00100148 CITY OF CUPERTINO " - f,
BUILDING DIVISION PERMIT CONTRACTOR'INFORMATION: ' - -
BUILDING ADDRIiSS: - ' w "r' • PERMIT NO. CC J IO� I eJ
�. 214 �dLt,fTi tii:S ..LNC ' , 1` Cl
OW'NHWS4(0825 DRYDEN AV APPLICAT _ M11 .
• PHNE: BERGER WILLIAM, H ET AL SSlitNo.
°
GG .CHITI;CTIENGINCER: - - .. NUILDING PERMIT INFO
�r m I OGS ELECT PLUMBMUCH
].
LICENSED CONTRACTOR S'DI CLARAIION
o, c 1 n by «or ma l ma lion col e I ' ns ofCl nne,9 mamme c g' - Job Descrip on -
w wnor s i 71401) r Dllsono'3 J llv Bu II feZsxlnx Cf.cundnyref.
im III rcc and ell' C ( 7 7'll
z , License Class Cm p—� 70
Date_/Il.-�,�0[] Comracmr
3` ARCI `2'S
A A S tdTlg SHAKE TO SHAKE
C I undefsmnd my plan he wed a,
Licensttl l'nNesviunal' m �
NCR BUII DER IILCI ARATION
m_ 1 1 by th f 1 opt from th Comment,x L e 1 for the /
C z a fall mg raw '1031 5 Business d Professions C I Any city r namy -
5€C� wh h 4u P I construct. II I 1 I h p any shown .'
a 'pr t y d 'filo tf p II II t.lb J.I le I O
morn licensed 1 It thep of the Cordial Lc La (Chapter 9 S Ft. Floor Area a ation
(can feria g ,In Section 7"0) f D'�s 3 f m R : u fir Coda q _ 0
or that he is ex mild Ih reform and the half,for Inc allcgN exemption Any violation
of Seninn 703 L5 by ani applmum to,a pe.if,.hj,cis the applirnn ro anvil peach
ornal lm,re man roe o ndred dMir rs5(mr y - APN Number Occu ' pe
°will J the as ref kn and tprohe st Io isrty,or act I d J with wagran 1bmJ for as their (e compt
sale(Svc7014, ~
milijax,rdid Pinfiellimm Cada rn Carburetor's Lit La toe I pply m an 3561,4010. 00quired Inspections
r of pmpeny Who builds or f npnnes d ercon,and who dues such work himself
or II rough his own employee..provided that such improvmnanln are not Intended or '
offered for sole.Ir,11,11111,the building or In.prnvumem i%sdld within one ymr al
completion,me nwner.hmme—ill navethe ha den of pravmg that terbium buildn' 305 — FRAME
infprove for purpose of sale.). ,
307 — INSULATTON
°1,asownerofthe Property,amcaclusivclyeanlmeling won licensed contractors to - 60 1., —_ ROOF TEAR OFF .
Lirouuel the pmjen(Sec.1494,Business and I'ndaseums Codef The Contractor's -
ceneLawdnaxmnnpplyfaanawnar rpmpanrwbabaiinaorhnpmvesthereof, F02 — ROOF' PLY1400D 1xIATl_
and who aondects for such projects with a com ucmr(s)Iifecmcd pursuant m the — '
Committal,License law, 603 ROOF BATTENS
❑I am exempt under Sec ,H&1'C for this reason ,
Owner Lou - `604 — R06F IN—PROGRESSO
WORKER'S COMPENSATION DECLARA'T'ION
I hereby affirm under penalty of perjury one of the following decmlations:
° I have and will youlsid a Cenilicdte of Cn twal to wit-insureTor Wako,
'Cmnpensalion, as provided for by Section 3710 of the Labor Codd, for the
-rformmnce of the work roti which his permit is issued, f
have and will mainland Worker',Compensation Insurance,m rcyuirsd by Section
.3 f of The Labor Cade,for the performance'nf the work for which this percht is
tied M Worker's Cam tion ln.cumnce Fanicr and Policy number are:
e�r sad Akanrecrr Q o
CmrieriAJStiQQf _policy Nn.: S_� L2_8. 1 _
CERIIPTTCATION OPIiKENIP ON I7ROM ) RS'
COMPENSATION INSURANCE
franc section nred not be emnpicled if the permit is for dna hundred dollars
5100) ne,x.) -
I.
I%edify that in the performance of the work for which this permit is swed.I -
shall an,employ any perocn in any manner so as of hecomc call 1.the Wodefi -
Canysmnmion laws of California.Dae }. ,
APPlicanl e
NONCE 10 APPLICANT If,motor naki ng this Cerl ilicale of Exudation,you.should
QZbaro,ith comply the Workers Compero:toon pmvisiunsors,deemed Code.Yon mow - '
O ronhwith comply with.ash provisions mthis permit vault be deemed revoked.
F
CONSTRUCTION LENoilers NG AGENCY '
a I herchy duckir thus Ill is n mminmecn 4YO.g agency I'nnho perfmmenue '
0. of Lender's
woe for which this pennil is isxucA[Sot.]Iy)7.Civ.Cd - -
Fa Q Lender'%Name
5 z LcnJcr's Address
U O1 ready thin I have e dr,urnpli,micon and slaor Ih,f the choseinformal - '
correct I,1 agree a)comply with or cily nitty I a 'e d 'ba I' - -$Ing . v
QV to buildingdistortion, Jh rchy Thor I .uuulivesof lav city to enter slam -
r� the ahwcmemiancd propeny for inspection purposes.
(We)agree': indemnify and k ptr dem the City orCuprnmo against
liabilities, dg Ia .repw - -
which may in tiny stay accrue against said `
VZ CifY f. nl'h 6 til r ?�
r
SOUR C it n N WITH ALI,NON.POTNT Issued by: �O/ Date Z,6' l
n. n1 ApplicanUComrucmr pate Re-roofs -
HAZARDOUS MATERIALS DISCLOSURE
Will the applietmarframe budgingoccipital ,am orhaulicmosormaterial Type.of Roof
xx defined by the Cra,,ino Munici Pal Code,Ch tin,,4.12 and the Health and Safety '
Code.Section 25532(a)'I ,
All roofs shall be inspected prior to any roofing material being installed.
• Willlhaappficumarmt ilJingoccupamuseryuipmemorJcvlceswhich If a roof is installed without firstobtaining an inspection, 1 agree to remove '
emit noardnu,air emiurner as defined bythe Bny Arca Air could,Manugrmcut
Dixlricn - ' " all new ma ials for inspection. Applicant understands and will-comply"with
°v A"" all non- in source,%Pula on
I have read the Mmfdnus nmmrials requircfnent,under chapter 6.95 of.the 6 - -
alifarnin finch &Safety Code.Sued ms 25 2 ?]and 25534.1 undersland Ihm ---
itnchtildin• not,ureird have ryo,pn oihi111ymnaily l he /D —.2e a
occupant e If lu. 'In sommare of n Cenificme of
Oce
�e-2Q S' ature of Applicant . , Date,
Ow maamud.edagnfl Date •-' All roof coverings to be Class •`B" or better -
i OFFICE - - _