04010052 CITY OF CUPERTINO �-1Q7���r Tam` �a�* "y'� *�` ' I�r •`
BUILDING DIVISION PL1' Tl. �l\TAlt1 � 411 �11Ll
.:5
BUILDING ADDRESS: SULLIVAN CONSTRUCTION PERMIT"04010052
7A'R'CHITECT/RNGINEiER;
ER'S NAME: PERMITISSUEDATE
NE: - SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L� t�
u o O LICENSED CONTRACTOR'S DECLARATION
e I hereby affirm that I am hcenacd under provisions of Chapter 9(commencing Job DBSCl1pI100
n�
with Scniyyn]IXYJ)uf Division Jo(thc Busm end Prufcssiuns Codc, my license is
;N_ in falleand ofjCfi37.3
L;aena Claza �y; n TERMITE REPAIR
Date 1.—
B� � / Al1CHITECTS DEC ATION YI— t
�i alslfidcrstanJ my plans shall he uscdarllChlic rcunds
3 C I Licensed Pmfcasional
I OWNER BUILDER DECLARATION
MI hereby affirm that 1 am exempt Gum the CLicense Law for the
O o fallowing mason.Section 703 1.5,Business and Professions Code:Any city or county
JreK which requires a permit to construct,alter,improve.demolish,or repair any structure
_zvi promo its issuance,also mquins the applicant for such permit to file a signed statement
££22< that he is friend perstooll to the previsions of dic Contractor's Liecric Law(Chapter 9 Sq.Ft.Floor Area Valuation
y S (commencing with Section]o0o)of Division J of the Business and Professions Cona)or
Nat he is exempt therefrom and for,basis for he alleged exemption.Any violation of �n.n,,TTi,�wAss.s�a.A.
Section 7031.5 by any applicant for a permit subjects fee applicant a civil Penalty of 3su 4n�sow®'QC�� Occupancy Type
not more Nan five handled dmmn(S50). P Y YP
1,as owner of the pmpeny,or my employees with wages as their sole compensation,
will do Ne work,and lie structure is not intended or offend for sale(Sec.7044,Business
and Professions Code:The Convector's License Law dna not apply to an owner of Required Inspections
property who builds or improves hereon,and who does such work himself or through his
own employees,provided Nat such improvements are not intended or offered for sale, L
however,the building or improvement is wild within ane year Of Completion,the novel
builder will have Be burden of proving that he did not build at improve for puMasc of
sale.).
❑1,as owner of the pmpcny,em exclusively convecting wit licensed convectors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Lb
came law does not apply to an owner of pmpeny who builds or improves thereon,and,
„g who control for such projects with a contactor(a)licensed pursuant to the Contractor's
EFII/y7 License law.
❑l am exempt under See. B A P C for tis rcazon
J4 Prior Data-
WORKER S
anWORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the following declarations:
❑I haw and will maintain a Certificate of Consent to satNosun for Workers Conten.
sation,as provided for by Section 37W of Ne labor Code,for to performance of the
work for which this permit is jamod.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
37W of the labor Code,for to performance of Ne work for which this permit is issued.
My Workers Compensation Insurance earner and Policy number am:
C4 Tr F�+ PaOey No,:S-7/—g-6I/)gQO
CERTIFICATE Pf10N FROM WORKERS'
COMPENSATION INSURANCE
(Thissectimi need ao tmemollered if the permh is fnronc hundred dollars($100)
or less.)
1 CWHY tot in to performance of the work for which this Permit is;aucd.l shall not ..
employ any person in any manner set as to become subject to the Workeri Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this CeNficam of Exemption,you should
become$Object to the Worker's Compensation provisions of the Labor Code,you mon
�O fol Lb comply with such provisions or this permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
I—m rN. I hereby affirm that there is a construction lending agency for the Performance of
W'? Ne work for which this permit is issued(Sec.J09],Civ.C.)
W� Q Lamer',Name
a z Lender's Address
V Q 1 cenify that 1 haw read this application and note that the above information ii
IL U correct.I agree to comply with all city and county ordinances and Stan laws relating to
O building convection,and hereby awhorin representatives of this city m enter upon the.
W e'now-mentioned Fort for inspection purposes.
fy We)agree to save,indemnify and keep harmless the City of Cupertino against
n<y
half lilies.judgments,core and"for es which may in any way moron against said City
t) z In enceryuence of to Emming of this perm;!.
m"^ APPLICANT UNDERSTANDS D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC REGULATIO S
zt-C
4 0 Re-roofs
Si at c fApPhcam/ConMm`Ob Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant time or handle ha>allous material
tlrOncd by the Cupertino Municipal,Code.Chapter R.12,and the Health and Safety
ode,Section 255J2(a)?
❑YeAll roofs shall be inspected prior to any roofing material being installed.
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
emit havardnus air conmmimnts az d recd by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes
1 have read to hasardous materials nquiremcnts under Chapter 6.95 of the Califon
Me Havlt A Safety Codc,Sections 25505,25533 and 25534.1 undcrsmnd that if tc building
does not currently have a tenant,that it is my responsibility M realy the occupant of tc
rcyuiremcnts which d{an spoor¢r its or a crmficate of Occupancy. Signature of App licant Date
/'
0-inscivulm6ed ager Date All roof coverings to be Class "S" or better
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN 35601028 . 00
DATE ISSUED. . . . . . . : 01/13/2004
RECEIPT # . . . . . . . . . : 24216
REFERENCE ID ,# . . . : 04010052
SITE ADDRESS . . . . . : 10950 MIRAMONTE RD
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER DAVE MEUNIER
ADDRESS
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014
RECEIVED FROM . . . . : JOHN SULLIVAN
CONTRACTOR . . . . . . . : JOHN SULLIVAN LIC # 23091
COMPANY . . . . . . . . . . : SULLIVAN CONSTRUCTION
ADDRESS . . . . . . . . . . : 960 OPAL DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95117
• TELEPHONE . . . . . . . . : (408) 247-2147
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- -- --------
BPERMFEE VALUATION 3 , 300 . 00 97 . 00 0 . 00 97 . 00 0 . 00
BENERGY PERMIT FEE 97 . 00 29 . 10 0 . 00 29 . 10 0 . 00
BPLANCHK PERMIT FEE 97 . 00 82 . 45 0 . 00 82 .45 0 . 00
BUSLIC FLAT RATE 1 . 00 100 . 00 0 . 00 100 . 00 0 . 00
BSEISMICRE VALUATION 3 , 300 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 309 . 05 0 . 00 309 . 05 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
--- - ------- ------ --- --------- ---------------- --
OTHER 309 . 05 VISA
TOTAL RECEIPT 309 . 05
•
CITY OF CUPERTINP ` D
CITY OF PERMIT APPLICATION FORM
. CUPERTINO
APN#
3s� Date:1-133-o
Building Address: 4 01
i D qSD � 'n a wloil 7-e
Owner's Name: Phone#:
�a 7 77-D ,k
Contractor: Sol License ';7/,5 ?3�
Contact: 1 ( Cupertino Business License#:
Building Permit Info:
,Bldg Elect ❑ Plumb ❑ Mech ❑
Job Description:
Residential ❑ A- C rcial ❑
'Sq.Ft. Floor Area: j 37Sq.Ft.:
Cost of Project: 3300- Cp Occupancy Group
^
Type of Cons ction:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/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 <=206A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
7 � z/ 6
lof3 367, O�
,
CITY OF CUPERTINO
cuP TYOF vo PERMIT APPLICATION FORM
QuantityFee 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
BNUC0Wv M New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BOVERTRAE 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
BPINfERCEP Ind Waste Interceptor 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 rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10,000 cfrn MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l 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
BREMPOWER Power Devi ce/A aratus ELECTRICAL
2of3
(PITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMRECEPT Rc tl Switch & Outlets ELECTRICAL
BREMRELOCA ' Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Sips 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 Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
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
BMISCELL Building Mise Fees BUILDING
- r
3 of 3
Sent by: COLOWELL BANKER RELOCATION 925 244 0822; 11/25/03 14:41; N58; ,Page 2
JIJN-0.1-2003 17:00 U.S. INSPECT
7Q3 29315'
WOOD DESTROYING PEST AND ORGANISMS INSPECTION REPO,,I
• This is an inspacNon reocrl only not 5 Notice of Completion
ADDRESS OF PROPERTY INSPECTED
.L'e kowb 9cpc<Iron one "':Papca,
Ic950 Liiamomc Rave C,cen'vn 550fd 10!812002 Ip
'rime Exterminators of Northern CA
752Angela
75.03 COPY
qeot
an Jose,CA 95125
hone(.tDe)275-0384 Fax(4081)27S-0365
ex W 77.0509571 I
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!Dena a,: u5e> 0J•me<beln;-,cY]65p r:oneorOL PirlvwaY6�Tv 100 GnenWN.V.a 30131.14291600/0711:b(0 `
open Sent Te: U.6 mFplrF 1 me MaY{Yr:e1]650 Darlca4C P"G•..eY,SWe 400 GRnley,vA 20151.112*f8001 -]6fi0
repw,O.na 040n Bell Villeiy 169501eiremONa Rpae .• ..•.. --
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Gea:ral Dfra.PGee: 2 Story SIu(:ro end Frame ResldRrlcp Flpnisned.dntl
Oc,',pied with a Tile Root and A lath Garage On i'.
i.a u L{e e
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PORCHES STEPS we .tee anelflpa,See Napo _ ." �Oei9l: f, 1
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DECKS PATIOS Ray eccAw101 Reno wnnae-8aleom'
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,'.Sent by: COLDWELL BANKER RELOCATION 925 244 O822; 11/25/03 14:42; q58; Page 4/7
�'JI•+—KIM—cYJL'J.J ♦ r E)A
IJ.D. INMt'CL I.
THIRD PAGE OF STANDARD INS. —CTION REPORT OP THE PROPERTY LOCATED AT:
• rest of
taffy
acted, 10950 Miramome Road Cypamnp , 95014
Bldg No. Street City Zip
10/8/2002 LC35k.
Stamp No. Dale of Inxpention Co-Report No Record Number
:Don I
ches/steps COPY
.nq. V. Evidnnm W tunaes damage w dryrot net.d in Iron:porch 2k8 surface 1431 V �ram.
Immandalon. Remove sort..h4tgus and vest ares(s)with registered PoAgiClde.
'ches/steps
mg; 4e Evidonae of dry and ternvles nbled N port[porch stair eldnger as Vtd,cned on the d,agram.
amm todati.: Chemically 4Eel Beal dry•u00a larmlle Irllasted IimbarY wlln nasi-toed cnemical'N Oslole and accesai '� Y
arms.Remc+e or Cover evidence at infeslslionis).
h4 ( EA/flddenw of Ivopus dent a dryrot noted in mar deck header.joists,backing and Sn edting�
L/ mattered on the diagram r"
am..ndaticr- We reeernmend owner contact f cenyed care>cter(s)to me"necessary reparts and cormtlions•Der local;�'�� '
WiM"me C44C repubemema.
It appears slat watCr scants. Eaimmae house swam and dark,It Is ursrf w ,if this deck isprb' party
nosned.It does rot appear Ilial In.rmerX can be done soler frau bNow Ire deck
ter Exterlor
ing: 119 Evidence or Nnaaa damage or dryrot noted in balcony door jams as iMiclled an Ing diagram.
ammrnaawn: Orfsel primmendseat I .aria( ) wood.Treat Ina aroa(s)won Tim-bon mfT44 OmabetIft 7por;may
e),
pats:prime and seat 1ha steams)rn rteeeeea n It asailixwl anmepe la(eunq'a tupplenlental report ma)be
Swed Wllr ndddonel reDGlrG fBGommepded and Cast..
. :Don II
bsd'vcimm
ing: to Evdpncs of cobuloee tldbns nmetl i^sub loss oat as indkaleq on the dlagmm
amnroMetlo.T R*r VQ mOulose bells of a rahesble site from the subarea and take away from the promises.
CStI'LCtUYe '
ing: 18 Evidence of earth to woad oanli,cl noted h stored wood and bozos as indicated on Na diagram,
ammenaadon:
Owner shoos efiner remove sU b.zea ardelead eland on eat w mise;nam og me ground,
JI Shower
Ing; 2A EWdcncs of a mpafUm eon tion noted in stall snasv cnCloaure ff.od pane')is awicergo on rhe
Gegram.
ammendellon: The ovmer should saloon the se'vloss of a glass repair company 1.Seel Graved this door h viR be the
owners responsibility 10 maintain Ihis area in a water tent candilian.
)er Interior
ing: TOA Ev dance of a moisture condition noted in leaking aemtub enaosure as,ird•eilea on the Wagram,
ommewatlan: Res"the moowre in the most praoli.t way,IAriln This bre of enelos za.wa Carmol quammee to
Comphetaly stop the laakago.Onlyconnol it.It will be dre ownnrc resportibilityto maintain this endosure in a
t w>terproof conddtan. . . .
)Lf interior
IN: 106 Evidence of a moinens condition ruled at Mahan sink growl as Ind.mted on the dregram.
ammenbanon; 6...r is aovised b sc+nl and ma;Mfin lip,grouping ard/a caulking In toot.areas as neossary
1erInterior
Ing: W; Evidonco of a moisture condition noted it oar lop as Indicated on the d0limm.
ommondatiorT O v Cr is aaviscd TO'Gal and mantam me groutog endow mulk;M in masa areas ea necessary.
ter Exterior
'meq: 11A Ev+deneq o1J m.islare mnbKon ndled in neer aaek agowt stucco as inaiGated on ma dieQmm.
. ammeMation. SCe Rccommmdaaen. '
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p '.
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CITY OF CUPERTINO
Bu1Lo1Nc o1vlsloN - PERMIT CONTRACTOR�INFORMWTIQN " _
�- a:
Bu1LDINC ADOREss: SULLIVAN. CONSTRUCTION FEE"IT ND04010052
WNER'S NAME: PERMITI5SUEDATE
NE: SANITARY NO.
NEE: NO.
(408) 247-2147
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
U00 LICENSED CONTRACT'OR'S DECLARATION Job Description
O O O O
Ui I hereby affirm Thal I am licensed under provisions nr Chapter9(commencing p
n<s with Sectilpn 70QB DfOivision 3 ofthe Businsand Proft,uions Code, my fcantri,
m full�c cantle(j�ct.�
I'q: uem. ClaaaJ.Z. g�373 TERMITE REPAIR F�NAL.ED
e III'I----o Dame— I�iv4 �Conmethr_Tn c... Su L Lr`✓G�F_
q U J� /s ' AIICHIIELTS DECLIgRATION -
W ddtl mndmyplmsshallheusedasrMNicrem'da FEB 0 3 2004
jo LiccnuJ Pmressienel
OWNER-BUILDER DECLARATION
ue
E n E 1 hereby reason.Sect that 11S cBcmpr from the Cssions Co :Any c taw far the BUILDING
p o whichfollowing apermit
]IID.S,Busher. and w,Professions demolish,m Any tiny or county
which requires a Permit re quiresconstruct,alcor,improv,hrCritfile
repair any structure
yz prior it) issuance,also requires the applieem for such permitmhlcasigned srammem
p€0 Nhe is licensed Pursuonun the previsions Of tm
he Contractor License Law(Chapter 9 Sq.Ft. Floor Area Valuation
p 300
(m commencing with Section 7")of Division 3 Of the Business and Professions Coll)or
y Nat he i$exempt therefrom and Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of
net more man five hundred della.($50o). 3 y�l7 t"gr0 0 Occupancy Type
p 1,u owner of the progeny,or my employees with wages As their sole compensation, '
will do the work,and the malum,is not intended or offend for sale(See 1014.Business
And Pmfossions Code:The Convectors Littre Law docs not apply to An owner of Required Inspections -
propeny who buildsor improvea rhercon,and who does such work himself or through his
own employees,provided thatsuch improvements an nos intended moRerml(or sale.IL
however,the building or improvement is sold within one year of completion,the owner.
builder will have Ne burden of proving mat he did nor build or improve for purpose of
sale.).
❑I,as owner of the Progeny,am exclusively contracting with licensed contractors to
construct she project(Sec.7044,Business and Professions Code:)no Contractors Li.
cense law does not apply to an owner of property who builds or improves Neaten,and
who contracts for such projects with a contncmr(s)licensed pursuant to thO Contractors
License Law.
❑lamnemprunder Sea ,BAPCfmthismaon
Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations:
❑I base,and will maintain a Cenificao of Consent to ul6insme for Workels 6rupen.
satien,u provided for by Section 37W Of me Labor Code,for the pednrma^ce of the
work for which this permit is isms d.
❑1 ban and will maintain Workers Compensation Insurance,As required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued. r
My Workeerr'sCCompensarion Insurance candor and Policy number are:
Our:
Te u Pot icy No.: S7 I�O��6I/)Nl7
CERTIFICATE "ION FROM WORKERS'
COMPE ATIONINSURANCE _
(This wilirm road not be completed if the Pamir is intent,hundred dollars($I00)
or less)
1 certify that in she performance of she work for which this permit is issued,I shall not
employ any pcnan In any manner so as rat become subject o the Workers'Compemaslon
Law.of California.Date
Applicant -'
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become$Object to the Workers Compensation provisions of the Labor Cnde,you must
,J O forthwith comply with such provisions or this permit shall be deemed mvsked.
CONSTRUCTION LENDING AGENCY
l horny affirm that there issue (S.,3W7.lending agency or the performance of
Cli Iz Le work for which this permit is issued(Sm.3091,Civ.C.)
WM Q Lender's Nurse
�z Lender's Address
U O 1 certify that I haw read this application and more that the above information is
IL P: comet.1 agree to comply with all city and county oNinances and shire laws relating to
SCJ building co®wctlon,and hereby authorize mismsennrives of this city at enter upon the
W ahovomenrioned property for inspection purposes.
gym (We)agree to sew,indemnify and keep hvmlcss the City Or Cupertino against
W Liabilities,judgments,costs and eAperems which may in my way accrue against said City
r)z in consequence of the granting of this permit.
1 APPLICANT UNDERSTANDS D WILL COMPLY WITH ALL NON-POINT Issued by: Date 6
50URC REGULATIO S
94 0�
Re-roofs
Si at c 1Appluant/Cmilmewr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will disc applicant or future building Occupant store or handle h.verdous material
defmcd by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
code.oYCS 25532a)? / All roofs shall be inspected prior to any roofing material being installed.
Will the applica t Or future building Occupant a equipment or deviate w its If a roof is installed without first obtaining an inspection,I agree to remove
emit brOmmua air connminants u d by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
1 have mW the haraNDus materials requirements under Chapter 6.95 of the Calif.,.
six HeelthA SnotyCode,Sections 25505,25533 and 25534.1 understood than if dr,building ..
dors not currently haw a tenant,bar it is my responsibility at notify rhe Occupant of the '
requimmcm whirest et prior to its Ofa Cerdncam of Occupar Signature of Applicant Date
64
Ow th red agent Datc
All roof coverings to be Class 'B"or better
rl