03090025 COPY OF CUPERTINO ---
BUILDING DIVISION PERMIT . CONTRAGTnR`INFORMA xI.
B UILDING ADDRESS: WALLACE CONSTRUCTION INCr PITNo03090025
14C)7 T.TLTMV TDI
OWNER'S NAME: 7050 SAN FELIPE ROAD ��dR' ue DATE
PRTRTZ F, LINDA TnMr.
)NE: SANITARY NO. CONTROL NO.
(831) 637-8888
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
CJ t�
+00 LICENSED CONTRACTOR's DECLARATION Job Description
U F I hereby affirm at I am licensed under provisions of Chapter 9(commencing
with Section 7")Or Division 3 ofthe Business and Professions Code,and my license is
'.cct
in full mrta and effect.y Z License ClassLoc,a GARAGE REMODEL
�^ DaN. Comommir
PG ARCHITECTS DECLARATION
fCU .l oan
undcrd mnsy plashell he uuu
dpue rtmN
hlis
>a
at; LiccnudPm(cuionel
5 OW NEm exempt
m Ce Contractor's
ON
�00 v 1 hereby affirm on 11. cumpl Iran the dormsC e:Any c Law for the
mwhich re reason. er itI 7031.5;Business and Pm&axiom Code:Any citylircounty .
which requires a permit m corts the applicant
improve,demolish,lir repair any svunum
3Zi
prior to incensed c,rimana ace the Tarsuch Contrarmitmicense ave statement
=0
-.1m,he iscingwiit puntion7 the pmvivinm of she comines, nd Prof low(Chapter;Code)
Sq. Ft. Floor Area ValuaLlO❑
yd t$ (eat he is(commencingwith Section m and due basis
f r the
theegexempt on.Any
Cade)or
3 Nol he is exempt Nertfmm end Ne bazu fm Ne tllcgmd exemption.Any violation of 35624006 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to.civil penalty of - APN Number Occupancy Type
not mom than five hundred dollars(3500).
❑I,as owner of the property,or my employees with wages as their wlc compenution,
will do the work.and the someone is not Intended or offered par sale 7W,Business —
and Professions Code:The Convenors License low does not apply to an owner of _ d Inspection
propcny who build,orpowas camm,t dwhodoes.uch work himself.,through his 102 — PIERS
imth
own employees,provided that such impwveni us not intended oroffemd for sale.It. 103 — UFER
however,the building or improvement is sold within ane year of completion,the owner-
builder will hove she burden of proving Nat he did not build or improve for purpose of 104 - REBAR
es11,as owner of the property,am exclusively convening with licensed convenors to 105 — ANCHOR BOLTS
construct the Project(Sec.?UM,Business and Professions Cade:)The Condolences Li. 106 — SEWER & WATER 3
come Law does not apply to an owner of property who builds or improves diamond.and, 202 — UNDERFLOOR PLUMBING
who contracts for such projects with a conwcmrD)licensed pursuant to Inc Contractor's
Ike^,m sews 01 1 203 — UNDERFLOOR MECHANICAL
0 de D
. ezc p unden5 a&PCfo this arson 204 — UNDERFLOOR FRAME
o lie Date r 3 0
WORKER'S COMP S ON CI-AR 205 — UNDERFLOOR INSULATION
TI '
I hereby affirm under penalty of perjury one of the following deeloniom: 301 — ROUGH PLUMBING
J Ihave and will rommulm a Certificate of Consent to selfdnsum for WorkoNCompmm 302 — TUB & OR SHOWER
Ij anion,as p.video for by Section 7700 of the Inbar Code,for the performance of the 303 — ROUGH MECHANI CAL ,
.,it for which this permit is issued.
El I hers and will maintain Workers Compensation Insurance,as squired by Section _ 304 — ROUGH ELECTRICAL .
3700 of me Lothar Code,for me perfarmance,of One work for which this permit i,Issued. 3 05 — FRAME
My Workers Compensation Insurance artier and Policy number art: 306 — HOLDOWNS
Cartier. -Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 — C..r'HE}."`TROC'K .
(Thu section need not becompleted if the Permit is formic hundred dollars nIOM 309 — EXTERIOR LATH
.,leas.) 310 — INTERIOR LATH
employ any
that in on inperformance of the work for which this permit is rtes Com shall
nsa nm
L....anyperso.inaty manncrwssu Mcome subjccl to the Workers Compensation 311 — SCRATCH COAT
Laws of Caliromie.Data
Applicant313 — ROOF NAIL
NOTICE TO APPLICANT:IL after making this cc.i0cate of Exemption,you should 501 — FINAL ELECTRICAL ENERGY
become suomplyct the Workers Coons or this
sprout previsions of the Labor Code,you must 502 — FINAL PLUMBING ENERGY
`� forthwith comply with touch provisions Cm asthis Ppreitionll Mdeemedmote,.
_o CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hemhy aMrm that there its comwchom leading agency to,ft pefurmwm of 504 — FINAL BUILDING ENERGY
�14.W thewwsNamefor lmnmiaparrot l.ismm(sme.309?,civ.c.) 505 — FINAL ELECTRICAL
1J > the work
Name
Lenders Addms
5Z 506 - GAS TEST
:XC I cartory duet I have mad this application end all mal dim shove information ix 507 — FINAL PLUMBING
correct.I agree to comply with all city and county ordinances and same laws Rlaling to
UV bhav-mentionedfomandforinspectionpugowsenutivcsofmsscitymenmruponme FIN MECHAN CAL
ahavc-mcnnsirac formerlyformctionpurepua
(We)agme to saw.indemnify and keep harmless the City of Cupertino against 0 9 FIN 1�
ti h Imbi lodes,judgmens,costs and expenses which may in any way seems against said Cly 5 A G
J',Z in consequence of she gaiting of this Permit.
" APPLIC NT UNDERSTANDS AND WILL COMPLY WITH ALL ON-POINT Issued by:5 ' WORKS Dat
SOUR E E ULATIQ�s. ��
--LATIDN". 6 �*f Re-roofs
Sign to c ApplicanUCamrwmr a
Jp HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle harudous material
as defined by the Cupeni no Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)?
C]Y. )(NoAllroofs shall be inspected prior to any roofing material being installed.
Will the applicant of future building Occupant use egmpmam or device,which If a roof is installed without first obtaining an inspection, I agree to remove
.roll hozardous air contaminants as defncd by the Bay Area Air Quality Management all new materials for inspection.
al. District? \�'r
❑Yee ®N. f
I here mad t e haand.us materials myvommens under Chapter 6.95 ortha Cabral.
nim Halm&Scdey Calc,Sections 75505,25533 and 25534,1 understand that(tho Wilding
does not come tly tenant,that it is my responsibiliy m n tify cecy ant of the
mgairtr(t�n Me moat et pdm.lui{S.anem.r.eardna¢ary�. Signature of Applicant Date
Own`c{ Ill I—r All roof coverings to be Class "B" or better
r ser cum izcd mgcm Dam
t( - C*Y OF CUPERTINO
CUPEI OFIN(� PERMIT APPLICATION FORM
- N# � � � � O � Date: {
Building Addr
1Wll lac
Owner's Name: 1-1-0 Phone#:
�+er • To
Contract _ �L' � _ License#:
Contact: 1 TY�,kjC'3T�� �1_g�g� Cu ertino Business License#:
Building Permit Info: ^
Bldg9`P Elect Ly/ Plumb ❑ Mech ❑
Job Description: F,
Residential a- ommercial ❑
Sq.Ft. Floor Are ji►.�1 /Sq.
Cost of Proj ct: Occupancy Group:
Type of Cons ction:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler>500K to 1M Btu . MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 . Elec 600V> 1000A ELECTRICAL
BELEC200 Elee Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee I BUILDING
1 of 3
ME
COV OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE PbIg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREM3USWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting.Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREWMAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
2 of 3
Cp . CITY OF CUPERTIlA
CITY 0 PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT _ Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL J
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEumbin Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chan e BUILDING
3 of 3
V/
4 Garage Door He'ader
Beeinoa
(TM)6.06 Senal Nernber:7002019061 3 1/2" x 11 7/8" 2.0E Parallari PSL
User:I 8129a003951:48 AM
Page I Engine Vension:1.6.44 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN
CONTROLS FOR THE APPLICATION AND LOADS LISTED
Ezt�'w
FIR
116'7" _41 I
Product Diagram is Conceptual.
LOADS:
Analysis is for a Header(Flush Beam)Member. Tributary Load Width: 1'
Primary Load Group-Residential-Living Areas(pso:40.0 Live at 100%duration, 10.0 Dead
Vertical Loads:
Typo Class Live Dead Location Application Comment
Uniform(plf) Roof(1.25) 224.0 184.0 OTo16'7" Replaces mco"
SUPPORTS:
Input Bearing Vertical Reactions(Ibs) Detail Other
Width Length Live/Dead/Uplift/Total
1 Stud wall 3.50" 3.50" 1857 11633/013490 Al:Blocking 1 Ply 1"x 11 718"e-Rim Board®
2 Stud wall 3.50" 3.50" 1857 11633/0/3490 Al:Blocking 1 Ply_1"x 11 7/ e-Rim Board®
-See TJ SPECIFIER'S/BUILDERS GUIDE for detail(s):Al:Blocking APPROVED
'ACCORDANCE M 'A=RDANCE TN THE CITY W
DESIGN CONTROLS: CUPEnNo u, ES AND RDINANCES
Maximum Design Control Control Location
Shear(Ibs) 3420 -2951 10044 Passed(29%) Rt.end under Roo to din
,Moment(Ft-Lbs) 13895 1 13895 24878 Passed(56%) MIDSpagliNnder ool'111071ci,g
Live Load Dan(in) 0.380 0.406 Passed(U513) MID Spa M'er'Roof foadin
Total Load Den(in) rhl�isu
0.715 0.813 Passed(L1273) MID SpaGe sunder rnp.Aq Pm. pecificationS MUS*,
under Roof loadin
kept on Ira Job aL all times and it is Un
-Defection Criteria:STANDARD(LL:U480jL:1J240). 1AWful to make any ChahRes or alterations
-Braclng(Lu):All compression edges(top and bottom)must be braced at 2'8"o/c ui�qss detailed otherwise. Proper attachment and positioning of
lateral bracing is required to achieve member stability. ei sidifflission rrorr,
the buileing Dept., MY Of Cupertino.
ADDITIONAL NOTES: the stamping Of this plan and specification"
-IMPORTANTI The analysis presented is output from software developed by Trus Joiit!(TJ)IOTJIwa'rrdhtstthe.sizing ofuits products by this software will
be accomplished in accordance with TJ product design criteria and code accepted designLyalues-eTheisp cific.p.r.od6ct-apiSlickon,input design loads,
and stated dimensions have been provided by the software user. This output has not been reviewed a�J Associate.
tw, wtv - av urggr- or �m taw.
-Not all products are readily,available. Check with your supplier or TJ technical representative for pr udt availability:
-THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLYI PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS.
-Allowable Stress Design methodology was used for Building Code NER analyzing the TJ Distribution product listed above.
PROJECT INFORMATION: OPERATOR INFORMATION:
Peter and Linda Tong Roaten E.Hinson,Jr. �5ED ARC
Garage Roaten Hinson Architect H//VS,
11497 Lindy Place 7246 Sharon Drive,Suite A 0 C)
Cupertino,CA 95014-4814 San Jose,CA 95129A
Phone:(408)996-8114 c—
Fax :(408)996-8911 C-76 ?D
yright 0 2003 by Ttu. Joist, . W.Y.tha..... Business
fallam* is a registered tradgenork of 1Yu. joist.
R WAL
VI6 4 - I6o � 5ir7el GJ(�LtC.F
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Copy
FZ D
5 8 2003
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USED ARcti�
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RENEWAL �\
DATE
OF CAI-�F
• Building Plans/Permits
Additions, Houses, Condo's, Offices
• Structural Calculations
Beams, Retaining Walls, Earthquakes
"R.E." HINSON, Jr.
Architect, Architectural Engineer
(408) 996-8114
R O. Box 33253 • Los Gatos, CA 95031 /✓
- �! � 6F• ('iv�1�'1 N C1
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TY Ott'CUPERTINO �°°a'° * .BUILDING DIVISION PERMIT CONTItACTtlR INFOR ATI ,DING ADDRESS: WALLACE CONSTRUCTION INC, PFJtAdIT"°03090025
NE497 TTNnV OT,
R'S NAME: 7050 SAN FELIPE ROAD I�JLVn'ISSUE DATE
-)A TONIG
E' (831) 637-8888 SANITARY NO. 2 CONTROL NO.
ARCHITECfIENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MRCH
i00 LICENSED CONTRACTORS DECLARATION - '
a❑ 1 hereby off rid Nal 1 am li¢o d under pmviaions of Chapter 9(commencing Job Description
�iW with Section 7(g)0)ofDivision3of the Business and Profcssinau Code.and my license is C1Na���
in ren force And Affect.
GARAGE REMODEL ■ /�
34ca License Elm Lica
° °'m Contractor NOV 2 12003
As shall use DECLARATION
f� I understand my plans shall M used As public records
)i V
soG Liccnud Pmfcssionel BUILDING
g OWNER BUILDER DECLARATION a
<E I hereby of ire that 1 am exempt from Ne Contractor's License Law fur the
20 following reason.(Section 7831.5:Business and Professions Code:Any city ur county
4.9 which requires a permit to construct,all,improve,demolish,or repair any structure
prior m its issuance.alvu requiros the applicant for such Permit to rile a signed aatem m
�Z< that he is licensed pursuantto the previsions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
2,0 (commencing wi in Section 7000)of Division Sof the Business and Profession Code)or
$
that he is exempt therefrom and the basis rot the alleged exemption.Any violation of 35624006 . 00
Section 7031.5 by any Applicant for a Penne subject,the appreant to a civil Penalty of APN Number - Occupancy Type
not more NW)
an Ew hundred dollars(SS . '
I,as owner of the property,or my employees with wages As drab sole compeeaation.
will do the work,and thestmaoa is not intended or offered for sale(SAO.10W,Business —
and Pmfessi.ns Code:The Contractors License Taw does not apply to an owner of 102 - PIERS d Inspections
property who builds or improves Neuron,and who constructs work himself or through his
own employees,provided that such improvements Are not intended oroRered for sale.If. 103 — UFER
however.Ne building or improvement is sold within one year of completion,the owner
builder will haw the burden Of proving Out he did not Wild or improve for purpose of 104 - REBAR
105 - ANCHOR BOLTS
I,as owner of the property,am exclusively contracting with licensed contractors to
convect the Project(Sec.71N4,Business and Prefrssions Code:)The Contractor's Li. 106 — SEWER & WATER
cense law does not apply to an owner of progeny who Wilds or imporm daemon,and, 202 - UNDERFLOOR PLUMBING
who concocts for such pmjecu with a contractoru)Roamed pursuant to the Conoeetoes
L+Can=uW' 203 - UNDERFLOOR MECHANICAL
o lam axe p under `. B&P C fit thio Ion
fC.A� 3 0 204 - UNDERFLOOR FRAME
1531.1.1
WORKER'$COMP $ATION LARAata 205 - UNDERFLOOR INSULATION
iherebyaf rmunderPenaRynfperjuryOneanhefauawingdeclarations: 301 - ROUGH PLUMBING
w and will maintain a Ceniewte of Consentmul6insure sur WorkasCumpen. 302 — TUB & OR SHOWER
as provided farby section 3700.!the Laboreno,for the petrmm..ca.f the 303 - ROUGH MECHANICAL
or which this permit is issued. 304 - ROUGH ELECTRICAL
w and will maintain Worker's Compensation Insurance,as required by Stedon the labor Code,for Oc Performance of the work forwhich Nis permit is issued. 3O5 — FRAME
rkers Compensation Insurance arrierand Policy number am: 306 — HOLDOWNS
. CERTIFIC-Policy So:
ATE OF EXEMPTION MOM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 — SHEETROCK .
rThissection nem not m completed B Ne permit I$for ow hundred dollars(SIM) 309 - EXTERIOR LATH
Itcattilyt less.) 310 - INTERIOR LATH
e cattily Nat in the pean mancc of Nc work for which this permit u issued.I shall not
employe alif.i i.inanymannerarumbecomembjmu.mewomen'Compensation 311 — SCRATCH COAT
Laws of Califomie.Data
Applicant313 — ROOF NAIL
NOTICE TO APPLICANT.If.after making Nis CeltlreAle of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
encore.subject to the Worker'a Compcoatinn provisin,of the Iahnr Code,you most
• � z forthwith comply with such provisions or this Permit shall W deemed revnkcd. 502 — FINAL PLUMBING ENERGY
? 71 CONSTRUCIIONLENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby Affirm Nat there is consuuctinm lending agency tar the performantt of 504 - FINAL BUILDING ENERGY
Yi He work for which this permit is issued(Sec.3(197,Civ.C.)
4 q Lencu',Name 505 - FINAL ELECTRICAL
�
z amderaAaams 506 - GAS TEST
p 1 cenify that I haw mad his application and sure Nat the above information is 507 - FINAL PLUMBING
correct.I agree to comply with all city and county ordinances and sum laws relating to
�U holding construction,and hereby authonor representatives of Ois city to Amer uMm the FIN MECHAN CAL
0. Ahow-mcntioned property for inspection purposes.
(We)agree to new,indemnify and keep harmless the City of Cupertino against O 9 F I N
rg IIab11fics,judgments,curds eAd calories which may In any Way m.,.,.last said City 5 G
') ,Z of ccaseyyeenceof Negrandagufthis Permit.
APPLI UNDEI SAND WILL COMPLY WITH ALL ON POINT Issued by:5 WORKS Dat
SOUR L E ULATI S. T
nv A 3 Re-roofs
Sign rc Applicant/Commewr a�]f m
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store or handle hazardous marcrial
At,defined by Be Cupcnino Municipal Cmc,Chapter 9.12,and the Health and Safety
cWe7d.A
Sacdo.zssu('77 All roofs shall be inspected prior to an roofing material beim Installed.
❑Yea ) P P Y g g
Will the applicant s future building m.p.At use equipmanlarJcviws which If a roof is installed without first obtaining an inspection,I agree to remove
ardour air comaminanu u d�nad by the Bay Area Air Duality Management all new materials for inspection.
❑Yes KNo
I hove raced me hatmo n/us mmamaterials requirements underChapmr 6.95 ofNe Califonlth&S oyCode,Smug.25505,25533 and 25534.1 undeutend thatifthe Willing
crate dly eve a tenant.Nat it is my responaftelity us Wdfy me antofNe
An nm moa elpAm a,n f.cem;rAam.r p r Signature of Applicant Date
Owner ser Bum ivcJ agent Ill Dot. All roof coverings to be Class "B" or better