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03090220 CITY OF CUPERTINO, BUILDING DIVISION PERMIT C�ON'rkX&' )R INFbRMATiO BUILDING ADDRESS: BRUCE & CINDY LEGARY PERMIT"°03090220 7Rit;R Mr CLETTAN IRI) OWNER'S NAME: PERMIT ISSUE DATE BR 3 E: SANITARY NO. CONTROI,NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 jZ LICENSED CONTRACT'OR'S DECLARATION Job Description C 1 hereby affirm that 1 Am licensed undo,pre vision'n(Chap¢r 9(commencing p U with Section 7")of Division 3 of the Business and Pmfcssiuru Cade,and my license is ec in mo f...nd affect. SHED FINALE® 3? Liccnu Clan Lic.g O Dan Connector ARCHITECT'S DECLARATION MAR 1 p 2004 Z< 1 understand my plan,'hall be used es public records 6u i Licensed Pmfcssional w y. OWNER-BUILDER DECLARATION BU1�'�� i f 1 hereby affirm Nm 1 nm exempt from Ne Contractors License Lew for the z O following reason.(Section 1031.5,Business and Pmfcseiuns Codc:Any city or county 9 which requires a Permit to convect,alter,improve,demolish,or repair any structure S4289 ,y pnono its issuance.also requires the applicant forsuch pcmitat file a signed statement CC that he is licensed pursuant to the provisionsoftheComrsmr'aLicense Law(Chapter9 Sq. Ft.Floor Area Valuation - (commencing with Section7f)(B)ofDivisiW3alone BusinessandProfessinnsCade)ser 35903001 . 00 t$ Nat he u exempt therefrom and the beau for the Alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant m e civil Fertility of APN Number Occupancy Type not mom Dan Ove hundred dollars(5500). 0 1.As owner of On property,M my employees with wages As their sole compcalt-bon, will do the work,and the snet..is not hunded or offered for sale 704q Business J.U i — and Pmfmionz Code:The Contractors License Law does not apply to An owner of �Ldft10 2 - PIERS d Inspections Property who builds m improves Netcom,and who does such work himself or through his own employees,provided that such improvements arc not intended proffered(..vle.If. 103 — UFER however,the building or improvement is mid within one year of completion.the owner- builder win have the burden of proving that he did not build or improve for purpose of 104 - REBAR Asia)' 105 - ANCHOR BOLTS 0 1,es owner of the property.Am exclusively contacting with licensed contractors 10 10 6 — SEWER & WATER cons mm the project(Sec,7°00,Business and Profe'siom Code:)The Contractor'sLi- cemeLawdeannotapplytoanownerof property who builds orimp,ovutheater,and, 202 — UNDERFLOOR PLUMBING Lt.,.who eLaawufor such projecuwith aconaumr(gn licensedpursuamtheCantnctor'e 203 - UNDERFLOOR MECHANICAL Da lune funder see. ,B&PC for thismaaaa 204 — UNDERFLOOR FRAME D� n� re 21�u 205 - UNDERFLOOR INSULATION WOR 'SCO TI DECLA ION I hereby affirm under penal of perjury omo following declarations: 301 — ROUGH PLUMBING and will maintain A Cenificam of consent w saB-insure for WorkersCmmPen- 302 — TUB & OR SHOWER Ave ss provided for by Section 3700 of the labor Code.For the perfmmanee of the 3 03 - ROUGH MECHANICAL - WorkforwhichthirPermitisissued. 304 — ROUGH ELECTRICAL 0 1 have and will maintain Workees Compensation lmurance,An required by Section 3700 of the Labor Codc.for the performance of the work forwhich this permit is issued. - 3 05 — FRAME My Worker's Compensation Insurance carrier and Polity,number Are: 306 — HOLDOWNS Carrier: policy No.: 307 - INSULATION CEUIFICATE OF ION O WORKERS' INSURANCE 308 — SHEETROCK (This section need not M compimedinhe pormit is m,ona hundred out].I$lIX0 309 - EXTERIOR LATH ',lass.) 310 - INTERIOR LATH 1 certify that in the performance of the work for which this Permit is issued,I shall not 311 - SCRATCH COAT employ any person in any mannersn m m become subject to the Workers'Compensation Laws of California.Delo Applicant 313 - ROOF NAIL _ NOTICE TO APPUCANT:If.after making this Carilleaa of Exemption,you shnuld 501 — FINAL ELECTRICAL ENERGY become subject m the Worker's Compensation previsions of the labor Code,you most 0 „furthwwcomply with such pnvisionsorthis Farm,shall Wdeemed revoked. 502 - FINAL PLUMBING ENERGY .N. CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hammy al lure Nat them is A consuuctinn lend ,fey I.,the Perfurmma of 504 - FINAL BUILDING ENERGY r7 On work for which thin permit isissued(Sec.3M,Civ.C.) 505 - FINAL ELECTRICAL Q.-fun sNac z 1<naer'' mAdd. 506 - GAS TEST (� Iceni(y thatlhave read Nis eppiieation end:tate that the above informWun is 507 - FINAL PLUMBING (~ correct.I agree to comply with all city and county ordinances and soon uvea relating to — V building conswction.and hereby authodmrepreaenmivaofthiaCity menter Upon We FIWNWG'l L 4L1 ah ive-mentioned properly for inspection purposes. 0 9 F I (We)agree b save,indemnify and keep hArmless the City of Cupertino against s� y liaml litiu,judgments,roan and expenses which may in any way accrue against mid City zin APPLICANTeor On UNDERSTIing or ANDSthis AND WILL COMPLY WITH ALL NON-POINT Issued by: 5arm it, RKS Date SOURCE REG IONS. Re-roofs 6 3 OOF BATTENS Signaw P m'HAZAr HA2ARD=buil ER DI LOSURE Type ofRt84 - ROOF IN-PROGRESS Will theapplicant or future buildingfi uart atom ohandle nardousmanrial as defined by the Cuna Municipal odc .C .Chhapter 9.12..mtl to Hcilth and Safny Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. CYu cello Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove hmardoua air contaminants as O,Fned by the Bay Ams Air Quality Mamgomenl all new materials for inspection. Tin? O Yes flu I have mad the hvardauusm'anrialsmquiramenu under Clo pnrd,95 of the Califor- niaHealth&Safety Code,Santana 25505,25533 and 25530.1 understand thuifthe Wilding docs not camenity have A nnmr,Out it is my msponalhility to armattupam or the remonemc hichmmtbcmetpriorwissuancc.isCcnilimnof�cc anry. Signature of Applicant Date er ar aam izetl'sent ,n All roof coverings to be Class "B" or better CITY OF CUPERTINO I� 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp: Rng: Sub : Blk: Lot : APN . . . . . . . . : 35903001 . 00 DATE ISSUED. . . . . . . : 09/25/2003 RECEIPT #• • • • . . . . . : 23291 REFERENCE ID # . . . : 03090220 SITE ADDRESS . . . . . : 7868 MC CLELLAN RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER BRUCE & CINDY LEGARY ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4221 RECEIVED FROM . . . . : CINDY LEGARY CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : BRUCE & CINDY LEGARY ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4221 TELEPHONE . . . . . . . . : 01E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -- -------- ------------- ---------- ------- --- ------ ---- - ------ --- - - -------- 13PERMFEE VALUATION 4 , 289 . 00 107 . 00 0 . 00 107 . 00 0 . 00 13PLANCHK PERMIT FEE 107 . 00 90 . 95 0 . 00 90 . 95 0 . 00 BSEISMICRE VALUATION 4 , 289 . 00 0 . 50 0 . 00 0 . 50 0 . 00 -------- -- ---------- -------- -- --------- - TOTAL PERMIT 198 . 45 0 . 00 198 . 45 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - -- -------------- ------------ ------------------ CHECK 198 . 45 249 TOTAL RECEIPT 198 . 45 • OWN*-BUILDER VERIFICATIOV 1. (Check one) I or my immediate family (parent,spouse or child) will perform: • A. All the work authorized by this permit B. A portion of the work C. _ None of the work `�" t✓ , If B or C is checked,com Tete 2 or 3 ow. 2 2003 Y•• 2. A state licensed contractor will be hired to do: A. _ All of the work B. _ A portion of the work (complete sectio elow) Contractor Address/City Phone # State License # Type of work to '--— !_a vc uavaaa,cu 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or • portions of the authorized work. I understand that I may be an employer(see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. PersorVTirm Address/City Phone Number Type of work to be performed ........................................................................:........................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Owner's Signatui�` / 4 ate: � Job Address:,,, 2 9 9 L L L Permit# P T N d/ CA SSD I,�- Any changes to-the information prodded on this form shall be submitted to the Ci of Cupertino Build Department. • a City of Cupertino Building Department CITY OF 10300 Torre Avenu® C U P E i�T LN 0 Phone: (408,777-3228 Dear Property Owner:—._. An application for a building permit has been submitted in,your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself,you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as contractors or subcontractors,then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding,federal social security taxes,workers compensation insurance,disability insurance costs,and unemployment compensatiorl� contributions. There may be financial risks for you if you do not carry out these obligations, andthese risks,are especially serious with respect to workers compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor,only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street,Sacramento,California 95814: Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued v%itil the verification is returned. ; Very truly yours, Building Department, City of Cupertino Printed an Recycled Paper 1511 CIV OF CUPERTINO aS o 7 a Z,2 0 CUPEYOF PERMIT APPLICATION FORM R-TN# Date: % 3 cot 25 os Building Address: G$ c C 40,t o �'.r1 Own 's Name: Phone #: Con1-OOZ License#: Contac • Cupertino Business License#: a 1013 — /vo ildip� ennit Info: Bldg, \ Elect El Plumb ElMech El Job scription: idential Commercial ❑ Sq.Ft. F 2 $/Sq.Ft.: st of Project— Occupancy Group: Type of Construct' n: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits , foot BUILDING BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX hid/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 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of3 CT*' OF CUPERTINO err°� PERMIT APPLICATION FORM CUPER,TINO lmm.,Quantity I 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 Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste hiterce for 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 rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pipe PLUMBING BPWHEATER WaterHeater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BRENI URN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL • 2of3 = ` U CITY OF CUPERTIM CUPEf�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL r 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 Insection BUILDING. BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING i BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance -- PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING i I f i • 3 of 3 704 mc.v(ai-n R PbSL�p - G,t,aer+fna m_ 7'V..: � t i'x s oR) PATIO - 1 'Q • " l`{ ,i';u„�$n�; / /�% / � c : lt,t t' E�¢.i `r i1. Ff ti p.� r 1 ` 1 SUBMI T �,I � }' DATF G s �� ', RI)y� ",l�lV F �✓YA�'1 � ` (y IY��^ r tDAEE. . n rets jArYv 5: 4rfa 9�>r5Rdaw: ;i tar nc, DEPT. .._._....._. j I � FICE-C-0p,APP0VED I IN ACCORDANCE WITH HE CITY 05 f j CUP_ERTINO, C E ORDINANCES • I' DATE SIGNEDaIJEWAy ; } This set o plans and specifications MU$tbe kept on the job at all times and it is un lawful to make any changes or alterations } r on same without written permission from S thng-Dept W ;' Th A 121 op revel of the violation a1 atYJ � 9f aI any City Ordinance ar )tats haw, i V I�` i . • 4 CITY OF CUPERTINO BUILDING DIVISION PERMIT GONTRAGINFORMATION." 4a.rat- ..s ,a. ;��r,, :4t..'1 ;•'..: BUILDINGADDRESS: _ BRUCE & CINDY LEGARY PERMIT N003090220 PER'S NAME: PERMIT ISSUE DATE B 2003 PHONE: SANITARY NO. CONTROL NO. ARCHITE-CUENGINEER: BUILDING PERMIT INFO BLDG ELELT PLUMB MECH �O0 LICENSED CONTRACTOR'S DECLARATION Job Des C7 O O O 1 hereby affirm that l am licensed under previsions of Chapter 9(commencing with Section 7(1 of Division 3 of thc Business and Professinm Code,and my license is LED iq? in full farm and errret. SHED License Class Lic.0 Dale Contractor 0 2004 2-j m ARCHITECI'SDECLARATION MAR 1 ` 1 understand my plans shall nc used as public records )aU 03 Licensed Professional BUIL.D11% OWNER-BUILDER DECLARATION Ca I 1 hereby affirm er 11. exempts an me Contractor's :Any c Law for the p o following mason.Permit ],13:.5,Business and Professions Crede:Any city or county $ which requires a Permit req orm the alter,im[OrSu demolish,or repair any sbucwre 3ZY that he itscened pursuant urs arequites the applicant roe Contrcrmiuoicense aw(atatamem 84289 L,FEF< (commincingudruection7 )orDiviomnflhe ftheBuacmrinicenulzw(sCode)9 Sq. Ft. Floor Area Valuation CS (commencing with Section 7")or Division 3nf the Business and Profcaiom Cole)or 3 Nat he is exempt therafrom and the basis for the alleged exemption,Any violation of 35903001 . 00 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occu ane—Type .— _ not more than five hundred milen(SSW). P Y ❑ I,at owner of the property,or my employees with wages a their sole compensation, will du On work,and to structure is not intended or offered for Bale(Sec.7W,Business and Professions Code:The Conuncior's License Law oars nor apply to an owner of 1 O 2 - PIERS d Inspections property who builds or improves Orman,and who does such work himself or though his own con play=,provided that such improvements am not intended or offered for sets.If, 103 - UFER however,the building or improvement is sold within one year of completion,the owner- builder will bays the burden of moving that he did not build or improve for purpose of 104 - REBAR Ula.). 105 - ANCHOR BOLTS _ _ ❑I,as owner of the property.,B uness and professions s Car licensed n nuacloss to _ comwct me project(See.7044,Business and Profeai9h Cmc:)Toe Connector's u. lO6- — SEWER & WATER come Law does not pply in an owner ofpropeny who builds or improves Orman,and, 202 — UNDERFLOOR PLUMBING who contracts for such projects with a contractor(s)licensed pursuant o the Contracteh d-imnse Law, 203 - UNDERFLOOR MECHANICAL I an eWat under Sec. B&P C for this reaon 204 -' UNDERFLOOR FRAME ' D �O WORSC ION 205 - UNDERFLOOR INSULATION : I hereby afnsm underpenal ,perjury one.M rpllowing dorIan.tinns: 301 — ROUGH PLUMBING ❑l have and will maintain a Certificate of Consent a ealbiaum rot Worker's Compere 302 - TUB & OR SHOWER sation,as provided for by Section 3700 of the labor Code,for the peeformaren or the 303 - ROUGH MECHANICAL work for whim this phi is issued. 304 - ROUGH ELECTRICAL ❑1 have and will maintain Workers Compensation Insurance,as required by Section 37W of the Inbar Code,for the performance of dre work for which this permit is issued. 305 - FRAME My Workers Compensation lmunnm cannot and Polity number are: 306 - HOLDOWNS . Carder, Poll,No.: 307 - INSULATION CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK leas.) (This section nem not he ro completed irthep.it is rmis.hundred don(s:rcn 309 — EXTERIOR LATH rat .. 310 - INTERIOR LATH employ any Nur in the Performance mann of the work for which this permit is issued,1 shall not Lawsoanyperson antaide manncranambecome mbjccnn the Workcra Compcmelinn 311 - SCRATCH COAT Laws of California.Date 313 - ROOF NAIL NOTICE If. NOTICE TO APPLICANT. r',after Compensation p previsions of Exemption.you you ust 501 - FINAL ELECTRICAL ENERGY - beeome subject y the Wahpro CemlNnallo0 provisions of the labor Code,you man 7z fpnhwimcnmNywith mehPmviainnanrthisrermhahmlIn,seemedrevoked, SO2' — FINAL PLUMING ENERGY zM CONSTRUCIONLENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affirm at there is a comouction lending aSmy Ire doe perPormnncc or 504 - FINAL BUILDING ENERGY On x Lenders for Nameichlhap mirisiapea(s .3m7,em.C,) 505 - FINAL ELECTRICAL 3. A Lenders Name Z Lender's Addrea 506 - GAS TEST I certify that 1 have road this application and sate that the above information is 507 - FINAL PLUMBING J. torten.1 gree to comply with all city and county ordinances and stare laws relating to = U building constmetion,and hereby anhorionrepresenmtiwofthis city toenter upon Oc - FIWC AL III abovomcnrioned property for inspection purposes. r (We)agree to ave,indemnify and keep himeress the City o,Cuperrino asainst O 9 FI N liabilities,judgments,costs and expenses which may in any way nerve against set iry .J,Z in consequence of the grami ng of this Permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 5ORKS Date SOURCE REG IONS. bV2-7-7JU1:1 Pi UUL) NAIL Signuu ift, 00 6&4u�u Re-roofs 6p3 OOF BATTENS p ocanJCont b HAZARDOUS MATER DI OSURE Typeof Roe 4 - ROOF IN-PROGRESS Will the applicant or forme building Imam store or handle hasardeus material defined by the Caprine,Municipal Code,Chapter 9.12.and the Health and Safety Section 255320)?E3 Yes All roofs shall be inspected prior to any roofing material being installed. ' mllu If a roof is installed without first obtaining an inspection,I agree to removewin the applicant ar future building comfort use equipment or devices which ..it hcrardnus air mmarrinam as defined by he Bay Area Air Quality Management all new materials for inspection. District] Q Yes @Nu I have mm the hasaNu n/s`Materials requirements under ChaPmrli.95 ofthe Califor- niaHcalth&SafcryCadc,Smdons25505.25533 and 25534.1 undcrsmnd this if thc building docs nm n cucndy hveaa tenant,Nm it is my responsibility m orm. I occupant of the - requiremc hiehmostbemerpoormissuanceofaCcnlficaleofOce nney. Signature of Applicant Date ceur audd I h.d agent ,te All roof coverings to be Class "B" or better