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04110003 , � � � ;. �,. , � �� � - ',CI su��o ncnrEltoNlvo� � � � PERMIT : ..� CO�'I'RA��1'C1�I1�T+'la�M` A'�.'.TU�, :. � � . :. �.. .., ,_.,. .� . ._ �a : uF. ..� � � ����., „ . . _ ° � BUIL�INGADDRESS: ` " � -� ' ' ' ' ' ' � �, PERMITNO.' � -- . � .r. '. _ , - . - ANTIQUE TERMITE "& PEST 04110003 - - - , _ . ' OWNER'SNAME: ' . - . . . . . PERbi1TLS5l/0DAT0 � '" . � ' E:� . . . . . , . . . SANITARY . OLNO. .' . . . ARCHI'IECUENGINEER:. . ' • , . � . � ' BOIL�INGPERMtfINFO �" ' - � • , - . � . _, BLOO _ ELECT �PLUMB � , MECH�' 0 0 0 0 uo0 � ��' ' ' ' ' LICENSEUCOMRACTOASOECLARATION ' � ' ' � ]Ob D05 �7 � - � w � - 1 hcrc�y emrm thei I am IimnwE�unJcr provuiom nf Chap¢r Y(commcncing. "� � � � � cri uon ��� m�h5 tion lafDivlilon3 f Buaiqa57enJP �c��Codc.mUmYliccnxia . . .. . - � � "� ' . . _ � - _..'- ^ � m full fo ena cRe� ✓��� �- - Z�� Laeni¢ J�Iw��Lk:M � �� _ TERMITE REPAIR (1D OF lE) ` . - ,._ , DBN' ' COOLf�Cb� � 40 � 8Q _FT..� � � � � � � - RCHITECTSDECI:ARAT�N � 1 unacrsunJ m pl�n�shtll Ac�jV��h�l¢'hrords ��� '� �i� �C""� , ' . . ' . . . . . ._. . . .��'C, ne�utl Pm�nel�J � . , ' ��� _, � 5 OWNER-BUILDflRDECLARATION � 1 hcrthy afOrm Net 1 am.cxcmp�fmm Ne ConuenoYs Liccnx Law for�hc �" ' �O� fullnwinp rcasan.(Sccuun'i1131.5,Busi�sc and Profcsanns COJe Any miy ur cou ty �. .. ._ .,, - ' �/_ �. Y� � .�$�i which re9ui�ca rpefmit u�conawc4 al¢c�mpmw Jcmolixh.m rtpoir any swcmm .., . . ' ' 71.. , ' � . ca �,2�° prioriniBissuancc,a6urequims�hcappliunlfo�emhpermi�mNcani6^cdateMmem . xo IhaiheislicenxJpursuenlunhepmvisio�uofNeConver.mrslacenulaw(Chepter9 . .SL�.F'I.F�OOC/�l08 V3�Il$'�'^)n. � �F$ (commrncingwiNScclion7000)ofOrvision3ofNCBusi�v.vondProfcssinnsCoJc)u ., .. - ,., ,. . � ' . . . '+"'5,00- 5_ . ., . ...., .. , . . ., � .. � IIu1 he ie exemp�NemGom mE Ne besu(ar Ne dleged exemp0on.Any violafion o! �� " � � ' Sectlon 703L5 by eiry epplicant for e pe�ml�aubjccu Ne epplicmt m�civil peml�y of � APN NUR1b07 ' - :,..OCCU ane e � � ' . mt mae ma��w huneme em�en(S5o01. � - , . . . � p Y Typ ' .� ��- ❑I,uawnerof�fiepmpcny,mmyemploycetwlUwegesssNeireokcampense�lon. 3561�-�44'. �� - - willAONewaek.mdNeavuclumlamtinmiMedaroRuedforalc(Sec.'IOCI,eunineu - . , . - . " .�a r�r«,�o�c�x:rn�ca��an,u«�i..w e��o��vvir m.o,ow�«or .; =. ;:Required Inspections _. �..- . � , - _ , ..,propenywhoWildeoNmproveeNereon:entlwhodweeuchworkhimitl(orWouBh��¢ , p�o^,.:, . • .�*'- "- . _ .•.. . • .. ,'�:�,_.,_ , ownemployccs,pmvidcdNnnuchimprowmenuvtna�in¢ndeAorolRrcCloraale.lf, - , . , ''" ''' howew,Ne Euilding or impmvement ie sold wilhin ane year of rompleuon,Ne owncrv � . . _ � builder will hrve Ne buNen of pmving Nn he EIE not build or impeow for puryose of . ulc.). ❑1.u awner of Ne propctlY.em uclmivelY eomm�int wi0littnud conuecmrs m � ' . . contwct��e pmJen(�.]MC.Busineu antl Profrnsions Cade:)The ConvacmrS Li. . ,.._r_�,-,.,_^�__`^ " - ceve law Eors not apply lo an owner of p�openY who Wi1Ei or improves Nerton,anE ` -' .""`_ "-�' �""""""^ .---._.._.,_...__,..,.'....__. . fl .. - ��.�.�_-. �' whoconuecuforsuchpmpcOwiNecomfacmr(s)IiavedPursuammNeConuacwr'v ..__ _ ._ -. . —_ ;_�,.-_..__.�_._',_ " _ .. _.. ...,. . . . . Licenm Law. . �. . ' , ' . . . ' " -. ,..__...__" ' "" _'""' ❑Iamnemp�unEerSec. � .B&PCPorNiemuon ' - , „ Owner Da�e WOftKER'SCOMPENSATIONDECLARATION . - Ihcrtbyelllm�underpenel�yofperjuryauo(Ncfollawinedulue�lons: � , - IhewenawillmainuineCcnifirn¢6fConaentmstlGinmrt(orWarkcr'tCompem ' . , . ' '� , . ' � . _ , ' euion,u pmviEctl for�y Sttuon 3]00 af Ne Ishor Codc,fm Ne peKormence af ihc , , work for which Nie pe�mii is iuuc0. - . . ❑1 haro end will meimein Wor4cls Compertvetian Insurana,u reyuimd by Scclion ' � � � 3]O�a NCUborCoEe.forOepcKarmmeco(NeworkfarwhichNiepcemitisiuuetl. . ' My r's Cnmpennuan Insunnce articr end Palicy numbcr aze: � Ca Poliry Na: ' i _ �� ' � . � .CERTI�P170NFliC7�i�� �- . - -.. . .. . ' . . . . . COMPENSATIONINSURANCE - " � ' . . . " (Thl�uciinn�edno�lmcomple¢Jif�hepermliiePoronchun�rtEGolluslSiW) ' . . . � . .. . . � ' � OfI¢SSJ ' • . • • . . : 1 cenify Ihe�In lhe pedormenee of Ihe work for which�hie permi�u ineucd,l shell not . . , employanypersoninanymannerwazwMcomesubjeclmtheWorkersCompensalian � . ' Lawa of Califomie.Dem . ' APPiicam . . .. . _ . .._. .. . .. .:.. . ,. ,e _ .. __. . . .. _ . . . ... .. .. _ . . ._ � nu shnulJ .•. . . ... . -_ •. �+v-.. NOTICE TO APPLICAM':If,afmr mekin6 Nis Ccrtifmam of Exempiion,y - � - � � Ettome eubjcct io thc Wodcr'a Compuuetion pmvi�iom of Nc IshM CaMc,ynu mua� �z foMwi�h comply wiN mch p�mieinn�or tAia permi�shail M ticcmctl rtvokcO. „�,i O CONSfRIICfIONLENDINGAGENCY -[ro-N+ Ihemhya(firmNetihcrtiaaeoiuwcunnlcn4in;agcnrylorNcperfo�man¢uf . ' Rr' � ihe wurk fur which this peemi�is ia[ued�Sec.J09],Civ.Cd � �� lenticr's Namc . - - ', �z LcnGer'sAEtlreu� . ,. . . . , . . �J� I artify N�t I hevc rtaC Nis applicetion end sbm Ne�J�c ehovc info�maiiun is ., ' , � F corte<L 1 agme io cumply wiN oll cily and counly oNinences enJ sum lews rtlaiing io � - - pU builEingcon5wftian.an�hcmbyeuNom<rtpeennm�ivcsofNiacitylacmcru�mnNc ' W ahovcmemiunetlproperry(orinspcctionpurpoxs �y (Wc)�6mc la eavc,inOcmnily anJ Yccp humleu Ihc City o(Cupertino e�einsl . ///� � Iiebiliue;Ju�gmenu.cosuendexpenu�whichmeyinanyweyecnucu6einstmiJCi�y �� �/ � � V"� in conacqucncc of�hc gmn�ing of ihie permiL �. .y. � APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POIM Issued by: Date ! . � . SOURCEREG LATIONS. �` Re-roofs Sie o APVlican✓Conuacmr pok � HAZARDOUS MATERIALS DISCL� Type of Roof , WIIINeepplicantur(umrtbu' in6acupeNaiorcorhen0lchvudousmemriel ' . ss defineE by�hc Cupenino Muni' el CoOe,Chap¢r 9.13,anJ�hc Hcallh�nJ Safcty� , CoJc,Stttlon 25532(a)? � . __ -- - —All roofs shall be inspected prior to any roofing material being installed. � ❑Ym ' Nu � � �- - Will ihc applicant or Nmrc bui g attupant uu cquipment or Jcviree which If a roof is ins[alled without first obtaining an inspection,I agree to remove . itharardousuiroonmminanuea mcahyNaecyArcaAirQueliqMana6emcnl allnewmaterialsforinspection. Disuin? � ❑Ycs \` u 1 havc reaA�hc�vallous ma¢nals rcquimmcnu unJerChap¢r695 af�M1c Califarv , niaHralN&SaRryCotic,Scc�oiu25X15.35573anJ25534.1unJcrsmndNmifNc buil�ing Jms no�curtcntly havc�¢nan4 Nai it u my rcsponsibiliry w noul'y thc occupent of Nc myuimmcnuwhichmus�bcme�pn�orw�'sGsua�ncc—afaCcnifca¢�fOccu ry. � SignamreofApplicant � . Date • — � � �" ����� All roof coverings to be Class"B"or better Ow ramhonmJa6cm Dam