00030153 en;
UPERTINO I'ERASR No.
G DIVISION PER IT CONTRACTOR INFORMATION:en QUO
ISS: I dd �CAi e�Q IaLJ� SAN ARY NO. APP ICAnON SUBMff fAL DATE A^' � � �rIt'I�l/' COM'XOLp
�1�270/ 5 71k S� �� '�3�/ ❑GINEF.R n VC7S 2) 'C4' BUI.DING PERMrr INFO
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o�y z I lneebr� w�i4�d rode ,p iatons of CC aper 9(4amlvencle[ r Job Description
vilh$Mbe'IJDO)dDivlup Jdme Ba.iaw aM DoraiomC�r.otl mat Ucmats
7
�f:L1/3to �ro ' �p�C Clea7 Of/7`—
m Y eWle full fmgxayand dfat.
SLL� We�,� ,�Cooucr•r, ldn. ro
�_a o g ��yw.a1��r�YAxCtwtrlet:�crs DECwlhwlrcuwnoN
Qoofi�t)o I�ldl
xW OWN am Coto DFJr OECIARAnON
I hvcbY afflm�' I un eaemp fmm Ns COeVacuYa licca,,L.a'fa We `
O sfcOwin[1 ywl.lSaUm'roJ I.3.Blaine.ud Rdnuam CaEr AnY cilY a ommy� `Z,, * e'poroitW a°""•47oopno, e°m°•or"p'imywr"" Sq. Ft. Floor Area Valuation
prior to in,iYurra,also regnLe Uc ap
nplt for inch pab
mn liile a lWaxi urtmcm
IMt M1e is lic pvracl w IEc pnovis.of ma conoanrr.Idcrna law(Chaprv9
•Icormlra'iv[vim Secdcn 1000)d NviJon J 4 m Butairwti sd Prafeliw Cads)or
min k maaflom and tine Iiatot for me allgd eaa pum.Any violmon d PN N ber Occupancy Type
Seaton TE1313 by mytppliuw fora pcmit wbpera tha Rplpa b.civil penahya
m mort tlan Rue hu�ad dello(5300). '
❑I.Yowrc4dtieproparr.ormra^Wrya,wimw.[eYme'vaokacnryeeulbo. .Required Inspections
will tint wens ammo.auc ontraarinrnrrita ea not
apply
entln of `
and prdeumu Cudr:Tito o s mala',Liwiue lav doe nor appy m if aura d ,
popary wM1obona,p L that
tin ina who donn,n wortkmulfo mrau�
Ma own .thi,ptavided mr alum Impae told
w K not aladed a ofraad for
ala If,howcrc 11It bwldirymor Imp pining
1,sold within t youofcwfor Cs
-0uiac nil hv<dr buNrn d provin[Uu,M did min hula a hnpmc for pe-
pond G4
❑I.u Queer d elle papnly,am uc anal caahacdo[sold:)ra,d caou or,U.muuuct ma prOjm,Iy 1114x.Bu,ima aed Ra.1to W M or,i Th.tin al,LI. ,
aYe law dcu oa 1pplybcOwmorpapny who ddldaaimprnvn OartOa.and 7� .
who conaan+for.r..n pope,sold•cmtrrlOr(a)Ifceued pinata in me Coourea'a \v�/
limen IoW. /
(]lam ecmq aMaSa. .BkPCfa tela rtuov
Dvwl Detc _ .
WORlmlp COMPFNSATLON DFA.AfUTION -
Thaaar.rr rmea pm,Nr orpvryry one of the rdawin[drelvrim:
4013 m.inwnacaarlaaorcw,+mwr.lmwa rw wortar.corgrao. .
orlon,Y PovldM ya by Secdoe J'100 0(ds labor COdS fa Ne pvfomulra of tle .
work have
which lli pmUl is tsaual. '1
XI law m will rwwin Watara Compenrulm lvaIor u his pon by Seam .
Myw me labor Codr,ra Uc pafamurcdIliwart fa which del pmdl aimd.
Ca x".—V CwnPenrtio^Inauu)Cc colic and Polity p
r CYt�� G "ITIICCM () M PoINY OMIMIF
CERTInC ONITEN AFTO INN MOMIMI
CUM]'ENSATION INSURANCE
(Dux rcdm roalmrEemropleladAmaparoots(wcecrmmad dello(5100) _
a kat
L,my mrlinrhe my rod c<dme vmk fwwhkh Uu,paml ts' .w l,ball
nnenlUo,a alifnma�r m,nrcr�o yt orb�.en aNc Wohen'CooWev )j�) /1\ r..,
WJon law.dGtlrrgeltiDar 3/L
Applkat /a7. ae/Z7Ti3
NOTICE TO APPLICANT:If.aha vaunt tints Cm;w..,d EaemFHa
wn.Yat mJd
b D
rroc sobjW to the Wwtd,CwaaNan nppmme lalta wi,ioo,of eadr,you ora, MAR 2 4 2000
forthwith comply wilt. h aovi b g or Ni,penWl,Ialt ba deeeN mokN.
CONMUC7G0N lFNDTNO A(MNCY Cb
O p IboNyalGeln that mac itcaarvcJna lrnAo¢a[®aY fortire parfamana ar
Z tir vat ra wbkM1 tid,pemdltsiWsd(Sec.Jp9l,Crv.CJ
E., lilda'a Nuhn a
�i IsMala Addma
LT7 A Iwrnn,mat1have lead UUaamilcicarindmedW me tame Wwm,UmM
Wadi.lags to caopy.imNaYold caOVY wdm,xcaab aro law .,oat n
Z baiam,caawaion.,od hertbraahoriu rtpeWuuiva tido nlY to..,oat me
abavc(WO I.,ialnapctlm puryoraa. .
'+ F.. (Wc),[rtew nam,mmol yard try ay in ss mmeyarCity oft"a=aa[,iat
'O V Itsbilnie,jutl6mena,rnu,ed upeYY wb;aln nay in aY vaY rauaayinr.aid City e
E APPI.ICANTUNDFRSTANUS AND NTIl COMPLY WInI All WN POINT14
`
SW NCB REGUTAI'IONS.
z
Si[umc ofApptirnVCOvuaaw
Nantor US MATERIALS DISCLOSURE
Malinei1neCkYlon Mulicip.1 rdg Chaptrwaw ral nY,ldmatnatinial)Wfty Re-roofs
u Coil,
by Ute Cupaniro Multicipl cods Chaps 9.1;ab me lwlm and Safay
edea sa,;an xs532(.)9 - Type of Roof
❑Yn ❑NO
WiJI da apoie.w or hnaeNu,dlng aala,ant a a unip,�nt a dm ice,whk All roofs shall be inspected prior to any roofing material being
linb .0
„ mMcaa.mita,YdaBnedbylh,BayA Ai(2ralityM.a.[� installed. If a roof is Installed,
, Ta ]NO
without first obtaining an inspection
40 1 1 I agree to remove all new materials for inspection. Applicant
❑
Ia"�,me rWlooi aana,e9alm �„ Chiir.695dmi,Cat understands and will comply with all non point source regulations.
fania Halm k bafay Code,Secdora 25505.25333 and 255N.1 ancrod min if tis
Iwldmgdon ow cunenly Me.re�I,mrntsor,rtapaebitil
lynoairy dr aaapa 1 3 �•
d me rtquirtmaY whkb norbe rm that
iswrced•Catirlto n dOmpay.
Ora
Signature of Applicant Dae
Pwlrfw,umOtizW a[ea .
All roof coverings to be Class"B"or better
OF ICE