00090130CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
FERMI r NO.
)WN:R'SNAMB7671 ORANGE BLOSSOM
Arr...CNI'ION S( q,i,
IONS: RITTENER PATRICIA J
SANFARYNo.
].ARCHITECI'fENGINEER:
(408)719--0704
BUB.OING PERML INFO
BLDG 1:1.170 PLUMB MECII
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LICENSED CONTRACTOR'S DECLARATION
.lob Description
I hereby titin that 1 am licensed under pookioto of Chopter 90,om a.rrmg
u wish 5tt'lion 7(XX))of Division ofthe Businew and Professions Code. and my license
Is In full Inrce and L} .— 5
uL.Icrnw� ( Lic. N
nate frQl C,)FCLA� S ---
T/0 SHAKES, RESHEET i./2 CDX, RDD 30 Yl
N ARCIIITIiC1"S DEChARr\ ON
SHINGLES
gwnncalnmlaoypho,shauncmcd:+sp+llaianwon.
o Liccased Prnlissinnal
OWNER-BUILDERaULCLARAraON
that 11. exempt from the Commr,C s License Law for the
1 hcmhY incaati
/
.alfirinsisa t ymoorml.5. oli Any day or county
and lle.
ocroontermite,
0
/
aht'.,
de h, w
a pcmtit to comma, alter. impm,e. demolish, or repair any swdure
O which rca ail
which
In; tons sI is riscl p ukn requires the apPlicw I the Co pemtit m It le a signet smmmem
"a
thmhci,rin, dt nwritep fin, License Law (Chapter
Sq. Ft. Floor Area
•luation
folmunfthe paclory
Cock)
Iconnnemcis Seo of Division 3 ill the liminess and FI olAli, i nJcl
rwhit, (I,cmfi mr a l
ser thin be is Ihcrefmm unit the bus L, far the alleged cxampnion, Any violmion
that
31.5 b four($ I,:srtnin ,unjeco the applle:un m n civil pewlny
of Scn lou 703 LS by ams dird
APN NumberOwupancy�Type
doll
nrno:norndtaltawcl+andmadoBanastxp,
$ 6000
01. as owner of the property. or my employees with wage, as their sole compemadun.
'
Required Inspections
will do the work, and the zmusi is not intended or offered for sale (Sec you.
Business and Proessiom Cals:Ine Commetnrs Ueensc Law does nor apply to an
ovaer of property Who nullds or improve, thence, unit who doss such work himself
31661 1083.00
r Is h his sewn m,pinyw,. Provided that ouch Inlprn enter am all imended err
o0'emd for snk, If hawWeq Inc mill ing ,l Improvement Is odd within clic year it
-
nmplmian, nhc uwncrbuildcr x111 IInVC the nn dEn of pruning thin hC did not build or
mpowe for parpn,ecl nNU.
305 — FRAME
0 1. as owner of the political, ann exchu%iwly contracting with liceiv,ed conarracion. to
307 — INSULATION
mgmcl the pmjat (sec. TW. Ravines, and Pmfes,ion, Cale:) The Conlmanr's
License Law d(w, not apply to an ow, net of pmpeny wno build, or improve, thereon.
601 — ROOF TEAR OFF
aCnd who connotes loo such polect, with a wlnmern') liccmed punuum no the
uvema Law.
602 — ROOF PLYWOOD NAIL.
oloration,
C I an, exempt under sec. � B N I' C for ll... tenon
603 — ROOF FATTENS
owns` WORRGR's IOM VENSAI 10N DECLARATION
604 — ROOF IN—PROGRESS'
1 hereby anion under penalty of perjury one of the following declarations:
❑ I have unit will maintain a Certificate of Consent no ,ell -insure for Worker's
CamPemmiun, :is pmvidcd for by Swill 3708 of she Lunar Code, for the
-
performmrc little walk for which his Mmut i, issued.
have and will nwimain Worker's Cnnlpunvnion In,umnec, a, ....brad by Sc"inn
111x1 of the Labor Cade, far the pc11-or are. of the wark4nr which this .snit i,
Mand Al[y'+w'orrJk,'. cote eon lnwranm carrier/a�ndryP�licy numRrasci
Nn.: 2i _.00 — a /3
L
Cartier: �?'(RYi_ .paliey
CLRI'IIICAiION OF h%GUYI'[ON FROM 11roRKERS
COMPENSATION INSURANCE
(Thin ncaninn Iced not he complcmrl if the pcnnin is far lac hunJrW Johan
ISIfNI)ser
k'
1 lmly Ih:n in the perfoonaoce of the work hour which this penin i. Isori I
shall not employ any pcson in any mumer ser as u+ becanc omecn to Ne Worker,'
Compensaamm Law, of California. Date
Applicant
NOrLCE TO APPLICANT: IL a0er maAing this CCnifcme ill Encmption, you should
became subject to the Worker '\Commm pion Provisions of she L.aMn Care. You must
firm, ith comply with such provisions ser this penniI shall be dee ned revoked.
,
'3 CONS 'rRUC'I ION LENDING AGENCY
1 herchy union that Ihcm"u cras tido lending :tgcrey fur the performance
of she work fill which Thi, .it a issued (Sec. 3097. Civ. C.)
'] Lender's Name
L Under', Address
I wr ily than l have mad this application and slate that the above information i,
cnna't. L agree as comply with all city and county nNimaiw, and elate law,, retuning
mflitting ca ivnwninn. and hereby authon, r,nemmurn w, of this city to enmr upon
'or'm"'wh
the a rowanwnJnncd I aly a furrow,,
'
y I we) agmemmva indamnify and kee, a rrIvIl the ChyolCapcnlna against
'J1 liabilities, judgment,, cess and expenses which may in any way Nessus against said
Z City in consequence ofE greI ill this pern..I
APPLICANT UNDERSTAND -U ILL CO 'LY WIT1 ALLyf/O
SOURCEREGULATIONS,
100Sigaatnreon
Issued by: Date �ZU—Uy
Re -roofs
ApplieanvCnmmaur Dae
HAZARDOUS. IATERIALS DISCLOSURE
Will the upplieunt sir facers bnilding ts:cnpant e,am err hauJlc h:v;Wou, tm¢riul
Type of Roof
as du6md by Jr.tCupcninu Mm.....al Cndu, Ch:gner 9.12, unit the Ileald+and Safety
Cora, Swtil 2553200?
❑Yc, u o
All roofs shall be inspected prior to any roofing material being installed.
Will me ... lima m future buildings*vhpant me cilail'rmin ,, device. wmdt
If a roof is installed without first obtaining an inspection, I agree to remove
iii h radius nil contaminant, a, derned b e Bay Area Air Quality Alanagcmena
all new materials for inspection. Applicant understands and will comply with
strict?
DYc, �' a
all non -point source regulations.
I have Iced the huenrdou, n+nwriul, rnlui rcnwm. under Chapter 695 of the
Cali fomW l lnlhh bt Safety Codc, Set tinns 15505, 25593a 125534. 1 understand that
n
26 ,
it the nuildi ng dce..v not crocadv have a tenan. that it I ay, v "awibully to minify d+c
/--�
cwtutnn of she requiremems which muse he amt prior to "ou re of a
Occup
k
i Y. C /
!
Signature of App -ant Date
All to be Class "B" or better
Owner nr:mnmdsed �nt if 1`�
roof coverings