01040130 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMI'Y NO.
119122 PENNINGTON LA gnB SERE MASONRY 01,0401:30
OWNER'S NAME: - APPLICA'I ION SUB DAP I?
ROBERT 9 BARBARA HAFNFl 480 CRORL�31 FES DR 04/24/2001
PRONE: SANITARY NO. CONTROI,NO,
(40A) q7P-1 P85
a9Z ARCIII'I ECI/ENGINEER: BUILDING PERMIT INFO
00 BLDG ELECT PLUMB MECH
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adialIDCOlca,ld OR'S UEC'IARAIIUN Job Description
z IZ= I h by al'linn Ilett I um licc;ned unJur provisions of CM1:IPmr 9 ftommcncing P
t9, with secl'I��]�poty> ]ot the Nu.in•.a:;yr{Prydcssion.CeyLeynxd my li[en
Y I i,in Illi fa �If 7
dont Idanw• 1 1.ic CHIMNEY REPAIR FROM FOUNDRTION
Can -
77 .m Andl'ECL'ti t,p ...
1 mler,mmJ mr plan..Bantu be used ax pnnfi[recmal�
W_d'o License)Pmfe.¢inwl
a. OWNI.R.IfI111.DER DF,CLARATION
w 1 hereby affirm that I v exempt farm the Carnation's License Imw for the
.=a y following reason.(Seaton 9031.5 Businov,and PaftaGon,Cade:Any cry or cnunly
`FSO which requires a Permit Ia,vnamct,ullc,i;npmvu.Acnudish,Lir repair any,.mca;,c
�3m prior tolls i,csuanco.Nan agnires the appliemo fin such permit to filea signed statement
that he is licensed fouricaut to the Prusisions of the Commicam's License iza,(Chapter 9 Sy. Ft. Floor Area Valuation
(commencing With Section 9100)of Uiskion got the llusiness Lid PoolesBinn,Code)
o,mal he is c,empl therefrom and the bu.l,Ib.the allcyad cxauptionAny violation
,it Suction"loll S by;my up,le;nt La a Pannil,.beer,toe npplicam m a civil penally
.r„nlrm,renmrmthundred dodarstgslal, APN Number Occupancy ype
❑1.as mvn[r of Ile progeny,or my employee,will wag,,as their.ole contpcmain 1,
will de the work,and the structure is not intended or offered for sale Nes.10,14, -
Basin[.,and lhafeaxion,Code: Me Cmmmaear,License lu,w does mm apply an an Required Inspections
lhr of totaled,Who build,an immense,thereon.and ao sh.,such work himself
rougl his own employee..pmrlrd that,.,It nnpra,aneas or not intended or 101 — FOUNDATION
onkurd for.vole.II.Lowevcn the l uddhok or impnrvennrl i,sold within one year of
im;plction.the owner-boddco will have the burden of proving that he did not Wild or 312 — CHIMNEY REBAR & STRAPS
mprove for Purpose of sale.).
❑I.a nldteproperty,an,excw.avelycntaamewith rccmedcomm[mr,nn. 51.4 — FINAL PUBLIC WORKS
mvm¢nhe ,,,j,,t(Sec.7041.Bmincax rad Prof..ions Gale:)The Contactor,
License I.aw Joos not amply at an owner of property who buil.or Improves thereon.
and who eardeass for such penjeeu with a contras ao) licensed puduom m the
Comraaar..Liteme Law.
plan exa,d,t antis Se[. .Bk PGfor ibis ani,ourFINALED
owns nam
WORKER'S COMPENSn'I'ION DECLARATION
1 lcaby ablon under mearly of perj.,ynnc,,f the blikosrgdeclari MAY 0 8 2001
I have and will main ain a Ccnlfmatc Lir Corvert to,d[-inaurc for Workah
lm,pensotiun, as provided for by Section 3900 01the Labor Code. for the
ertormancc of the work for which this permit is issued. BUILDING
❑1 hLid
ave and will nm mn Waer's mad
Coneninn Imsnaoa
.e,as ,ninud by Section
3]00 Of Labor Code,lar he purl mwnce,of the work Iia which this permit is '
issued try w'orker's Compen.mdn Insurance carrier and Policy numnerrm:
Carrier: Police No.:
CEKt114CG'i'ION OF EXENIMION FROM WORKERS'
COMPENSATION INSURANCE
(phis action neral nm be em,plead if me Penni,i,f+r one handout dollars
p
7fol Wl fir las.)
1 certify that in the perfommnce a1 the work for which this peril i,ivsutJ.I
,hall not anploy any person in tray manner,o as hr Iwcome subject to the Walker,'
Compensation Laws or Caif vrni.,Date
A,plicant
NOTICE TO APPLICANT:If,vOcr mvki t,this Cendicme n1 Exemption,you,hull,]
became suhj,,,e,the Worker',Cnmpcnwtian,io nx or the Labor Code,you noiu
Q Q hadonfil comply with such provisions or this permit,hall be deemed revnkcd.
CONSTRUCTION LENDING AGENCY
C 71 hereby About fairthere is a aomiruelon lending agency Ito the Purl ounance
(s7 of the weak In,which his permit i,issued tSea.3m)7.Civ.C.)
6. 0 i,enda'.v Name
Z Lender',Address
U Q 1 artily dull I base read ou,npOicatinn and cure thin the mane information is
k, F” emrttv I o8mc no eonoy with all dry all could,nrdimmce,mrd nam laws relating
Q U tobuildingcar,tmnion,inl hereby amhmiee repec-madve.dmi,city a eme,upon
W the share ancrifibriud pmpe ly for inslraina Pulp","
y p,
(WO g. ,, avc.indemnify and keep bailout...the City of Cupcninongainst
V1 linbilif ant,,toll,and uxpcnscs which n,ny in any
way Litt gars mid
U Z Ca m a fthe enf ibis pcnail. '4(/ 2
'� O LICAR fir cA R.' COMPLY WITH 1, or-PN'f Issued by: Date ` `
—nmmaT,`nl lit-tors ma �f Data / Re-roofs
I HI=US MATERIAL,DISCLOSURE
Will Ire appf d fir ldam Wildirg occupam,mn rat handle h1laulou,mncdal Type of Roof
as defined by the Cuptnino Municipal Calc.Chapter 9.12,and the Health and Safety
Cale,cute i2s5R(a)? CJ NO
All roofs shall be inspected prior to any roofing material being installed.
Willman,di,nolo,mtmehnihlirt,o,eupnnluse emipmealor devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
;it Imrandons at,countmimud,nn defined by nen nay Area Air Quality Management
DTomr,rr all new materials for inspection. Applicant understands and will comply with
o ve, ElNo all non-point source regulations.
1 have read fire harxnlon,material,reyuiremeats under Chapter 6.95 of the
California Ilallh R Safety Code.Sections 25505,2553?and 2553el.1 understand that
Ifthc Fuildt mons not cuncmlly ave a mrah.that,,i,any re,pnn'hllhy to Lily me
neap d t ,e9incturnks inch rad be;nm prior to Iduw It n C dluute Lit
h' u Y
t� D� Signature of Applicant Date
Z ,rte ,,aa a nada -I !- -� D,11C All roof coverings to be Class "B"or better
OFFICE