01040120 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS; PERMIT NO
20200 LUCILLE AV 01.040120
OWNER'S NAME. APPLICATION SUB DA'I'I;
STONESON DEVELOPMENT CORP THE 04/23/2001
. PHONE: SANITARY NO. cosTROL NO.
D K 7 AI{GI{I rlXIII:NGINIililt BUILDING PHRMI IINFO
�0 0 REI C' El EM PLUMB MECII
L
F N LICENSED CON RACI OR'S DECLARATION lob Description
OO a_C 1 hereby off no that 1 am licensed under provisions of Chapter 9(commencing
f 4tkcwim$action](XXDofDi,mim Sof the limincuand Pmfcasiom Code,and my license
,,xuha'cattle j �(o �G REROOF REMOVE SHAKES INSTALL 1/2" CDX
-- i,in1L
x 3 LL N DAIo s DEC ARAI-
ARc11In_crs Dl:cLARn1CF_RTAIN FEED SHINGLE
1.,mecaard any plan,shell be toed us public accord,
fay
uu p Liscood pme"ival 1
OWNER-BUILDIIR DECLARATION
e v1 I hereby affirm that I am exempt Dom the Contractor's License Law for Inc
C L Ne, following recon(Section 70315.Bnsines,and Professions Code:Any city or emery
which rnpiirc,a permit to<umuuel,idler,iinprnw,dcmolivh,or repair any structure a
3� priorminirvmsec.idonrer,otheemoapplioof loner.pu Im',Lilco,igncddwcmenl
mot(commencing
Sectio Ira 00 peni.iom ad,neCeBovine, andPrlaw(Chap1ef' Sq. FL Floor Area Valu Ion
or that he is excu Section7000)and the
basis or lino Bu,inc conniption.Procession,Coded
or that int is rxenapt any pli and enc basis for the alleged pli,mAny vialvtion
of S I than
S hY any Bred and for v 500), wbJec¢Inc applicum lu a civil pcnahy
of not conte man llnr retard aonar,ls5an. APN Number Occupany�r&M0
Cl I,as owner of the property,briny rnoployccs w'nh wages as Iheir role compensation,
will do h k I 11he marionarej,no,inuended or ollered I (See.9144,
BmNr"1 nProic,ion,Code [In,o - l 1 Lon.,doesI apply.r an 31.602094:4yFd Inspections
r of lnmeny Who binds,,,i prove, hereon.and ho J essuch work M1nnell ,
or through his own cmployttc provided that such improvements an,nor intended or
offered for sale.IL howevve the building or impmvc mmut is sold within one year of
completion.the owner-builder will have the burden ofproving that be did not build or 305 — FRAME
improve for perry tic oLvalu).
307 — INSULRTION
r I,m"the afore propene-am est e,,z d Prov ng with licensed The Comment h,
,alae.inti perm(see Ylo so - and Pn,re„ ,cite:)The e, mca'rx 601 — ROOF TEAR OFF
and who
Law tract sol apply t pm; eb,wih ;i ct who lnuimv m improve.ahto be
and who rontmens ear such pirajerlx wan r000armn,l hren,ed refine,.a,tae E.02 — ROOF PI_YWDf_ID NAIL
Comfmmnrs License law.
lein evempl and«See. ,ndrPefor his free'. 603 — ROOF BATTENS
Dale Ytr + y 604 — ROOF IN—PROGRESS
-W(RKE MI-12NSAI ION DECLARATION
1 hedy anima m;le,petrary of 'v'i y be or the ILIlowldg AeelumJn o:
t� ❑ 1 have and will maintain a Cenilware of foment m sellalum for Worker's
Coon,.moon, m provided for by Section 390) of the Lamar Cadefor the
Eadfonoance o1 the work for which chis prm,it is issued,
i4 have and will nmimaint Worker's Cnmpemntio i[.,.macs as required by Section
3700 of the limn Code.for the perinrmance of the work lin which thin permit is
sued.My N'uder'.v Compensation In.mance carrier and Tinley numhr mc:
Cardc,Am<r;rA" Pro �rolicrNo.: BRezez _�4_I.
QIiRIB'ICATION Ol7 EXEM711UN -ROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is list tine hundred dollars
(S 100)or less.) -
I ccNfy mut in the pedoneancttit the work for which mi,Peru...is is,wnl,1
thrall no oophry any pc,oa in any in be so as m Income:unleo to the Workers'
Cmnpemwlnn I-Re of California.Daly
Applicam
NUI ICC TO APPLICANT:If:alive ro,kin,this Cenifica¢of 17aen,pfiom Yno should
become come subjecto the Wom
Worker's Coppro
ensation visions,Dire acinar Cole,you must
Qforthwith comply with such pmvisioroor Ibis permit shall he Deemed revoked.
F zi CONSTRUCT[ON LENDING AGENCY
I harry allirm Ihnl there i,I 9onamnin i lending agrnty liar the red nuance
Gs] Lu or Ie work Im wnicll tai,Prunn i,itxoed rsec.3097,civ.C.)
S A Lender's Nanoo
5 7 Lader',Address
U G I really thin l have real this application and state that he alhave minumarion is
R. F.. correct.1 ager to comply win all city and coamy ordivarrces and ,are laws relining
Q f, .o handing cowdererion.and hereby amboriac mpmsenm.isen of this city to enter urym
4 the Above . d property for inspectionPr, , .
(W )'6 t save.uneamr,' Jkeep 1' aM C.y f Cupscrtiroagin.a
Vi Iat'ji ....ly ds,c t .I 'I 1 'y inany w.y. ..e a,rat said
U z Ca,in coancyuence of a he gmmngrl ah,Iwrnnl. Tf�p
r SOULICAREGUI,ATIp UNDERSTANDS AND W11,1.COMPLY ALI. Issued by: ✓y` ��T'k'�c(.-2 Date 1�—J��1
S veofApvhranvcoanme a Dae Re-roofs
I IAIARD :RIALS DISCLOSURE
Will dao applicant or future Naming accm*tm store or handle ba.mdoa.neurrial Type of Roof
uv dcfinct by the Cupcnlno Memkiyal le:Clmp¢r 9.12,and 0m Ileaim end Sanely
Code.Sevin 1255320,!
11 ye, "" All roofs shall be inspected prior to any roofing material being installed.
Will the vpplieant or furore building rmcapaur use oyuipmem nr de,lrev which If a roof is installed without first obtaining an inspection, 1 agree to remove
coil hazardous air conmminanb us Jelin ythe Bay Ara Air Quality Managenmm
niaemr. all new materials for inspection. Applicant understands and will comply with
"" all non-point source regulations.
I hvvo end he hwardoux ma neral.a'cou beano s anew Chapter 6.95 or the
California Health N Safety Cade.Seedrna 25505.25534 and 25594.1 onder,mnd man
ifthe building Jon,nolcurrently haven mamm.that or noyre,lanvibilitytonollly lire
occupant of the ob ieomm.which earl be mel print to issuance of a Certificate of
Ocripanry.
Y�23, mature of Applicant _ Date
D orann,miveaigen, �- Dale All roof coverings to be Class"B" or better
c_
OFFICE