01050154 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS VERMI I'No
1094 MILKY WY EXTERIOR 901_I-ITIONS 0:.0501.54
OWNER'S NAME: - AI`VLICAI'ION SUB DATE FI.IMIO AND VI4J7Ahl 1771 SMITH AVE •05/1.8/2001
PHONE: SANITARY NO. CONI BUT,NO.
' G408) W58-1.233' .
❑zZ ARCHITECT/FNGIN[ER: BUILDING PERMIT INFO
FOC
z ❑
X, 11.EC1' I'IAM11H A1ECfl
a
Z S m Z LICENSEUCONTRAC'1 OR'S DECI.ARA'I'ION ,lob Description
1 hereby u(dnn that 1 am licensed under provisions of Chapter 9(commencing
FiZstw wish Seen I70(Xpof Division Sof the Busineswnnol Prolusions Codeantm Ilccnac
a_ , is in full Ii,recRe`I'G � f
Baa I.ie Dass_ 1 3 REMOVE SHAKE,.
Dat �p—� cW.ImIWr- /y/ INSTALL 30LLD. 1=EI_'f- .
m nRCHi rECr'SDECI.AR ) 1
understand my plans Ong ne mea a.panfereeWrJs SOC.J�OA! $ I_A M
:.0 N AX-
i o Licensed Professional "' -
a. OWNER BUILDER DECLARATION
ti
M, I herchy..Bunt then I urn uscmpl from the Couttmmr's Licce,c Law for the
C?x� follow....ma..m.(Seen 7031.5.Bmincss and I`mreaiam C,x1e:Any city.,,'army '
EFe which requiese permit I t.after.improve.demolish, repair' ny wriname
i3m Poor—
print t sur 'I q 'd ppl' tl 1, It 1, _, LPI,ncnt
hill he licensed imIt thepevoi,jar,of the C t I ,,License 1 (Charge,9 Sq. Ft. Fiew'Area ValuatiO4
(u, , 1hSat 7(HX)) fD' 3 0he Br,itus,andl fess' Code)
or that hes exempt dowl tom and the bat f r the all g d e pt .Any violation 3 00
If Section 71.5 by any aOdinmt for a peamit sub,iecd the applicant it)a civil penalty
ofmltm,m man fisc handled dollar,($500). APN Number Occupancy Type SFQ
01.m Wwncrof be au,uy.clniy moplo,yev, oh wega as n,air,0e cn...Na,ttlou,
will do the work,and the swemre is not intended or offered for sale(Sec.7WJ,
Bnsincxx'end Itolcxsions Code.The G,ntnmlm',Liccme Law docs not apply to an Required Inspections
Wisner of property Who builds or Improves thereon.and who;dues such work himself'
n hrough his own c a,ro,cv,.provided that such improvements arc not intended car - .:/6220009. 12,10
Written for sale.11:however the building or improvement is sold within one year of -
imnpletinn,Ihn ownc,ludider will have the burden of proving that he did oat build or
ntpmwermPurpn.WWntJe.>. 305 — FRAME
01.a.owner Wr me poperty.am aaelmivu,y'ou"eering with licensed"anne" I, 3L1,7 — INSIILAT,T OhI
co..smml the form(Sec.701).Bmmexs and I'mmswinnw G,dep'rhe Conwcmr's
Dans,:Law does our alp,y to an owner of property who buildsor improves there').. 60,1-r — - RQSF'. TEAR OFF
and who convects lir such project,with a,ommclons)licensed pursuant to the
Contmmodice
Lnse Law' 602 — ROOF PLYWOOD NAIL '.
❑turn uanpi under See_.B&PC for this reason -
Ow,ner 60.E-- ROOF. BATTENS -
WORKER'S COMPENSATION DECLARATION G04 — ROOF IN—PROGRESS
Ithereby affirm under vataltY ofps) ry rare ofto followhigJ 1"
❑ 1 have and ,If majuu,Im a Cc,filkaw of Cud,vur II,sclf-ivi,arcf WWtlmrs '
Compression. provided l by Section 370(1 of the LaborCode, for the
n
pada ,ssofluw')kfit I,,-hmapmnl', ,amd. - FINALED
IINLICaul will melmain Wod.dw Compensmion Insurance,as required by Section
of the Inner Craft,for the perionnance of the work for which This lwrmit Is
„ted M Wurke',Cm,t 'onInxmtmeecarrierandPnfcynumberam: MAY 3 1 2001
Gartien���o=IMP ea�(
CIiILfIItCA'I'ION OFEXEEXEMPTION PROM1t WORKERS'RS'RS' -
COMPENSATION INSURANCE BUILDING
(This w<ction need not be oniplvwd if the profit is lilt one hundred dollam
(5100);o Icas.)
I certify thm in the perfsnnunce of the u'rk for which this pcmi"th",inured.I
shall nrn employ conn in unymynuc 'to
c%,
�(e��p Icct th�e��Workers'
Cnmpe.Mtion 1 o n'
Apphnim
NOTICE TO 1''.CANT:11,after to ungI its cat ma c WI lase pis, ymt should
hemnmsn I)the Worker's amtpensationp ,visions ofthel,ubor Cede.you mast
Q O limhwith If,1,with such Pm,visions or this pcnnit shall he deemed rcm,kal.
F r_ CONSI RUCTION LENDING AGENCY
1 hereby aff rot that he.is a cnnswchon lending agency for the performance
of the work for which Itis permit is iwsnml(Sri.3097,civ.c.)
A. Q 1<nder's Name
D Z Lend,,*,Address
C.1 0 1 viably that I have read this application and state that the above information is
U+ P correct 1 agree IW comply with all city and courtly o..hrer ties aid sums laws relwing
Q V Io building convocation,and hereby amhoriec mprewmativcs of this city to enleruprt
Q. the nbovommano.ed prop,,y li,r l.spalion ma,oscs.
(We)a,mcmxave.indmnnil'y and keep hmmluss the CltyofCupcainW agarum
U (P liabilities,judgments,ensu and expenses which may in any way meme against said
Z City in emwcyucnvn oI the gnonfr,of 0ii,per 1.
li UNDE S SANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date
SOURCE Al
Sgnomrc nl ApplicunVCunlranor Doc Re-roofs
HAZARDOUS MAI ERIAI ti DISCLOSURE
Willthe:q,plicam or luwm building everpant store(it handle h:vardoux material Type of Roof
as defined by the Cufcalne Mmticipal Code,Chapter 9.12,and the Ileallh and Stfe,y
Cale,Section 255320)?
0yr, Xo All roofs shall be inspected prior to any roofing material being installed.
Will deapplieentor tuane haild'mg-,mom ow ,tipmear or device,which If a roof is installed without first obtaining an inspection, I agree to remove
emir hr,rogms air vorma:nun,a define)by the Bay Arca Air Qualify Manage car
Distdeh7 all nat rials for ins •et' t. tic• t understands and will comply with
0Yas 'L'No all new)-- oi t source g IaC L.
I havc reel the hr,auomn mxlcriu6 a ptircmcats,radar Chapter 6.95 ofthe
California Health&Samy CWe.ticctions 25505.25533 and 25534.1 muk,mndthat
if the boil •)neve oath cumnly lave I tk it lx""respnnsibilitymnotifyt
uccu, WI rcyuimmem x cb riot uh iasunnce of a Cerl':cam I'
Da° Sir tore of Applicant Dat
`� All roof coverings to be Class "B" or better
Uwn rwtburimJ agent — - Um
OFFICE