02030053 �CITY'IOF,CUPERTINO! -
� p"' 1 r „ CONTRACTOR INFORMATION:
,L BUILDINCDIVISION-tl' ERMIT; ,., ,,.., .. . .. ., ... .. -
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IUILDINO 'HEATHERW
HEt1S .._.... _._ ._ _..._. .. .,.,... ._ - PERMITNO.
B7541' OOD DR " UNITED.'ATR' `COMFORT .. .,... _.'' ' _. ,02030053,
- ' APPLICyTION S B DATE ..,
FERRUCCI ,DOMINIC A""ANDANNA7l-. • _5819 N -ANDREWS- WAY' ""` "'03'/1'3'/'2002 '
=PHONE;"!' '' '•-' - " --• le. r •. SANITARY NO. CONTROL NO.
(408) 771-8967
ARCHITECrrENGINEER:•"' BUILDING PERMIT INFO
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BLDG ELECT PLUMB MF.CH
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•' ILICENSEDC6WitACfORSDECLARATION
5„? it
Job Description
i Z- { I tion 7 )of that I am licensed B under provisions ofn,Code.(commencing - ,,
._F� upness and Profns ons Cock.and mylicense FURNACE .. .. - .. ._ .. -
wnh Senron]BOB)of Dlvlsron 3 of the B
te11 force nn B
nous DLhehse
13 LL y am' / Z Conwoor_ .
.a O a ARCHRECT'S DECLARATION -
i�y 3 i I I unEermanJ my Plans shall ne'used as public records
i¢O 0Licensed Professional f
OWNF.R-BUILDER DECLARATION,
- ' 1 hereby fr n hot I m e pt f m Ih .0 1 cm s License L f the ��1 - t t ,
t_afollowing rea. ntsat ADISBIr ndi r .cd-;Ay�tYre ty '.;i; r ' 'r r,. 'lilt l $2150
which y e apermit I construct,'all improve,demolish fmp any structure - P,' t'
win .pn 11iune,.61 yr applicantthe l :uchpermit fl 'Rued rt tl IS I' I ` il r•t
.:
hot 11
hamou lM< Cd punuandlo the prl i p s of he L l t r License Lo v(Cha ro 9i C d / Valuation
from tie g uh Set, nl]fNNO f0 p 7 pp_,,��® 11 1 ^ I'
I,yp p pP y I� 7 [rh �5 ppatpPmf syMl lunshy� 1 I 379 P�� 'l7, a sl %..lr. ,
ouh lhes smrNet Ilddeh lfo the ell bcken on civil
olatn �� .- ..• r. . .... ......._
d no,t 701151 o II I( u rml h 1.IM1 u I v 11 1 I - -
ofno�mrcNvl en d adollar,($sum 2044 N FLOOR' F ME.;•' Occupancy Type
❑I ow or he Uel rIn esti t with n �-'y��BTN -
o,.atofpmp1my hlsProdesstirm CMc:no Contractor's wa e61;uilds r adedeih l,sachL cense d wh dmemeoo,,oes not kIdWelf 304 ROUGH M��.yuu.a+..+ �Ctions ' '1
'Busiriis Bud d Ina s, at r I<tib lea 1 n ed r r sic sec.nwa y In an 3 0 3 _ ROUG
or
rr up.rta r rause In,'I p _ H ELECTRI CAL- '-
'dfrcrdd inn Ihe'uwn io be bu Id ng mtpm inicut.is poll w th n one Y of -” - -- ,i
e
ple
erwbudderwillhavetheburdenofprovingthat he did no,build or 505 - FINAL ELECTRICAL^r
mpmvctnrpP seorauln.>: 507 - FINAL PLUMBING
:.�'A� ❑1.as owner of the..`,.,^s,'..._..1... _.out. ..,._...,_ - .._.-_.. _ _
pr pe ) am cxdusivdy mmrvcting with Bcenud comrecmrsm 508' — FINAL _MECHANICAL;
construct the prolect.lsec.]Out Business and Professions Code:)The Contractor's
Lic514 — FINAL PUBLIC WORKS
ense Luw goes not vpply m on owner of pmperty wbo builds nr improve thereon,
`" _ond,who contract&for.such projcns.wilh a,camracmr(g.Ixtumd:pursuent m.,he
• .-. .
Conlmame,Liecnse Law, ._ _--_.--_.__...__..-..._._ ..__�.-- -- -.---__--_
--._._.__.... .. .___...-
❑lamexemptunderSec I`•'' X19 ' B& for this son .li.�C r .. "`r'r,
t- , Date
to01 Ftp/ALE®
.'WORKER'S COMPENSATION DECLARATION - •V
f h reby Al undei ptmrrh,aipats ry na cul f0h wmg dedarauons
APR 16 02 .
d�❑ 1 by a nil'. -proynimn a Cen lit&, of 3 n i t` If' for Worker's 20 ,
r I Co rmanc pro ace hi by.Sect n 3]OO of Ih Labor Code, for ,he s
it Pcrf sore'fihe work for which this ye ,isl d - -
-P 1 have u d wdi mitt in Wd ker i Com,pansaiion'Ttrimao'ce,us requhrad by Section
(3700f the Lab r Code forthe_,perform r therk far which this perm t s 11 B VIED NG
Issued My W rkCC mp , In moan c mer anJ Pol cy u M - I ^
•t•f, ilak L• t
c6 f�Xy C� ' Iry^lJG 2cf9/�46 Z7r tt'' 1 6 t {.• .. _ . ...--
+''? I, );CEH FICATION.OF EXEMPTION FROMIWORKERS' f.\.='9 t1 .'n; " ' as J. T„TIp ,
COMPRNSiTION INSURANCE -f _
lir 1('ITs ccuonn Wn Ih•mnplcad fth panne is for one hundred doll
I
sH100 o Ie J ,,.i IhC vrf rmnncdnf II ' k fir which Ihts perm,'s issued I s < '
all ret ny �
CPp mU n lawn pars n u y n i e s us 1 become uhJe n Inc Workers - -.. .. ... . ... .. ... ... ...
+ I c<ufy Ih'll iI
PI Y
xnf Coll n Unie' ”"� -
{,t INO'fICGTO APPLICAh'1'IL afier mvkingthn Cmlfemeof Exemption youmost ,• •'i' ,".�� I ""
bac me suhJ a to Ote W rker Cu proms piny s ns of the Lan Caae:
youu host st '
0 fonhw rh c mply with N pro i nr th pe m t shell m il e d ked:
�',I'CONSTRUCfION LENDING AGENCY "' ' •' 's t ''
F' ' '1 h by affrm rhm Ih rt I:a connmct n Iending age cy fo the perfodn ee _ r I
�' w�., v(the w k f r mh ch th¢tpermu Is issued(Sec trN1T Civ.C) - "' ' •
�fQ '.L<ndcr'e Namr' ... , aa.;. , .,.r. ti '. - ..::..•. r .. - .._ _. .._. ..._. t
V z
'co„ I comfy Ihvi l h ve rtud rhes epplicmron end xmlv,hw the above nfomudon is
GT+=[r __trcn.1 agree m comply with ell city'uld eoumy,ordinvntts end,nam laws elating -
� V. ,o bund gro wciio nil hertby euNonze iep ietivu f,h ny, ¢r poo
�i ril ,he ebote mem tied propcnY fo nspenion purpou U///l/I
f.,'d fWl gree,os emdemn fy naA pharml the Cny of Cupeninoaga tier
L V1 sub lu es Judge tits.c s¢end xpeniei hash m y ny ay ttme against mid
V'rZ. City n co q ce of the gmnung of Nis permit - / V
APPLICANT UNDER$TpYD$A LL COMPLY VIYHALL Nb PoI T'
souacE RECDL'Anoas, � _ 9�3w Issued by: " Date
ea defined b •Re-roofs .• ), . .,, .. , J -
A 'HAZARDOVS MATERIALS DISCLOSURE - _ _
S•g rwwdl the gppli�a for fmure builditig'ottupam swie or handle FazeNotis mmeval' TypCOf Roof. ' r . .mss. __
Y R .p p 9'll and the Healln and Safi ry i; - _ ... .._.
Code Section 2553718)Ino M c l Cod Cha a s t l r 3 1 ` f� h s G h i's 1 1 * is f :: s -„
..,.t ❑Yes MI IC I r
i 1 I I All roofs shall,be inspected pnor_to any,roofing material being Installed.,
_..._
,Will the applicant o futurebuilding occupant usic equp t ordevi,des wmcn If a roof is idsialled without first obtainingan ins ection,'I a ree.to'remove
cmitrict? us circ nem m.esllefnW by lh Bay A ea Av Quabty Managemem IJ g
District? - a ctlon I n and
11 new materials for mspe Applicant u derstands well comply with
Coir Oid ilio°&sin sec ae'raa es r riumoils' all non point source regulatwns
.I - ..
4 oder Chapter 695 of the _ � -• - ._. .� .-
y
c not currently have ote am lhol t, ny nw, b l ry l ,notify rhe - "-- -
the of the }
c p m of the rcq - is In't a b,,me,pr M 14 a of a Cen'fcet
y occ Pan r Dae 3
f
• �/, 2. ,.Signature of Appli ant ,,_, - Inr
_. t• .. .. . . _ .. t - .. ... .
_ OZ
,r w r nmp.ae gen, , t D le.. All roof coverings to be Class "B" or better '
OFFICE
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