00100220 CITY OF CUPERTINO
nuu.DwO DIVISION PERMIT CONTRACTOR INFORMATION:
HUU.D INC,ADDIUSS: ITRMIT No.
.7 .�
OWNER'Sh(std4.07 PALDS VE APPLICATION SUB DATE
7 7
7ZARCHITECTAMNEER:
ONE: THESING, KAREN & BRI SANITARYNO. CONTROL NO.
a *1 �-`1— BUILDING PERMIT'INFO
Ii1.DG ELECT' PLUMB MECM
1nem, wfinn Inw iw„I)NruncrtrlrsDrcl.nercrlO" Job Description
LICENSEDCI y cun,eJ under pmvrnianx of Cbapler 4leommcneingsh Section ANgl)ofDmi,In 3M the Bmincs—rd Pmfn,imnCalc rosy licenm
nlullforcevnyVikq.q p, —tq-]rannc Clan Lic.N_1 t_J
nam_ amp REMOVE EXISTING WOOD SHAKE, INSTRLL NEW
5 d��Onyrla"nanl .<J, r.LARn FELT AND WOOD SHAKE
Etr7.
atke p' p Licensed Prof..imed
XOWNER-BUILDER DECLARATION
a.
W= I hcrchy a Lina that I aro e r ri Poon the Con knerl,s Licmue l.aw for the
following reason(Section 9031.5,B.,inern:,ad fort nine.Code:Any city ar county
o F p which require,a scram,In casters seller.impnrva demoli+n,nr repair uny arucmm
a, in..its issuanci resume,the applican lin wch pemmm file v signed soomem
that he I%licensed pursuant to the provisions of the Comtacmr'+Licame Dow(Chapter 9 Sq. Ft. Floor Area Valuation
Ifs.......cal,ing w11h Seen I70"n ill Div mon3Ill'the liu,inen and Pmfc,xion.C,ab)
ol Ill he is exempt 1M1crclmm and the parte for the u s be sea applicant
n.Any I Wil on
of ourSviark,a than
, any hundred
oll for n partial auhjects be oPPiicanl to v civil penally
annm more than fisc nanamd Jclmm(ssrin. APN Number OccuunT pe
$p12
Cl 1,ns owner of tM1e idtheproperty,l o Ina cnmloyccs with x'agcr ar their sole k,mlpereation,4
will do the xork,and Inc ode I It,is ,set Int..r,1. er a('Low fors:,,,apply IIlga,
nation,vud rode,+ion,build,
,,improve,
rove,d or's Licen,c Law s such
sol apply firmer
an Required Inspections
of ,,,,,yhis o y who build,nr improve,thereon,and who Jain wen work himself' 3561 7001 . 00
or though cal own employees.provided that such impmvemrn(s within
no,mender or
after) 1 If e b II building 0 t Id (h' yearof
v,Illf In - h II III m h J fP btbih I'I (h llJ nr
"1" f parlf ' ) 305 — FRAME
01 of the progeny, I si ly contracting th licensedcontractors it) 307 — INSULATION
n+lruu,he project(Sec.]wd Business and professions Code:)The Commerce% 601 — ROOF TEAR OFF ��
l sense Law des Lou
ot apply o,au oner of foil a who n,Ind+or'Impro es merern,
rte who.calla,. for.,ell projers w0h a,mammon,) IIa,1seA pm can,In the 50� _ ROOF PLYWOOD NATI_
C:aarki is Llcen.e haw.
❑I am akar,all Sec. .It&P C farmis mown 503 — ROOF BATTENS
Owner woRKER'SL'OMPENSA'IION DCCLARAI'ION 504 — ROOF IN—PROGRESS
I hereby all ruler ILL of lis Jury one of the following Jeelarmienr
1 have and will maintain a Cetilicate of Consent ,n self-insure lin Worker'+
unilla,a(ion, ns provided for by Section 37N) of the I.vhor Code, lot the -
pednmaa ce;,I the walk for which phi,porn Jt Is inred.
A1
han
ave d will normal.Worker'+Compensation lirstm nee,is realSimilar
mord by Silar
of the Luton Cade,far the performance of the work for which his pemnil is
i,wed.My WW..see,Cnlr9,Pfc�ran.lmumme ranked,and(Policy�nlumhr arc: (,7 - -
Currier:`�'i,1,� I `^ Pol'my Nn.sJ_/.-'UV 'Ob 101117
CCR I IFICATION elli EKBAIPI'ION ITt(M WORKERS'
COMPENSATION INSURANCE
(This sermon nal na,be complemd if the pa mil i,far one hundred dollars
(81110)ser las.)
I certify that in the performance of the work for which this permit is issued.1
shall not employ any person in any manner,a v,to become subject to(he Workers'
Cnnl provadon I.Itws of Calit....in.Uwe
Apure: I .
NO]ICH TO APILICAN'r:lt,ahar making(hex Cctifcam of Fl amplack you should
become wbjecl to the Worker',Compensation provisions of the InMv Cole,you must
Q O
farthwi(h comply With such pami+ina pe
or this rmit shall be deemed revoked.
r
,n ._(Z),I CONS Iare RUM
it'ION LENDING AGENCY
a > ,achy alliner Ill.,paou 1,ae..a (Sec. enlrlvgagency far the p,crformanoc
nf,he rod fur which his permit i,Issued(Sec.7097.Civ.C.)
0. C
Ixnder*sNk
,eul
� � LsnJer',Address _.
V Q I ccnity Out I halve reuA Chir uPPlic:nion and amm lam me uMno inlon luion's
4rN (~a (4,rrecl.I mime In comply with;ill city and cau.ty ordinunen wW sone luwr rclvdng
Q U to building corderelion,and hereby vwhmiue representative,of(he%city In enter upon
W ,he abivo-memioncd propel,far impectinn pull
C+ (wpngrce o,rave,all y and levp hared ,the City of Cularm no against
N liabilities,ludi..costs:nd expnwcs which Italy in any wily aaruc against sell
f„) - onmgnc ..nl'(hc gnuuingo' crnllt.
AI'YLIG ."'1N1S VILL 'O TLY WITII 1 I(JpI WINT iC
SOU( I lyy�t r Issued by: !l Date G (�
•` sTlm Arrlicandccmnn„ u:nu Re-roofs
Ill S MAD71111AIS DISCIMSUR
Will l e ar fmure budding meapam ane cnlanme nwadca..matedm Type of Roof
as defined by(he Capemno Municiled Code,Chapter 4.I A mad me Health and Safety
Code Sen nim 25532(1)^.
❑Yc.r 0N All roofs shall be inspected prior to any rooting material being installed
wised al,pheacicr(arranaBdingnallpal,taseegary,Inan(maeama,welch If a roof is installed without first obtaining an inspection, I agree to remove
molt bwaMous air cnnmminark,vs JefirmA by the Bay Arca Air Quality Management
91a,nell all new materials for inspection. Applicant understands and will comply with
bYe+ 0Na source regul 'ons.
I neve read one M1oal rder,ankfaiala a earmno ander Chapmr b. 5 of IhC
'linnia Health&Safely Cdde.Section,25505,25533 rand 2,5534.I unAcr land That t
if tlm Mal nal currently nasc4Js 4 that i(i,my my"m,ibility m n ify the
ne,o'. ,Monts x' (�mmuu t prior a,I+wase ofa Ccrtific f
0, k_
Signa plicant to
criminal L,e Dm All roof coverings to be Class `B"or better
OFFICE