01050037 +r ~iCITY OF CUPERTINO -
(/ BUILDING DIVISION - PERMIT - CONTRACTOR INFORMATION: 4' -
BU I LD INC,A 13DIEB..I'00 _ HUYHi" ' PERMITNO.
jUt
OWNER'S NAM . KRIVIVILLL1.314n - APPLICATION. y:,I2 -
PHONE: f ',= —t'- G r. SANITARY NO. CON]ROT:NO,
BUILDING PERMIT INFO
tu0 ZO ARCfIITBCI/F.NGINEF.R: ,BLDG ELECT PLUMB MECH
E IJ _J
• F
yi LICEN SEDCONTRACTifR'S DECLARATION 4
h_ I hereby affirm that 1 um licensed under Provisions of Chapter (cluddam in JJ nI, ppe... I
p " p s REMOVE` SH4nik Y1� fALL 1/2" . COX &.— 30 Y
P C; with Sea n7WIIllifD Sof the Huanessund Pmlesanns Codeandmylilena -
��(C 'a
"'a
im
Yl d LLll
y D't tlmemr ' ' w • '
f, G ARCHITEC'1"S DECLAR
1 unJcmanJ my plans shall he uaul as public resinous
} LED.—,C Licensed Professional
OWNERBuil'iRDt CLARATION
u1 I r by Ii I Ih I I an, acruld rounuse C m t License Law far IIt• r
•+CLQ rohoh ll g .(Session 70315.Businessunit fes C Any city A14 @@ pt
$ m wrequires a Permit t c t t II r t p dem 11 ry any sS ,4 2002
u� p t t ones al tcyu -the pphewlf hµmtu I I jmd ua m dt
°•5� 'tithe is licensed purnall to the provisionsoffla,c tactor License law(cnamery Sq. Ft. Floor Area 'Valu '
fes g thSection 7000)of Division l(if the BusinessdPmf ,
o ll.t he i. puh f doh basis l the ill g l Pf n A y pfiI DING
ors t bay Y ,l' tf -ape d mea,lhe pplcuni'm Y
nov 'APN3shfrrt�eiQ194". 1,n0 Occupancy T e
of no n n.than trine handled dollars(s5pn .- P Y yp
❑L.,owner of the pmperty,or my employees with wages,us lheir sole compensation;
will di the work,and the structure is nil intended or offered for sale(Sec.T alal. -
Business and Professions Code:'The Cintmchtr s License Law does not apply to an. 305 — FR6iL+t sired Inspections
owner of property Who bu'dds or improves thereon,and who does such work ldmwit, I 307 — INSULATION
or tluvugh his ion employees.p,l,idcdohm such Intpravmnetnx are not intended or I
offered for.able.If,however the haddingo,impmvemetn In sold onium one remor •601. .— ROOF•_'TEAR OFF - .
impletion,the owner-huRder will have the burden of proving that he did net Fuild or _
ntpmveforputpoxeaf,ale.). : '602 — ROOF PI_YI4OOD NAIL
❑Lmuwmerirmeurn,riy,am exela,ively contmedng with licensed emanseote to - 503 — ROOF BATTENS
construct the project(Sec'7044.Business and P f "on Code') Ph Contractors !
L c v J a apply to an iwne tp f, tyt hmld. rapproves hcrean
ddwhis coronas for such knoon,woa commuters)licensed pursuant to rhe 604 — ROOF TNI-PROGRESS
ROGRESS .
Cunlmmnfs License Law. - -
❑ltunexemptunderSec. t .B k P C far this
Owner - - - Dates
.WORKHR'S COMPENSATION DECLARATION
I hereby affirm under penahyil penury one of the Hollowing declarallons.
❑ 1 have and will maintain a Certificate of Consent to oltFinwre for Walker's
Compensation, as provided for by Section 37M of the Iabsr Cale, for the,
off nenee of the work far which this permit is issued.:
1 Arne wW will ntulnmin Worker's Compensation Insurance,as required by Section - -
37[NI d the Labir Calc,far the pofon umbee of the work for which this permit is.
issued.My Workers Compensarias lnsumnce carrier and Polity number am: _ ,
arrier_,[Ioz",LC-41 —PoseyNi.:riRRDJSt3S�7DI
•CERfIFICNI ION OF F-KEMI'1'IOIYFRI�IWORKERS'. y _
COMPENSA'T'ION INSURANCE
(Otis welio_n nwA not he completed if the permit is for one handled dollars `
IS Ifidnr lessd
1 certify,that in the Itcrformance of the work for which This permit is issued.I
shall not employ any petmm in any neoner so a,to become subject to the Workers' - )
+Cimpcnsution Lows of Calilbrnia.Dom !
Applicant - - - - t '
NOTICE TO APPLICANT:If,after making Nis CeOilicme of Exemption.you should '
because subject to he Workers Compensatin.provisions of Ne Labor Coale,you at
Q O finhwith comply with such provisions or this peemit hall be deemed revoked.
J,
F ti " CONSTRUCTION LENDINGAGENCY
;0 -
1 Terelay affirm that there'is a carishocuar,lending igen,for the perp-mance
_ r
� r. orotic work forwhich th npe�mtt.rss eJ(Sec ifH7.Civ C.) + -
Q] Lender's Name
7z Lcnder'e Address
U (:) Ic mOthat l have bmdRB,appli,,iobad rote that m hosto intaloultim,is
W 'P. c m't 1 d' t Ply wilt all sty tl tY ,diem a kind.tt law, hfng
m huddiag reastmelnn.and hereby mol 'pre tmiv fid uy mum upon I, -
the adwvi-tnani akst property for inspection Perth
F p,
(We)agree to save.indemnify and keep harmless the City of Cupenini against - J
(n 1 b I t c judgments.costs d pens:which may m any way acome agv I said _
U z C'ty' c sly enc, f th g t g or N.pc mit.
AI ILIC'm UNDCRSIANDSANU WILT COMPLY WITH ALL NON-BOINT ]SEE by: Date k•v
v501J .RF.GIICATIO 5 -
J mare ofnpphcanOContmco r nate Re-roofs
HA]AN ALS DISCLOSURE
Will the spplicamm mgaceupanyxtutem mushe haaouous tndsmid Type of Roof :.
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cade,Soidan 25532(al'!
❑Year /,� - .+ All roofs shall be inspected prior to any roofing material being installed.
Will hs� p iieamorinm'renuumttsMmpanta,wewipment^rdeviceswhich Jj'a roof is installed without first obtaining an inspection, I-agree to remove
omit luvu+da.,air amtaminants as fined by Ne Bay Ara Air Quality Manngegm0l
Istria? all new materials for inspection. Applicant understands and will comply with -
°Yei °No allnon-point source regulations. -
I have read tho Imomblousmamials7tafaireartarts under Chapto r(ns
C I'f rmn Heahh&S f ry Coi Smaikon,25505,25533and 25534 1 undebland that -
lfthebuJiingdoes n t currently laba,aten i that ri is an,respon.'brtyf notify The
ueeupam if the regmmnmms which must he mel poor to asuantt of a Certifi ate of
oueupandr. - tgnature of Applj�a Date
tI � �L ' G/ All roof coverin 1s to be Class `B"�or better
D audlnrlL'd agent _ .Ira i �. D '
OFFICE -
+r ~iCITY OF CUPERTINO -
(/ BUILDING DIVISION - PERMIT - CONTRACTOR INFORMATION: 4' -
BU I LD INC,A 13DIEB..I'00 _ HUYHi" ' PERMITNO.
jUt
OWNER'S NAM . KRIVIVILLL1.314n - APPLICATION. y:,I2 -
PHONE: f ',= —t'- G r. SANITARY NO. CON]ROT:NO,
BUILDING PERMIT INFO
tu0 ZO ARCfIITBCI/F.NGINEF.R: ,BLDG ELECT PLUMB MECH
E IJ _J
• F
yi LICEN SEDCONTRACTifR'S DECLARATION 4
h_ I hereby affirm that 1 um licensed under Provisions of Chapter (cluddam in JJ nI, ppe... I
p " p s REMOVE` SH4nik Y1� fALL 1/2" . COX &.— 30 Y
P C; with Sea n7WIIllifD Sof the Huanessund Pmlesanns Codeandmylilena -
��(C 'a
"'a
im
Yl d LLll
y D't tlmemr ' ' w • '
f, G ARCHITEC'1"S DECLAR
1 unJcmanJ my plans shall he uaul as public resinous
} LED.—,C Licensed Professional
OWNERBuil'iRDt CLARATION
u1 I r by Ii I Ih I I an, acruld rounuse C m t License Law far IIt• r
•+CLQ rohoh ll g .(Session 70315.Businessunit fes C Any city A14 @@ pt
$ m wrequires a Permit t c t t II r t p dem 11 ry any sS ,4 2002
u� p t t ones al tcyu -the pphewlf hµmtu I I jmd ua m dt
°•5� 'tithe is licensed purnall to the provisionsoffla,c tactor License law(cnamery Sq. Ft. Floor Area 'Valu '
fes g thSection 7000)of Division l(if the BusinessdPmf ,
o ll.t he i. puh f doh basis l the ill g l Pf n A y pfiI DING
ors t bay Y ,l' tf -ape d mea,lhe pplcuni'm Y
nov 'APN3shfrrt�eiQ194". 1,n0 Occupancy T e
of no n n.than trine handled dollars(s5pn .- P Y yp
❑L.,owner of the pmperty,or my employees with wages,us lheir sole compensation;
will di the work,and the structure is nil intended or offered for sale(Sec.T alal. -
Business and Professions Code:'The Cintmchtr s License Law does not apply to an. 305 — FR6iL+t sired Inspections
owner of property Who bu'dds or improves thereon,and who does such work ldmwit, I 307 — INSULATION
or tluvugh his ion employees.p,l,idcdohm such Intpravmnetnx are not intended or I
offered for.able.If,however the haddingo,impmvemetn In sold onium one remor •601. .— ROOF•_'TEAR OFF - .
impletion,the owner-huRder will have the burden of proving that he did net Fuild or _
ntpmveforputpoxeaf,ale.). : '602 — ROOF PI_YI4OOD NAIL
❑Lmuwmerirmeurn,riy,am exela,ively contmedng with licensed emanseote to - 503 — ROOF BATTENS
construct the project(Sec'7044.Business and P f "on Code') Ph Contractors !
L c v J a apply to an iwne tp f, tyt hmld. rapproves hcrean
ddwhis coronas for such knoon,woa commuters)licensed pursuant to rhe 604 — ROOF TNI-PROGRESS
ROGRESS .
Cunlmmnfs License Law. - -
❑ltunexemptunderSec. t .B k P C far this
Owner - - - Dates
.WORKHR'S COMPENSATION DECLARATION
I hereby affirm under penahyil penury one of the Hollowing declarallons.
❑ 1 have and will maintain a Certificate of Consent to oltFinwre for Walker's
Compensation, as provided for by Section 37M of the Iabsr Cale, for the,
off nenee of the work far which this permit is issued.:
1 Arne wW will ntulnmin Worker's Compensation Insurance,as required by Section - -
37[NI d the Labir Calc,far the pofon umbee of the work for which this permit is.
issued.My Workers Compensarias lnsumnce carrier and Polity number am: _ ,
arrier_,[Ioz",LC-41 —PoseyNi.:riRRDJSt3S�7DI
•CERfIFICNI ION OF F-KEMI'1'IOIYFRI�IWORKERS'. y _
COMPENSA'T'ION INSURANCE
(Otis welio_n nwA not he completed if the permit is for one handled dollars `
IS Ifidnr lessd
1 certify,that in the Itcrformance of the work for which This permit is issued.I
shall not employ any petmm in any neoner so a,to become subject to the Workers' - )
+Cimpcnsution Lows of Calilbrnia.Dom !
Applicant - - - - t '
NOTICE TO APPLICANT:If,after making Nis CeOilicme of Exemption.you should '
because subject to he Workers Compensatin.provisions of Ne Labor Coale,you at
Q O finhwith comply with such provisions or this peemit hall be deemed revoked.
J,
F ti " CONSTRUCTION LENDINGAGENCY
;0 -
1 Terelay affirm that there'is a carishocuar,lending igen,for the perp-mance
_ r
� r. orotic work forwhich th npe�mtt.rss eJ(Sec ifH7.Civ C.) + -
Q] Lender's Name
7z Lcnder'e Address
U (:) Ic mOthat l have bmdRB,appli,,iobad rote that m hosto intaloultim,is
W 'P. c m't 1 d' t Ply wilt all sty tl tY ,diem a kind.tt law, hfng
m huddiag reastmelnn.and hereby mol 'pre tmiv fid uy mum upon I, -
the adwvi-tnani akst property for inspection Perth
F p,
(We)agree to save.indemnify and keep harmless the City of Cupenini against - J
(n 1 b I t c judgments.costs d pens:which may m any way acome agv I said _
U z C'ty' c sly enc, f th g t g or N.pc mit.
AI ILIC'm UNDCRSIANDSANU WILT COMPLY WITH ALL NON-BOINT ]SEE by: Date k•v
v501J .RF.GIICATIO 5 -
J mare ofnpphcanOContmco r nate Re-roofs
HA]AN ALS DISCLOSURE
Will the spplicamm mgaceupanyxtutem mushe haaouous tndsmid Type of Roof :.
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cade,Soidan 25532(al'!
❑Year /,� - .+ All roofs shall be inspected prior to any roofing material being installed.
Will hs� p iieamorinm'renuumttsMmpanta,wewipment^rdeviceswhich Jj'a roof is installed without first obtaining an inspection, I-agree to remove
omit luvu+da.,air amtaminants as fined by Ne Bay Ara Air Quality Manngegm0l
Istria? all new materials for inspection. Applicant understands and will comply with -
°Yei °No allnon-point source regulations. -
I have read tho Imomblousmamials7tafaireartarts under Chapto r(ns
C I'f rmn Heahh&S f ry Coi Smaikon,25505,25533and 25534 1 undebland that -
lfthebuJiingdoes n t currently laba,aten i that ri is an,respon.'brtyf notify The
ueeupam if the regmmnmms which must he mel poor to asuantt of a Certifi ate of
oueupandr. - tgnature of Applj�a Date
tI � �L ' G/ All roof coverin 1s to be Class `B"�or better
D audlnrlL'd agent _ .Ira i �. D '
OFFICE -