Loading...
24209 APPLICANT TO FILL INA,:0RtA ONITA WITHIN RED LINES — USE BALL POINT PEN ONLY �. Buudlnq Project mendflcCion PERMITNCO' Build ing Add ress: 1 ^� Z 4 Zt9 C A V�IV� cC?–r-I Ni 1 wne s ane: I K one: A ?20.31 CITY OF CUPERTIN4BUILDING DIVISION 61 a._1 �•�^ Contr d •sN ,e' sJ� LI=.nix: APPLICATION / PERMIT ^� L BOLDINGMDCTRICALML BIND-MECHAMCAL CATEGORY CONTROL N A rohited/Engineer. al LIc.No: �• a� QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address 02230 C tj L C_ PERMITISSUANCE ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l am licensed under provisions of Chapter9(commenc- APPLIANCESRESIDENTIAL JOB DFSCRI19ION ing with Seddon 7000)of Divbdon 3 ofthe Business and Pro(essionsCode,and my lirense dein full and dfttl. -/ r'2- PANELS Lirense Cla Date_ - ontrado. p11000 AMPS ARCHITECTS ROTI N reuau�O I understand my plans shall be used u public records. OVER 1 ODO AMPS SQ.Fr.FLOOR AREA $/:Q.FT. U(Cj Licensed Professional SIGNS ELECTRICAL w OWNER-BUILDER DECLARATION SPECIAL CIlZCUIT/MLSC IhercbyafOrm that lam exempt from the Contractor's License Law for the 9LFr. following reason.(Sectlon 70313,Business and Protewfons Code:Any city or TEMP METER OR POLE INSr. 5 v� county which requires a permit to construct,alter,Improve,demolish,or repair � .a any structure prior to its Issuance,also requires the a ppBnnt for such permit to POWER DEVICES c. alea signd statement that he It Imead pursuant to the pmvisiOre Of the 3w Contmetorb License Law(Chapter9(commencing with Section 7000)of Divi- SWIMMING POOL ELECTRIC HUNOs sion 3 ofthe Business and ProfemiorsCode)orthat he is exempt thereVALUATEfromand CJ!%� o{ the basis for the alleged exemption. Any violation of Section 7m L5 by any OUTLEISSWITCHESFIXTURES applicant fora permit mbj is the applicant to a civil penalty of not mom than five hundred dollars(S500). NEW RESIDENTIAL ELECIR as owner of the bees with wages as their sole �.FL STORIES TYPE CONSTRUCTION 1 Property,or my employees 6 �7.� compensation,will d o the work,and the structure is not intended or offered for o sale(Sec.70K Businev and Pmfessiore Code:The Contractor's Lt..Law B does not a pply to an owner ofproperty who Wilds or improves thereon,and OCCGROIIP RES.UNITS F-$^ who does such work himself or through his own employees,provided that such improvements are nes intended oroffered for sale.If,however,thebuilding or TOTAL: improvementbsddwithinomyearofcomptdiortthe°wner- Werwl]have tt`9„�nrdanof proving that he,did not Wild ortmpmve(ee purpose o(ale.I. QTY. PLUMBING PERMIT FEE FLOOD ZONE APN uu I, a owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE contractors to candimd the project(Sec.7066,Business and Pro(eadom Code: The Contractor's License Taw does not apply to an owner of property who ALTER-DRAIN&VENT WAIIIt(EA) Wilds or dmproms thereon, and who contracts for such plojeds with a Cgat.(ad.,(.)licensed pursuant to the Contrador'a Lt...I.. BACK F'IAWPROTECT.DEVICE FEE SUMMARY LJ I am exempt under Sec. R k P C for thus reason ' SANITARY Y N DRAINS FLOOR ROOF,AREA,GOND. ;Owner Date RECEIPT N s'/ WORKMAN COMPENSATION DECLARATION FIXTURES-PER TRAP SCHOOLTAX Y_ N_ L�hemby.1fl.that I have a certifleate of consent to self-insure,or RDCEB'T N di0cate ofWorkerx Compewtion Insurance or.certifladcopythereof(5ec. GAS FA.SYSTEhI-I INGd OUTLETS PARK FFP Y N 3800,lab CJ — RECEIPT# ToLry q GAS EA.SYSTpN-0VER 6(FA) BUILDING DIV]51 ON FEES cramp ray I. I CenBd copy la hereby furnished. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE edifled copy b filed with the city Impeedon division. CERTIFICATE OF EXEMPTION FROM WORKERS' CREASE TRAP PAID COMPENSATION INSURANCE f# SEWER-SANITARY-570HM E.A.200Ff. Date Rocci (Thissedion need nest be completed lithe permit bfor one hundred dollars ($100)°r less') WATER HEATER W/VENT/ELLCTR ENERGY FEE Y_ N_ I certify that In the performance of the week for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the WATER SYSTEM/TREATING Worked Compensation Laws of California. Date PAID OZ Applicant NEW RESIDENTIAL PLMB. SQ.FT .PDate RCCeI t# Z O NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers'Compensation provlamm o(the Labor TOTAL: N Code,you roust forthwith mmply with such provisions orthb permit shall be ILDI CCj deemed revoked. NG FLE W a CONSTRUCTION LENDING AGENCY SEISMIC FEE CL Ihembyafaren that there b a construction lending agencyfxr the perform, TOTAL: ELECTRIC FEE 7O aaca.fthcw.rkf.iwhd ntlila mot b}yuNd(3Tc.3q� ,hick PLUMBING FEE Iender.Name �C INv I/�4T L. `f''l F— LL r Lender.Add. 7,A j.,; t QTY. MECHANICAL PERMIT FEE MECHANICALFEE OW IndifythatlhavereadthbappBmrlonandwatethattheaboveinfomutim S bmrrecr.l agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID: misting to building construction,and hereby authorrepresentatives of this H Z ize city to enter upon the above-mentioned property for InspectionFRH. Inspection purposes. ALTORADDTOMECDate Receipt# (We)agree to save,indemnify an d keep harmno less the City of CuCupertV AIR HANDLING UNIT(TO IO,oDOCFM)againat llabilitica,jidgmenb,cost.and expenses which may In any way accrue SUBTOTAL: again Citylnconsaq ce of the granting of this penult. �������� AIR HANDLING UNIT(OVER l0.000CFM) CONSTRUCTION TAX S aturco( p (cant/ tractorr/tfacto Date' EKIAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant or Tatum building occupant store or handle hazardous HEATING UMTGO 100,000 BTU) Date Reacf t# material as defined by the Cupertino Municipal Code,Chapter 9.12,and the - Ilealthand Safety Cod e Ion 25532(a)7 HEATING UNIT(OVER 100,000 BTU) TOT L: ❑ Yes VFN"DIATION FAN(5INCLE RESID) Willtheappllcant future building occupant use equl prrcnt or devices ISSUANCE DATE which emit hazardous air contandun4 as cleaned by the Bay Area Air 4. QualityMann tDisoct7 BOILER-COMP PHP OR 100,000 BTU) semen p p 'd D Ycs o have read the harInfortis materials requirements under Chapter 8.95 of BOILER-COMP(OVER100,000 BTU) e California Iinith k SafetyCode,Smions 25505,25533 and 75536. I understand that notify theocgdces of the require encs tenant that it met NEW RESIDENTIAL MECH. SQ.FT SEP 5 5� respo�sibi i to ndlfy the occupant of the requirements which mud be met prix 1 ofd Certitiatc Occupancy. /� �/) Falr� ) nit's or authorized agent ate ISSUED gr'; 70TH L: OFFICE COPY k--juPERj,jW • NATIONAL BANK September 9, 1992 Stephen M. Jerbic SEP 1 5 D p 1992 Julie A. Jerbic O 21684 Olive Avenue BLDG. INSPECTION DEPART Cupertino, CA 95014 CITY 0,E CUPERT[NQ Re: 10575 Meriman Road, Cupertino, CA. Dear Mr. and Mrs. Jerbic: Cupertino National Bank is acknowledged the existing structure on the above referenced property will be demolished. The Bank has concerted to this action. Should you have any problems with the building department, please let me know or have they contact me at my office. Regards, • /Awc, Construction Loans OFFICE COPY GENERAL ACKNOWLEDGMENT CAL-23 '.. State of California ••••• ••••••• ••• •On this the�day of �•• 19before�me, ° S C/� 1 SS. McC�M- S • �t �e County of k. l the undersigned N ary Public, personally appeared Ce-ct lice k -77t) personally known to me ❑ proved to me on the basis of satisfactory evidence OFFICIAL a¢wt. to be the person(s) whose name(s) S subscribed to the �AWPueu� within instrument, and acknowledged that >hX Pxecuted it. SANTA CLARA COUNTY WITNESS my hand and official seal. 49 t tUU M C OP s . Notary's Signatu 20230 Stevens Creek Boulevard, P.O. Box 1350, Cupertino, California 95015-1350 Telephone (408) 996-1144 FAX (408) 996-0657 • 21684 Olive Ave Cupertino, CA 9501.4 (408) 720-3717 September 9, 1992 �[ (� �(� 1 uU D City of Cupertino tm SEP 151992 10300 Torre Ave. Cupertino, CA 95014 BLDG. INSPECTION DEPARTMENT Re: Demolition of existing structure at 10575 Merriman Rd.,Cupertino,CA. CITY OF CUPERTINO To whom it may concern: The owners of the above property,Stephen M.Jerbic and Julie A.Jerbic acknowledge that the existng structure at 10575 Merriman Rd will be demolished. Please issue a demolition permit for this work. Regards, ee /� //St phe . I-1 • A ulicA.Jer ;'; ' � INDIVIDUAL ACKNOWLEDGMENT NO.201 State of�'u-� ISS.. On this theS�/1 rL day of fad,before me, County of c 5. &J000 - Scff�riT- , the undersigned Notary Public,personally appeared 6 IePr4en Al. -gna - tluuC A. jctegiel OFFICIAL NO SEAL E] personally known to me ( DECBRA SWOD-SCHMITT03 proved to me on the basis of satisfactory evidence �e Notary PudCaliforniaSANTA CLAA COUNTYto be the persons)whose names) � subscribed to the Myomm.EW s MAY 23,1595 within instrument,and acknowledged that 19:E� executed it. WITNESS my hand and`official seal. 11�Dpul:w"( (- . )OV4Notall Signature " ATTENTION NOTARY:Although the information requested below is OPTIONAL,it could prevent fraudulent attachment of this certificate to another document. + THIS CERTIFlCATE Title or Type of Document MUST BE ATTACHED Number of Pages Date of Document TO THE DOCUMENT DESCRIBED AT RIGHT: Signer(s)Other Than Named Above 0 �11eN NOTA ASSOCWION•aZi6R tm .•PO.B 71M-Ca Po ,G 913e1-7184 • STEWART TITLE of California July 29, 1992 (� Stephen M. Jerbic �� ESE E ►'/�(] E D 21684 Olive Avenue U ►U, Cupertino, CA 95014 SEP 1 5 1992 BLDG. INSPECTION DEPARTMENT RE: Policy No. : CNJP-1597-117576 CITY OF CUPERTINO Order No. 35204926 Loan No. None shown Dear Stephen: In regard to the above referenced Order Number, we are pleased to enclose the following items: (XX) STEWART ORIGINAL CLTA POLICY OF TITLE INSURANCE We consider it a privilege to have had this opportunity to work with you on this transaction. We trust that it has been handled to your satisfaction. • We look forward to dealing with you again in the future, so please contact us if we can be of any service. Very truly yours, STEWART TITLE OF CALIFORNIA J By hmn 01FICE COPY • STEWART TITLE OF CALIFORNIA 2055 Gateway Place, Suite 150 San Jose, California 95110 14081456-9200 CLTA STANDARD COVERAGE POLICY 1990 _ - 'i POLICY OF TITLE INSURANCE ISSUED BY t � { } STEWART TITLE GUARANTY COMPANY } } SUBJECT TO THE EXCLUSIONS FROM COVERAGE, THE EXCEPTIONS FROM COVERAGE CONTAINED IN SCHEDULE B AND THE CONDITIONS AND STIPULATIONS,STEWART TITLE GUARANTY COMPANY, a Texas } corporation, herein called the Company, insures, as of Date of Policy shown in Schedule A,against loss or damage, not exceeding the Amount of Insurance stated in Schedule A,sustained or incurred by the insured by reason of: } 1. Title to the estate or interest described in Schedule A being vested other than as stated therein; } 2. Any defect in or lien or encumbrance on the title; / } } } 3. Unmarketability of the title; / } } 4. Lack of a right of access to and from the land; } and in addition, as to an insured lender only: } } 5. The invalidity or unenforceability of the lien of the insured mortgage upon the title; } 6. The priority of any lien or encumbrance over the lien of the insured mortgage, said mortgage being shown in } } Schedule B in the order of its priority; I 7. The invalidity or unenforceability of any assignment of the insured mortgage, provided the assignment is shown } } in Schedule B, or the failure of the assignment shown in Schedule B to vest title to the insured mortgage in the } } named insured assignee free and clear of all liens. } } } } The Company will also pay the costs, attorneys' fees and expenses incurred in defense of the title or the lien of the } / insured mortgage, as insured, but only to the extent provided in the Conditions and Stipulations. } } Signed under seal for the Company, but this Policy is to be.valid only when it bears an authorized countersignature. } } ) } .San,my of ('omrtov I I STEWART TITLE } GUARANTY COMPANY ,,,,/ �o` t�.......,,q . I 0" LUG Chairman o t e Boar �t`a'�r •r. N �. President } as • :4i ntersigned bYe3]r400.POF�rP 4g 19 0 8 o } Authorized Signatory �}, •w' ;w A } STEWART TITLE TEXAS-,00 } GATEWAT Mur. SUIIE 1M y SAN JOSE, CA 95110 } City,State —_ - — -- -- PPeraYN.QNJP- 1591- J- 1 ' c — - —0 Ud I Fd 0--IQ 151 (Rev. 1-19-91) CLTA STANDARD COVERAGE SCHEDULE A Order No.: 35204926 Premium: $ 1, 527 . 50 Date of Policy: July 28, 1992 at 8:00 a. . Policy No.: CNJP-1597-117576 Amount of Insurance: $ , 5 000.00 47 Loan No.: None shown 1. Name of Insured: STEPHEN M. JERBIC AND JULIE A. JERBIC 2. The estate or interest in the land which is covered by this Policy is: A FEE 3. Title to the estate or interest in the land is vested in: STEPHEN M. JERBIC AND JULIE A. JERBIC, husband and wife, as Joint Tenants 4. The land referred to in this Policy is described as follows: Section 72 , as shown upon that certain Map entitled, "Map of Inspiration Heights, Monte Vista, Showing Sections 1 to 222, • inclusive" , which Map was filed for record in the office of the Recorder of the County of Santa Clara, State of California, on April 11, 1917 , in Book "P" of Maps, at Page 13. APN/ARB 342-16-100 • STEWART TITLE 1512 GUARANTY COMPANY Schedule A - Page 2 CLTA STANDARD COVERAGE - 1988 Policy No.: CNJP- 1597-117576 • SCHEDULEB PART II 1 . County and City Taxes for the Fiscal Year 1992/1993, a lien not yet due or payable. 2. The Lien of Supplemental Taxes, if any, assessed pursuant to the provisions of Chapter 3 . 5 (commencing with Section 75) of the Revenue and Taxation Code of the State of California. 3. DEED OF TRUST to secure an indebtedness of Amount $475,000. 00 Dated July 16, 1992 Trustor Stephen M. Jerbic and Julie A. Jerbic Trustee Cupertino National Bancorp Beneficiary Cupertino National Bank Loan No. None shown Recorded July 28, 1992, under Serial No. 11470505 Official Records • • STEWART TITLE Schedule B - Page 4-A GUARANTY COMPANY ENDORSEMENT ATTACHED TO AND MADE A PART ' OF MORTGAGEE'S POLICY OF TITLE INSURANCE No. 35204926 SERIAL NUMBER 1597- 117576 ISSUED BY Charge $ 0.00 STEWART TITLE GUARANTY COMPANY HEREIN CALLED THE COMPANY 1. This Endorsement shall be effective only if at date of policy there is located on the land a structure designed for and used as a residence of not more than four families. The Term "structure" includes the principal dwelling structure on the land and all other improvements related to residential use, except lawns, shrubbery or trees and except perimeter fences and perimeter walls. 2. The Company insures the Insured, as of date of policy shown in Schedule A. against loss or damage, not exceeding the amount of insurance stated in Schedule A. and costs, attorneys' fees and expenses which Company may become obligated to pay hereunder, sustained or incurred by said Insured by reason of: a. The existence of any of the following matters: (1) Lack of a right of access from the land to a public street (2) Taxes or assessments that are not excepted from the coverage of this policy in Part I or Part II of Schedule B. (3) Unrecorded statutory liens for labor or material arising from a work of improvement on the land completed at date of policy, except liens arising from a work of improvement for which the Insured has agreed to pay or for which the Insured at date of policy knows payment has not been made. b. The enforced removal of said structure or the interference with the use thereof for ordinary residential purposes based up the existence of: (1) The encroachment of said structure onto adjoining lands or onto any easement referred to in Part II of Schedule B onto any unrecorded subsurface easement • (2) The violation of any enforceable covenants, conditions and restrictions (3) The violation of any zoning ordinance, but this Endorsement does not insure compliance with building codes, housing codes or other exercise of governmental police power c. Damage to said structure resulting from the exercise of any right to use the surface of the land for the extraction or development of minerals. This Endorsement is made a part of said policy and is subject to the schedule, conditions and stipulations thereof except that paragraphs 2, 3, 4 and to of Part 1 of Schedule B shall not limit or exclude the insurance otherwise provided by this Endorsement. Signed under seal for the Company, but this Endorsement is to be valid only when it bears an authorized countersignature. STEWART TITLE GUARANTY COMPANY 1tt'k•E CUq ff� t �y wok 1908•,;0 Chairman of the Board •••. ••• • rest ant TtzAs Countersigned: Authorized Countersignature Stewart Title of California San Jose, California E-35204926-1 153-HOMEOWNER ENDORSEMENT ATTACHED TO AND MADE A PART No. 35204926 OF MORTGAGEE'S POLICY OF TITLE INSURANCE Charge $0.00 SERIAL NUMBER 1597- 117576 ISSUED BY STEWART TITLE GUARANTY COMPANY HEREIN CALLED THE COMPANY The Company, recognizing the current effect of inflation on real property valuation and intending to provide additional monetary protection to the Insured Owner named in said policy, hereby modifies said policy, as follows: 1. Notwithstanding anything contained in said policy and any other Endorsements attached thereto to the contrary, the amount of insurance provided by said policy, as stated in Schedule A thereof, is subject to cumulative annual upward adjustments in the manner and to the extent herein specified. 2. "Adjustment Date" is defined, for the purpose of this Endorsement, to 12:01 a.m. on the first January 1 which occurs more than six months after the date of policy, as shown in Schedule A of the policy to which this Endorsement is attached, and on each succeeding January 1, 3. An upward adjustment will be made on each of the Adjustment Dates, as defined above, by increasing the maximum amount of insurance provided by said policy(as said amount may have been increased theretofore under the terms of this Endorsement) by the same percentage, if any, by which the United States Department of Commerce Composite Construction Cost Index (base period 1967)for the month of September immediately preceding exceeds such Index for the month of September one year earlier; provided, however,that the maximum amount of insurance in force shall never exceed 150%of the amount of insurance stated in Schedule A of said policy, less the amount of any claim paid under said policy which, under the terms of the Conditions and Stipulations, reduces the amount of insurance in force. There shall be no annual adjustment in the amount of insurance for years in which there is no increase in said Construction Cost Index. 4. In computing loss or damage incurred by the Insured Claimant, the amount of insurance in force shall be deemed to be the • amount in force at the date the Insured Claimant first learned of the defect in title from which the loss or damage resulted or the date of receipt by the Company of the first notice of claim, whichever first shall occur. Nothing herein contained shall be construed as extending or changing the effective date of said policy. This Endorsement is made a part of said policy and is subject to the schedules, conditions and stipulations therein, except as modified by the provisions hereof. Signed under seal for the Company, but this Endorsement is to be valid only when it bears an authorized countersignature. STEWART TITLE GUARANTY COMPANY airman of the Board President ri'x'ws Countersigned: ✓fin � / ��t'�� Authorized Countersignature Stewart Title of California San Jose, California E-35204926-2 Inflation 5537-6 u M4 •�'�\ I � h � N � � 1 • ID J .M _(D f x AI -.l r[`. I 1 oisho I I m a •- nn ,p Yln ! 7 "'J � �• a � iuiH ^' SM 3^b I a �YY •u[ ^4¢ w A. GI �ozaQ 01vb lS�m i S -R •m - _ o'= W o 1 -+ _ L xl 11[17 .M'[os•' ,� � ¢ O V I ••; - , � a - - rMl 1Il'f1" � CCH 240 z �e Nd l^ x•i bII .tel IIrd1 ? d b� Y x � A/J7� �W � ¢ p O Yi -y. N 'IR 6 _ \I _h'y} 1011 I . L•Jy W � � � f,.. ru = VNI33 u _ �_eol X IC I IQ 8e ( n • I Y ... ~ m 7 I �I ^t�IYY ml I � akil �I R � I C-_--iY 'M I'Y �I gy • � aa,.,j �---F"l4 ry 1 0 Yh-----^ Ii Y lij !nl e J LL 1 ._ e,/ all . O -iol T--I�-- a q• o1a1 . Y L=_--x¢ R„P p •w n Iru �.: en. 30,tlo,V l .i )3 � . I /NSP/RR Tf DlY HA"/GHTS XONT�9 !//S TA ��.,/r�Ao /y7 .1 �, « Yr'... �\•'/�.1 ,f n 1= � ��r � •. jw. .... A t 11 L,t ., r • t i .G hc.:...C:_.,..rei...✓, .i... .. .'t -- t I +r � t:} V L ' IJ TF/-.wY.�..�..�-.• /RSenri,+'Y, .Y. :n- -Iie 1" i+wi • � �(^'!�' •� O. •r Ne Ci Y O N � A 1.1 .a.• Y.��'Vit. O ¢ p ¢ yam.wYn��wn-I-.wI '.. .1'd \ �� �„.•�a `•+I m�6y m Z O p ZE CD /I.�..•w:,fa�.«.r.,«✓ y/ e pro/ ' ....s�yrl.....rr.r�. � � z 1.. u..^ ..y s..+.:�,..+f�sa.i:.w Y/-�i' :«c < I ., w.w:.�.✓rwr.Yl.b...r Cx �f"• .w .r.ys.... t" 1 n... w..r.......Yw... c � c �w C/�.rwzy 4wd[yilr y. - .;f ..,.-�.�.r•r..-. z W .- (<.U.�lry-.pay /Iw.Jr./ M1' _ II.Kn_ii.Y.YrYiJw .[ W H U Jr .✓I, I J.',i LC�iA.[.L ! ,� , K�.��4v�.Y.fr«1� � W J `,.ly� J.~/-�n u..IMr wYAr sa.Lyorl. • q N.,.:i. �,{.��c`..�:�rvyiy i... r'w`.'t�.++: µ.Y'::.�'e.'..^�1.'.' '9",��.✓�.,n.s...��:f.'..' �lw .....wr.� /arw�.M1✓ �A I.df. v.i�'LS4'J .swY....abf•14.r.../ws�f'✓�.rRa./.) j.G....Y 0 ' ws� �+: YYa �' N p.J li.Y.i..//•'•f•'/yw' .r.b aer .•- �.•�pAG�Ir / «4.I.w'Y.'1".yml�A.Y•.;«Awr N.YN yYM1.. - ay....... r'••wb X:ib/...i/«/.M K..n� . ./ [w/yµ4.w./+ygr4/y..✓�.glw'n+Y 1 il'/n •/.�--ti.�.w.. .�;N�.wW y�'/r�yAr A..I..L......»wlr/r..AM �'p'MKYWmu IG.«•r.Ku.�./...ICJ ' . .I.I�..ai. w..r«Y✓«.J._Ir)..ww.r..r... . ww.:w.Iyv - s{.i�.�ij� N�.:..n/ N yu7•«. a a�fM,,�AF.w✓y 9 .'�-'. "4 F p o L io o r Q0 m � a CD -� o o 0 I N a = p a O D N O n O O (D �-4- //`��I O. d cD O O V E d CD o w O a m (n O (D < N (D Q Q ' CD - N I , o Q G � Z � � v .CD � S �� ro � mcr TI gm p 0 z a �► D. ' SEP 15 1992 BLDG. INSPECTION DEPARTMEfi CITY OFCUPERT 0 M P L I A N C E STATEMENT - - - - - - - - - - - - - - - - - - - California State Law, as promulgated through the various codes (Section(s) 7028.1, 7028.2, 7058.5, 7065.01, and 7118.5 Business and Professions code; Section 49410.7 Education code; Section 24223, and chapter 2.5 (commencing with section 24275) to Division 20 of the Health and Safety code; and 6325.5, 6436, 6501.5, 6501.7, 6501.8, 6501.9, 6503.5, 6505.5, and 6508.5 of the Labor code) requires that prior to the issuance of a permit to demolish any building or structure, the person(s) requesting such demolition permit notify, in writing, the BAY AREA AIR QUALITY MP MGMENr DISTRICP of the intent to demolish such structure. Signing this form states that this requirement of the law has been met by the responsible party. � I eP-�, Y4t � �Qo�,.��✓ game (pr t) Signature Date D0CU-DEMD(BLDG5)