01050060CI#Y OF CUPERTINO
CONTRACTOR INFORMATION:
li-IRLDING DIVISION PERMIT
BUILDINGADDT0635.. AVE.
PERMIT NO. 010150060
OWNER'S NANEQERNON EAST
..
APPLICATION 10131Y&/2001
PHONE:
SANITARY NO. CONTROL NO"
zARCI II"fliC'1'IENGINEER:
BUILDING PERMIT INFO
o
❑1I ELECT PLUNIR MECH
E
w
._I LI 1_I l=1
j LICENSED CON'l RAM OR'S DECLARATION
.lob Description
I hereby adfirm that I um licensed under pror ms of Chancr e) (en milacing
°re,.inn,c,
Jwimsucnnncandebui.'kionaorthenu,me„and lint recce
TEAR d GRAVEL TO CAP SHEET.
is in se lass a erect.”
License Class Lic, p
U Date Cmm�lcmr_
ON
S Iu n hall'. u•A :rs Puhl''reonl,
m
;/;z7
/
/
-IIUILDIiIt nl!CLAR,V9(lN
I he 11 r vet the arta .en,a teen me Cn Irwin, Liccnac Law nim Ihe
O
I n•ree, 171131.S�Eu,ine, and 11 fe,io I, Calc: Any,ny or enemy
/
Owhich Termites a permit n+ amen, alcor, impmve, Jenmlieh, m repair my micare
nes a
prier toer i e, aim requires IM1unpplicant fonueh permit to fie., dgneJ>mmmem
Sq. Ft. Floor Area
Vahnoglbma
— mat he is
(commencing wim Smion ](XXII of Div n 3nfthe Bmimes,amd Pddhr uwrCNe)
or that be i, eacmpl therefrom and the hack for the alleged exemption. Any siolmion
of Section 7031.5 by any applied, hit a permit subjects the applicant In a civil penalty
�.L,mh
APN`'I`7
Type
of not nnnom than five hundred dahao(S500k
�01�. 00Occupancy
01, an owner of the prnpeny, of toy employees with rages as their sole compensation,
LLIrCd Inspections
will An the work, and the structure is sot Emended or offered for sale (Sec. 71144.
Basin, ;Old Pnffc.,sinn, Code:'The Contruuuv's License Law Ices nut apply m un
of property who hand, or ingmoves thereon. and who does such work h oselt
—
305 F RFt19Y
�rr Id, two I, fill, ........ sided [hat such iniln v eat. a mm intended or
within
307 — I NSULAT ION
nOnomgh
lla'ed Ibe :it,, 1[ hawcvea Ihn building m' impmveincmlui% sold one year of
........ tine ocaner-bander sell have me harder of proving that he did not build or
601 — ROOF, TEAR OFF
improve for pu+pnse (If sale.).
602 — ROOF PLYWOOD NAIL
❑I.a of heImpert;,emsivelyeo+nmaclingwitlnhcensedronnraen„„It,
eon,N<� the pn+}mt (Sol. 70ii. ilu.ineN and I4o2,siom Codl The Comrmm”
603 — ROOF BATTENS
it) owner of property who hands or impmve, thereon.
Lirensc Law dues nm apply u
and who contract, for such project, with a commemrf,) licensed pursuant m line
604 — ROOF IN—PROGRESS
Conraeme's License Law.
❑ 1 elm exempt ower Sec. . R & P C fon his reason
Owncr Dam
WORKER'S COMPENSATION DECLARATION
'I hereby aftirn under penalty of petjnry one of rhe lidlawimy dccbuaiun,:
❑ I Iauve and will maintain a Certificate of Consent to self-insuro for Worker's
C'n u,naniom, a, adviJcd for by Section 371X1 of the Labor CIA , for the
Imtlonuunce of the work for which tlit,..mein is issued.
Cl I hm'c moil wi11 mainmin Worker', Contpensaion Ina ma,r. as repaired by lection
,
3701 of The LuMr Code, for the performance of the work far which this permil is
Wor\r—, Insurance varier and Policymark, amm:
ismcJf�.
/My
7C�ym�pcn�,ai�nn
.
Cu(m/"dSIPuti,ya.: IRmoKFR$'_
CERTIFICATION OP EXEIIPIIO FRON wO
COMPENSAI[ON INSURANCE
1'I his section need not be emoplaud if the Iwrmit Is for one hundred dollum
IS 1010) or less.)
1 ,,roily than In the Il nonce of tire Wolk I'ITT which this Pc nil is i, It 1
shall nun annploy any per Iso nay nnannnso 4, ea bemma x.be,( to the Workers'
Compmtmtin I Laws of California. Date
,
Applicant
NOI'ICH 'r0 APPLICAN'k If. after making thi, Cenif icam of Exemption, you should
beconne abject to be Worker's Cn r,loanion provi,iunh of the ludo Code, You ams)
forthwith comply with such provisions or this Permit hill he deemed rcvdkld.
O CONSTRUM ION LENDING AGENCY "
I hereby ahem Thal there i, a rxm,usetion Lending alecey her the performance
of the work for which this permit is issued (Sec. 3097• Co. C.)
.
❑ Israir,, Name
[.carter', Address
tiemnily last I have dead this application load ,Eric that the dWve intonation is
I agree to comply wldn ell city;t I county ordinances uad state Iowa relating
') e;i'ect.
;uuninycom,lmctian.amnhcrcby aid +o.iI. m...r"radvc, of this coy m carr upon
-
Ibe abuveanemmned properly roc impectiun pore.......
(Ale)agree to ,ave, mdemnily and keep btnmle” the City of Cupenlao ugalm,
A lixhilitic, juJgmmrr, case stn •,penins which mar in any way sore against said
G Gly iso comaqucn c he gr lit ;,I his permit.
ALL NON-POINT
ST DWILL COMPLYWITH
Issued by: Date
SOURCENT
Re-roofs
si nate
OUS NIX] PRIAM DISCLOSURE
NSR the apphc future building occupor stem or handle havaNtws mumrial
Type of Roof
n defined by the Coleman nicipul Cale. Chapter 9.12, and the Health and Safety
Clore, Section 25532(0)2
ElYe, ID No
All roofs shall he inspected prior to any roofing material being installed.
Wiuther,hroamt or metre bandir,.wo,:+nl nuc e,myraemo,dcvi,u, Whhd+
If a roof is installed without first obtaining an inspection, I agree to remove
cmtit b vaubms all commmiallas rs nursed by dm [toy Area Air (j:amy Mmmgemeat
Di,trierr
all new materials for inspection. Applicant understands and will comply with
LIYe, ClNo
all non-point source regulations.
1 have read the b dmdoun matelots rceryfrcnncnts under Chapter 6,95 of the
Cmlfomia Ilcahh & Safety Calc. Sections 25505. 25533 and 25534. 1 and..... dot
filnchnildingdos—tcu ally have a mount, that it as my rcspomsibility to nntidythe
^d
ccupaof yui m J s which nmw W n plot to isuaace of a Cmdreme of
xv
Daam p
(cant Date
All roof coverings to be Class "B" or better ,
t Date .
11 I mire
OFFICE