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00120148 CITYof cuPERTNo BUILDING ut SIO PERMIT CONTRACTOR INFORMATION: © 1 Z of Y8 BUILDING ADDRESS, PERMIT NO. o y ( l Zuck OWNER'S NAME: APPLICATION SOH ON]17 I • PHONP. SANI'T'ARY NO. CONTROL NO, p exi ARCHITECT/liNGINEER: BUILDING PERNII'I'INP() w u o ELIiCr PLUMI, MfiCH Qi f I_I 1.I 1=1 rF¢y O N z LICIiNSF.II COKI'RACR' fOS DECLAR HON Job Descriptio O z a,p hc,chv Nano than Ian lic"a"d under provisions 0 Chapter 91camnameng lir, L,-ae with Section700(nof Division 3ol'Ihe ltusincusund Pnd'cssions Cole.and my lleenw n mer rnroe an urn Class — e. .f p a D1 -Itz ate — G„mmetms-� W 3p. AO, DECLA A'110, C t—`0.Qi 1 understand my plain-hall ere used m public accord, wc S p O Licensed Pn,lcvsional � OWNIiR-BUILDER❑IiCLARA'f10N W M,n I huuhy all!....that I um cxungn fi'onI the Cromodor'k hiwroe Law for the r z 2 following reason.ISecdo„7413 1....Bmine,,and Pofle,ion.Cold Any city err enemy cp which momma pcm,it to cnmwat.alter,improve.demolish,of repair any structure i6� prior to its issnance,;iko rein frestheapprlicam lorsueIt perm,to tile a signed.lanemem that he is heclt.cd pursuant tnthe pmvloons(it the Coal LicenwLaw Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section]("n of Division d of the Itusiness and Pirnowinn-Code) or that he is exempt therefrom and the naris for the alleged exemption Any violation of Sccion 703 L5 by any amlleam ora prinil-abject the applicant In a civil'chatty of not mom than live hundred dollar--sun. A PN Number Occupancy Type ❑l.n—Nue,nOw,mpenyo myemployee with wages as l hcirsnlecnnlleawn I. will Jo the work.and the-Imcare is em amended or offered far late(Sec.7094. Business and lainfesxiona C dc:The Contractors License Law Jin-not apply m an Required Inspections oI lmopcny WI m builds or improves thereon,and who dock such work re—if ' or through hi-own en,ployeen.provide,!Iha such improvements are not printed or offered for vale.If,h vvcvc,the building or ins sivenmm is sold within me year of ionmletion,line nwnar-builder will have the notes of prroving that he did not twild or mprove for purpavc of sale.). ❑I,as owner of me prn)peny am esiusivdy comnsting wllh licensed comracnns m m,slruc the projercel m(Sec.7044,llusineks unit Profe-sans Colc:)'n,e Commchn” `=1 NALED Liceave Law ds not apply an bui owner of property who ld,or inflames diction. and who enmacu but such pfmmI%with a co,nrucmny licensed pursuant to the Cnandar,Lioannc Lew. E]I nm exmnpt ander See. .It K P C far This reason MAY 21 2001 Owner Dme WORKER'S COMPENSATION DfCI.ARA'I'ION 1 hereby afro,under penalty of perjury one of the following decimations BUILDING ❑ 1 have and will reampan a Cenilimla of Consent it,ell-arum for Woder'k Commenvation, as p...mcd far by Sema. 3700 of the Labor CMe, for 0e pnlot anec II the work for which thin'mall is"'act ❑1 have and will maintain Worker's Compensation Insurance.as ayuired by Section 37a)of Iha lahnr Coda for the Perfnmu lwe of the work I'or whmh mac pentat is sued.My Worker's Cominnsmion Insurance earlier and Policy number arc: ' C:urier: Policy Nov: CER'1'119C61'ION OP I:xl?MI"1'ION FROM WORKERS* COMPENSATION INSURANCE I I his wdian ,evil nm be e,.,I leed It the Per'11111x lin one hundred doll urs (S lav in Ices) I cconty that in the Irv,hur n a,c of the wad li,r which This'count is issued.I shag not employ any Kom in any mon a,IrgMgQlnc-nhgcun he INkc,, Cars, at t r(.I�r„W 3sDole! f CJ O NlctnicsuDct to the Werke s ofmnnaklugnprocnoic,sof i,dan od You u muld st ' Ice ova subject m the N'adeh Con,pcn,,his provisions of me Inhrn re—k n,a must Q 0 fnnhwith comply wilt such prnvi>ionn or this pm,if hill M1c dcnncJ mvokcJ. F (O CONSI'RUCI'ION LENDING AGENCY ai 7 1 henry a irn,that them is a construction lending agency for the performance _ M the work fns which this feral a issued(S,,..1097.Civ.C.) _ 1 C Lcndcr's Name 7 Lenders Address V Q I verily that I have read ibis application and stale that the-Move inforination is I3. •e. comet.1 agree m comply,with all city and county ordinances and state laws relating Q [) v,I ilding mnan.mion.anal herchyauthorim representatives of this city it)enter upon r� the ahavclneminncd property In,Inspcdion pugwkc-'. . t„� L (We)trash,to save,indemnify and keep harmless the Cay of Cuperom agamt N lirul'tics,judgments,evens and espemes which may in any way roue against said ^ C PPLICANT UNDP.R'pAND A DWI per'mit. (� y u,romcyucncc nitol A STANUSANDWILLCOMPLY WITH ALL NON-PUINT' Issued by: Date SOURCE RIiGULATIONS. Signature of Applicant/Cmlracmr Dine Re-roofs IIA%ARltl MATERIALS DISCLOSURE Will In,appbaanf err hose Iaudnny iscrupam um or haudlc hn.ans Ienal Type of Roof as defined by he Capxlim Mamclpw Code.Chaplet 9.12,allrdmaf I]the I lezlth alld Safny . Code.Section 2553200! . °Pa, 0N All roofs shall be inspected prior to any roofing material being installed. Willlnc applicant rorsame buildingacupml um equipment or device which If a roof is installed without first obtaining an inspection. I agree to remove emit moodue,air eonfaminams as defined by the 11,Arca An Quality Mme,,nuent • Diktrice all new materials for inspection. Applicant understands and will comply with O''°a 0N all non-point source regulatio1;___� 1 noc ,ad the i uurdons mamrials r,lb rnaenn.under Chapter L 95 of the /1 ><chaiIll& cay Cmle.iSadirons ,955A and 25534. unJewond thin iftenuilJingdoes not tenant. that rmy¢spnlo notify the 1./lt2-- Per amiremean,wha,h um,1M,metpriur fro issuance Inra Cenircate Lq of imm r 1ture )f plicant Date - /Z � — 2 —U n hari.nt,yam All roof coverings to be Class ” "or better - IDale B OFFICE