01040063 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
B UILDING ADDRESS: _ PERMI1 NO.
210200 ti
OWNER'S NAME; APPI.ICA'1'ION SUB DATE
PI{ONES SANI'I'AI<V NO O^
•
C ce/ ARCHITECTYENGWEER' ( 408) 279 2332 !{UILDINGPERMn'INFO
kCVI-101111 ELECI' PLUMB MECH
u C iI CI 1= 1=l
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LIcl.Nsn)coNTRAcroR'S arcl.nR,al°ry Job Descri Ion
0 O I nanny [sol i, um al he A uncia.pnd Prole,d Chantee license
F 4t`cu with Seninn7lNMp of lli,i,ion7ol the Hu.ine,.and l'roles.innsGxle.:md my licca,
< e t� is in full force an ff
sower ueen,ecfIr Lie IT 7(�4 1p REMOVE SHAKES INSTALL 1/e^" CDX
's LL H Dom_ 1_ e( Contractor
s
O ARCHRGLT'Sa[CLARAI'ION & 30 YR. CERTAINTEED SHINGLE.
C o 1 mukramnd my plan.,,hill,be T,ed a.,public records
w 6�O Littn,cd Professional
a%sOWNER-BUILDER DF,CLARATTON
W � 1 harchy allirr n than I n pt tan I the Com ado's LiceT,u Law for the
FZ� fol4,wing mason,(Section 7031.5� aBu.sinessand Pulessions Cale:Anyci,yorcoumy
S x o xM1ich myuim,a permit to conawe,xtler,improve.demolish,or rcp it any structures
3� pull "II"ic,uanca.III"m11111ircs The uP,l(enm for such pcnnimn ole a,igned,mtemenl
Nalhe is hemmed pnotesm to he pTo...inpistil the can,moble,Li«n.e Law(Chapter v Sq. Ft. Floor Area - Valuation
(nnnmenring with Section 700)of Division 3 ofthe Busin®and Professions Cade)
ter dial he is esen,pl durcfronl anal The basic far the TJlcged even, u.Any violation
of Scubmn 701 by any applicant for a permia subjects the npplicanl to a civil penalty
of not mom than five hundred dnnat.(s500). APN Number eOccupa c Ty�emO
C 1.a, un T'mcnrin m
be py employee with wagme
es a i,.nll,com,ensaron. 20
will do he work.and the arvdum i,nm intended or olTercd for sale,(Sec.70syL
Business Tnul Prom.,,ions Calc The Contractor's License Law doss nm apply m nn e(-�ry�1V' Inspections
r of property Who hoild,n,inap,ose,mama..,.and who does such work.bitrsall �160209 . tLt l[I
Inviter
f through his own employee,.rnmidTd Thai,uch iniprovene r,are tea intended o,
offered for sale.11,hnxevcr,The building or in,provcmm�l is old within one year of
mmplclioT.me nw.....hnildrtwpnD
iwe Tb
un ntal nrr of proving mhe did rm bald or ^0S — FRAME
impone Iia puryme of ale.).
0La o
wnhrpro,sat,;me,dro'cly"mm<rngwill,live....leormteo-H, 307 — INSULATION
construct project(Sec.70.14,Bovines,and Prom,,inns C,de:I I he Corp raen`X 601 — ROOF TEAR OFF
License Law due,Bol apply u,an owner of property Who build,or improve,Themon,
Cand who,....pads Iia such rojells wilh n,ontrarmgs)licensed pursuant to The —
anmeror'sLiceimUse 60� ROOF PLYWOOD NAIL_
0 l am esempt ander See. B&P C lot this mason
603 — ROOF BATTENS �� J
ox"art Dam 604 ROOF IN—PROGRESS may/
WORKER'S COMPENSATION DECLARATION
• I hereby al'l inn under penally o1 perjury Inc of the lidlnwing Tallman Is'.
01 have and will maintain r
in a Certificate of Consent ,sulf-insure for Worker's
Comp, .alio s pnvldcd lir Iry Sun nn 3700 of rite Lubar Cndc, for The
performance of the work for which This Penni,is issued.
eI huva and will maintain Wod.crs Compensator horrunce.as rcyuiNd by Section
.71X1 oLama Core,The LamCode,fort the pedi,mance or the cork lin which this permit is
Hu ed My Worker',Coorientation��ftr(i a carrier and Policy numMr am:
Cartitt:�a CH IFICATION Op FAt FM
C WORKERS'
COMPENSATION
OMPENSTIONINSURAMI
(Thin.mesion need nm be,completed if da permit i,far one burden dollar
(g I INp or less.)
I certify that in The performance of the work for which this permit in issued.I
shill not employ ray person in any manner to as u,hecmou subject To the Workers
Ura,,sallor L.to%of cullwmla.mile
Applicant
NOTICE TO APPLICANT:If,alter making this Cenificam of Esemption,you should
zInemueelbj...vu be Wn kmr,Cm.ywrwuiou r, sins tel thCoca.e La, Gh.Ym oust
QF
Q hmhwuh,nnnply w,Tlun.
ucl,pmvki is or This pe ..I.hall he de reed resume.T a f~�1/
CONS"rRUC'I ION LENDING AGENCY
1 he,ehy author Ihur TLtrc is r nmsurrubm lending agency or lire ro'&.nnanau
of the work for Which this penin i,issued(Sec.3097.Civ.C.)
0.. a Lender's Name
;D z Len let,Address
U Q 1 certify That I have mad this application and state that the above intimation is
V. (� .....el.I agree I,comply with all city mrd oanly n d arose,and sure lows relmirg
C) (� mbuildin,,nummuction,and hereby amhodm rtpmWilede,nf do,edy to came,.,on
the abovcmenhnned property for no,schon parryrses.
(Wes)ugrec to Fare',Inda lain,end keep n less It,City of Cupeniva a,,,,!TTST
h Iiabiliur,.judgments,rio,s rad c,peme,which any in any way aecmc agmina said
U z City in consequence of the granting(if this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WI 111 NON 'HINT Issued by: Date
SOUR NEGULATIO C9, t 1��� f
�I
SI arc ul ApprcalntConvaen Dam Re-roofs
IIA%✓,NIlO(JS Al'IiRIALs DISCLOSURE
wdl me arrheam m(marc dding aeapam.are m nacelle na.:,w,a.mmedm Type of R
s defined by the Cupertino Municipal Code.Chapter 9.12,and Ila Health and Surely
Code.Scclinn 25532(a)? '
El ye, 0N All roofs shall be inspected prior to any roofing material being installed.
Will he uppneam or hum,lndlding occ.... (rune enri,rheia,n device.wits,+, If a roof is installed without first obtaining an inspection, I agree to remove
,mil hamolous air contan,innnT,as defined by the Hay Area Air Quality Managenicnl
• Dhrrim all new materials for inspection. Applicant understands and will comply with
11 Ye 13 No all non-point source regulations.
1 have,cad The hunrdnm maeriaA requirements under Chapter 6,95 of the
Gdiforniu ImIgh k Saley Cndc,S,,iion,21505,2.5533 au1255,14.1 mWcaumA mail
ittheJoennolcams ly which must b,met els myssuance'Iility rtfica 'If - D�
re
occupant MtM1d e,not comenwhich moa be mel prior m issuance of Leminity of
Oeaup:m, Sigs0ture of Applicant - . - Date
- . own, ,hTlh,aanaagerl Dim 96- -ovenngs to be Class"B" or better
OFFICE