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00060018 CITY OF CUPERTINO , xun.m 2 ,otvtst ryERMIT CONTRACTOR INFORMA'T'ION: BUILDING nDUNE55; o e�1 1A/N /`1,a PERMIT NO. OWNFR'SNAME: (/J, 1 . 117 34 �gnlpl�,• AM APPLICATI I'11ONE; / SANITARY NO. COVE ROI,NO. n re0 ZOARCIIITIICT/ENGINEER: BUILDING 1'RRn11T INfO x w_ BLDG EL1:Cr PLUMB MECH I_--i L_I =j 1=1 ¢? LICENSI[.CONTRACT'OR'S DECLARATION 5 I tion 7( tdrrn,mat[.at Ecem.eL under prow i,h,ns ore,Ccdca(e at,fi. w TEAR OFF SHWPiL er'1 tom"' PLYWOOD, COMP o,-%,Cz Milli Section and)of Dlviainn3of the liaaincza mA i'mm,+ions Cods,and myliccnsc ' is in full knee and clomp ce K 6 License Class Lie.q o.u Dom Contractor H ARCHI'I'ECI'S DFCLA1tATION [1 I understand my Plans shall be esus'as,antic mcnN, 7• to-�r z / i p O Licensed Profe,ounil / e. o OWNER-BUILDER DECLARATION ^ u�Z a I heresy aRm,that 1 1,.cxempn'tern,he Cuniones C x Licenw Law fur he Imo•/1 ac%S Much reason.(Section IDBI S,B,alter,mvl or,de toli it a, Anycoy m county \� 5 F o which its issuance, v,cams requires e aumuum.applier,cant nt for such hscrunit i or repair nay statement 65q hjalie incensed prlso sunt oche thehavtpiov al fur Contractors Licenseie a aw(ned iChanenl footioeixncen+ithSetionmOEI)ofDiion.n3atth busine,ssandPaLawlcnaCtRa Sy. Fl. Floor Area t (commencing with Section om and Division J of ea business i,,,mJ PtnrAny v Cock) or ism be is exempt therefrom a"m and the basis forme alleged nemOIL to Airy violation of Section 703 1.5 iv troy hundred am fora permit su„jects the npplleme o-,n civil Penalty . or not more man hue nunerea dnna,a gsoB). Occupancy Type 01,as owner of the property.or in,emNoyees wins wages as mei,role cotnpenmdon. will do the work,and the stmanre isnot intended or offered for sale(Sec.7feO. Business sad PrNcs.aans code:The erotica'',Livenw Law docs a...apply to an etLlred Inspections owner of prowny Who builds or improve%thereon,and who goes such work himself 307 — INSULATION or,hmugb hi,own cmploy,r,,provided ohm welt im,rnvenmnh,ee nal,mended ser Offered for wee.If,howeve,the building or improvement is sold wih in nor year of 601 — ROOF TEAR OFF �,nple.lon,me ow,erbuildcr will have the burden af,raving than he did nut build nr improve err purpose of sale.). 60._,� - ROOF PLYWOOD NAIL 01.asu ne uldic,ropers'.an,cxltor,,ycounachn,wim licensed cm.amen...,o 603 - ROOF BATTENS construct,he pmjeo(Scc.7041 Bosinew aad Profc„ions Cade)The Commaarx 604 — ROOF IN—PROGRESS Lleunse I.uw does nu,apply loan owner of p,npcny who ballet or baa,ovcs,hacon, and who ca tract.fur.such ,.ts with a rontmaorfs)licensed puncta.a the a Comms c 1t/)�Iy� M L13y❑lam m acro l µ, 1�{t.L: V 17&i'C list thin rt.rsnnOwner DataWORKER'S COMPENSATION DECLARATIONIheieM1 Binn under It f ne of the following declarations.ya pen° yo perjuryn y 0 1 have and will maintain u Cenificam of Consent m xalf-balm-lie Worker's Co,npcn+elon, us provided for by Section J7W of the Labor Coda, for me ���performance of Isework forwhich this permit is issued.01 naveand will moi noun Wader's Caa,penso,inn Isurance,m rcyuired by Srction 37M of the l.ano,Cade.far the performance of the work for which this permit is Issued.My Worker's Cmnlmnsetion Iwmnaa nvrier and Policy numberarc: _ Carrico Policy No,1 CHR'I'IPICAI ION OI'I:XEMPI'IQN FROM WORKERS' COMPENSATION INSURANCE rn,is section re,oil not be completed if the permit is for one hundred dollar, ($Iql)or I-,,.) I certify than in,he perh,mence at the work for which this permit is issued,I ,hall not employ any Noun in tiny manner so its a become subject Ir the Workers' Compensation Laws of California.Date Applicunl NOI'IC17 TO API'I.ICANr;If.°fur making this Cenilicme of Eserniumn•you should seen,..subject m the Warkcr's Cmnpcn,ein l pro,Niom of tic Lou urCame.you must C Q fonhwim comply with such provisions or this permit shall he dcerned revoked. F ^ CONSTRUCTION I.ENDING AGENCY CI 1 hereby affirm,hut there is a construction lending agency for the performance of the work far which this peril is issued(Scc 5n)7,Civ.C.) Q Lcuder'.c Name 7 z 1,ad,,'s Arid.... V I cvoil,that 1 herr o,ad mil application and state than the above information is core t I agreeit, mpy with II c it,and county rujamances and ime law,cloning [� mb' . , dh by authorize representatives fthis ry' ter upon �����/((11���//■L tN6 tt he M ti adpropeo,to,im,arcl iturI ” S 'I— V• T F t' IK 1 g I a indemnify and k keep I the City fC peri oat against z rahW e I Pn,c+ h 1 > Y 'i is V G Cito- a gm, g of Tho,conn. ^ APE r 1 ND WILL COMPLY IT I . ssuedby. Date SOA siga hCnnnnmtnr Dec Re-roofs IIAZARWUS MATERIAIS DISCLOSURE ' Willln-a ppBaanno,mlum leudrl,o ,npann,lore,a handle haeallon.manorial Type of Roof as defined by the Cupertino Municipal Code.Chapter 9.12.and ata Health and Soley Cods. m 25512(°)^ OYes13 No All roofs shall be inspected prior to any roofing material being installed. Will the upph.,do,h art, l„�gnreuhamuse cyuipmemn,devie-.which If a roof is installed without first obtaining an inspection, I agree to remove mit haaanlou.s air contaminants as defined by the Bay Arc°Air Quality Management District' all new mit teri.ls for inspection. Applicant understands and will comply with 0 Yes 0 N all n -p nt S arc regal tions. 1 have read me hamrdaus mmcnid,',,boat,under Chapter 6.95 of me Cnlili,rWtgEq Cade.Buttons 25505.2350 unJ25JJ.1 undemm�d that dtM hmc yhave tv'nont.mut itk my Vn 'h',by lis nntiryd mcupanl hien m st be ern prior m.wane are °OeYp° gnature of Applicant Date Owner or aumorited agent Date — All roof coverings to be Class •B” or better OFFICE