI\l L;, 7'iVC 00720178 OWNFI25N h1', APPLICATION SUB DATE 1J.'9/2Q60 I V INGGOOD 1.41,8* DOUGI"AS ST - 12/7 9/2Q00 PHONE: - -- - SANITARY NO. ` CONTROL NO..(408) 9 -1—` 000 t 0 RCHIIEC I/ENGINEER: - "' _ ,BUILDING PERMIT INFO a t� of I "s, • BLT -ELECT-,' PLUMB MECH' H¢6 ! Z S y (beach, - LICENSED CONTRACIOk S DECLARATION . 706 Desarl tlOn .. OZ ❑ II hY H Intl I' J J p : sof Chapter 9( me 'ng Description Cyt with I 71HHI) fDivision' 3af lbeBu dPror . .0 1 ryl' - ` �x �. ai pnf and «el. Is SHANE TO• COME) ROOF'' ,dC ,Lia mom, L M cb g,� Dam I C t..at., ARCHIFECT S DECLARATION 0� 1 d .c 1 Illypl plane J M1I' J. OWNER BUILDER front (h ARAl10N w I heathy 0- Out l pt f m Ih C I t f tb - C ¢ I,hi q (Section]ITU5 Ensure, 1P f e C e Y an r ofny x❑ ' h h t, p II e, n ,h p d 11 p nY.valre �( - � I q he c,plicautI IIt its bwdCh I t _ mash with n d p . nl Contractor iu � Cod 9 S Ft Floor Area ^�' alai 1 - s (awn g crucial t "IOW] 1 e 3 'he H :' d Professions Cdr tI'. -' . �T - nl t h e pl Ih f J tb h lot lse 11 g l pt A y b JYJ ') of Se u0 7031.5 by y ppl¢co for p I h3 t.thepl Itcant m a I totally , er, -APN Number '�Qccupancy Type ❑1 f m property. ratty employers with 6 :their nP f :sF197 t0?0, 00 JJf P:, ill U thek and theI t Iintended offered for le(See,1614 - - But .:and P f.. Code fn c 1 t r r I 1 t apply t - _ Required Inspecntions;. rp p tv wl b II p _e me A ha J n workn a 'a+ 30� FRAME rthrough h'. pIY 'totaling' atht. h' P l: t' r td r Be d to, cle.11 however the building or ounprouscrincon'. . Id wahir at year f • - 367 -- .INSULAfION . saplCn,me owner hu mer w'd based nrdenafprtvng that he did not build or _ „ .' mproveforpurpe.cafoilr.). 60 1 . ROOF' TEAR .OFF 01,al owner ofu property, 1v contracting withratn d iaCtnran 60 '' — ROOF':' PLYWOOD WTI.. Hco t t.th project(S 7044 B d Professions C b ),Th C unduat s ite Lae .nTapplyl ofproperty wn houlds or jTdoesm n 603' — ROOF BATTENS and H c t is f h p afters with a< r aunr(sl.l c d pair-live,a the ' c w 604 ROOF TN—PROGRESS .OI nntnt",Sec. ',Bk PCfm misrc: n. owner awe W dPENSATION DECLARAINON - - 1 yr penu Yo p Jtry o,co gJ laradons, �. . 0 1 nava and will,maie,ain'a Crefficam of Consent m self-insuro for Wo,ker', e coopeausatprovided tor by Section 37W f the Liter Code, for,the . -rf e of(lie work fwhich this parentiIins W, r ] - - 01 not.and will nadroun Workle r Compensation Insurance,as acquired by Section 7� 3700 of the[,fiber Calc,for the per6rirunce of the work for which this permit is. - ssueJ,My Worker's Compctvation I....ance wirier and Policy numbetvva: so �Carrler: r Policy Nu.f- - CERTIFICAT ION OF EXEMMON FROMWORKERS' COMPENSATION INSURANCE „ , , (Thissutlon need not becompledul ifthe permit is parent hundeeddolntrs ($I Wry br I... I certify but In be performance of the work for which this permit is Issues[,1 mull d pl y p r y o t l .ubjwt 1.me Workers ' r CantinAir. „pSeL1 q__C1 APOIc I �9�..-rill NOTICE 9CIA PLIC 1 pair. Ih' Celfl bf�xemptmn yrn sh Id4111 , bco II tt th W 1 rt pIf lnc Labor Code you must ' Q Q formwtth corply with such provision.or this crinif shall be deemed revoked. d' .F ► CONSTRUCTION LENUINO AGENCYy t herchy df....[hit there is construction landing agency fnr the pe rfomance of the work for which m s pe idit I Issued(Sea 3097.Cie C) Larder's Noone Lender's Address, t r' t t V 0 1 certifyIn[Ihave read On, pd t d.late but ah.,"inforniction is '• W �y cooled.1.'ree,to ply with II tiny not county indoneence,.,ad cle Is,,chain, 1 - - 0V to building con,bactiou, adI by aund i,c re,refentinotolif do,all,doer,,upon �y Tp] the above olenl coned pr P ray for inspectionpurposes. �y ow (We)agree to .,I,andonard 1, ad keeph I..the ClY pCP r ga t3 t fr Ln l shift 3 lg t t 1 p which ay in- my way accrue ritual load City in consequence of the grunting of th is pernei t, k i s . APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL /2 -IANON-POI NT su'ou kro0 , Ised6y �•- f Date sgtt ati Date rOofs RD(US MATERIALS DISCLOSUkI f ` , Will ihppliciiitorintbuildiiig«cupaiitstomorhuadihazEiMinornal ` a,dor eamr m c p rt o Mrmopsl tact_ cb'w 9 Iz,aha m tieahn ann sof ty, ..�'Pe of Roof Coda S I 25s32(a) . • Is ❑Y T _ _ , - , All roofs shall be inspected prior to any roofing material being installed: �+ wd Je'v11 t l t e n iia g p r .t�q,pn I 1 lien If-'ainof is installed without first obtaining an inspectim ;I agree to remove amitn aJov,a,camm�eral,a,def tedbytha Bay ArwArQualty,M.babemed, - t Di.tritta - all new a, clil -materials foi`inspebtion. 'Applicant undefstaitds�and,will comply'with °Y all non-point source regulations. + Ila,readth hatleallail r,taliallyart,under Cl pt 695 Mlhe" vhf" 11ahh&Saf tyCodc SoSelect,25505.25533and 25534.1 unallablandt1at al •` -fille Idildingdoes not currentlyne t arent,that it Is Illy re,onsibilliyt really th ccup t ofthe retry con eon whch must be do P,or,to tai e f a Certificate1 Octaipare - ignature fA t� '-' '.Date f2 l 'moo . neroraatneriae at Dade' AlLroof coverings to,be Class["B" or better . ` . OFFICE " _