01010068 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILbING ADDR ": PBRMII'NO.
1115 ROLL.INGDELI_ CT 01010068
OWNER'S NAME: APPLICN'ION SUB DATE
VUCENIC WAYNE AND KUBI N. VALRI 01/18/2001
sDUNE. SANITARY NO. CONTROL NO,
pa> ARCIII'I ECrICNGINIdHR: BUILDING PERMIT INFO
r 0 2 ULU(i iLI:Cl' I. UMit MIiC1
VU
m w LICENSED CON'IRAC'IOR'S DECLARATION Job DeSCrIpIi
G 1 retch,affirm dial 1 not dianvcd under nuke.....of Chapter 9lemmnmncing
F=rw sur Secuon]IIUIBnf Uiei,ion3ofthe business and l'ntf�cssio�sGxl Jmy liccnu
<x mnfmccand effect it— 7-! � � REPLACE HEATER w
a0, Licennc Clasx_ [.it.
Dam L'unlrnnnr , / c-7
mF w ARCUrI W me UECLARA'1'ION U
g I unJcntwJ my plana sM1all he uttJ as public rnurJa
T
w6 p O LiccnccJ Prot isinnul .
OWNCWBUmpt fi UIiCe ConCoION
1 hcrehy a(Sca mar,1 am.Bernd lion the Conior,C s License Law ler the
tZn whichim i n.,Satian]o7L5,Bual soar Profen nsCWr:Any city^ uure
Fo which I p 'rot r r p' c 1 ren r,rrl cure
to3 pionI I In y rl ppl'c rf 11 till .'L Irmuco
'bar he is Ie wapta,wit us,pinoullomolthConmClor,L Law chapter Sq. Ft. Floor Area Valuation
(Commencing ithSnt ]ate) fD is 3 of the B cs n ic, .Cave) $4000
nr that he is escmp,therefrom rad nue basis hx'be alleged eaanptior.Any violation
of Salon 7031.5 by any upplicarrt Int attend,°object,me appkat,ata evil hcn:dty
of mare than file hundred dollars fs50(u. APN Number Occupancy Type
0 r.a,owner fir me p..peny,fir my cmpmyees with w.ges sthei,..ara earttpcm:mnn. 359-34008. 00
will Jo It,work,and the stmeum h not uncured or offered for sale(Sec.]ala.
nu.incot I Prm2...i er,Laid,'I'hc Cenurub,,s Licence Law does out apply I,an Required Inspections
orr of Cut Who Wilds or improves Ihacnn,and who does such work hinuvedf
through his own employees,provided that such intpmvcmema are not in esuird or 301 — ROUGH PLUMBING
offered roe sale.If,however,thc building or dapuuertmm is sold widen..roc year of 303 — ROUGH MECHANICAL
i�ntpdctinn,tea—o—baildcr will huvu ea bnrdtin of proving amt he did oar build or
nprme dor furrow,(I6ale.). 304. — ROUGH ELECTRICAL
01.as owner of the praperty.arta.ausivelycontracting withrceneelcastrate,tit 505 — FINAL ELECTRICAL
ljomann he protect(Set.91144,itm rod I'rnfes ,Corr;1 11 he Cantr:mtar's
ra,c Law doe:not apply I)fir ow�ear f'�o,eny no hard,°,Itttpruve,flue...I. 507 — FINAL PLUMBING .
and who contracts for such projects with a contrwrorls)licensed gement to the
contract^;°LicarmLaw, 508 — FINAL MECH AL
❑Irru uxn,pl weer See. ,11&P C For dila reason
Omer Date /
WORKER'S COMPENSATION DECLARATION /
Ihcr'chy ul)imu under pannhy nr perjury nue of reu fallowing Acclunrrinns'. ��
l I have and will maintain o certificate of Conserv et self-inwre, for Worker's
mpemnrinn, it, provided or by Section 7]a) of the Labor Cal, for he
mrfnmrn alr of rhe work fist whion this Prior'n rnaal. _
0 h have and will maintain Wouker's Compensation Insurance,as required by Section
37M of the Labor Cale,fur the pertormnnce of the work hes which this Penni,i,
issue I. keds Cnnrpi..n Iro
Policy
nrnncc carrier and Policy nurnM1cr arc:
CInier {
IIUN Or•L%CAUTION FROM WORKERS'
COMPENSATION INSURANCE
(Thin section need not be sonans eJ it the permit is for one hundred dollars
1E10(yor less.)
I smity thm I,,rhe In,fit neo It the woe for which thi,permit is issued,I
shall nal employ any ,on in any manner nn as to hcenn,subject to the Worker[
Counteraction Ltms of California.Dam
Applrcam
NUrhCI!'1 O APPLIC.AN r:If,alter making this Cunillcam of lisentption,you should
hcnnm x.r,cc,m be Worker',Compcoseimr pravininnv of the Labor Calc,you most
C O Ibd situ comply with.such provioin,or this permit shall be deemed revokcJ.
"Z" ti CONSTRUCHON LENDING AGENCY
I hereby aIli rm est them is a ernnlnoien I ndir,ugcncy for he perfam,anac
'If the work for which this Iconit is issued(ree.3SO.Civ.C.)
y p Lender's Name
Z Lender's Address -
U O I artily that i bavi,madd...appllation and swat It.,r he above inttmnaiou i,
Lt,. E.r aerrea.I agree to cmnply with all city and county ordinances and state laws'blaring
C.) to building construe,ion,and hereby authorise representatives of this city to enter albeit
the ulxwn.rnanEm,ca prorwny tar insdaetion pmpa,cs.
tq,r y (We)agme msrrvc.indcu.nlly and keep hat less d,Cityot Cupenum agadn,t
Z liabilities,judgment,,oasts and espense,which may in any way assns against said
V Z City in comequence of the gaming of Ili,poor
APURICCNTIL' 1^RSTA SANDWILI.0 IPLYWITHALLNONd'OINT Issued by: Date
sign u •
lib."n;ntr a — Use Re-roofs
IIAZARUOUS MAI eRIAfS )ISC .URE
Will ntcrrhhliaarn or forum hello,acealmnr nI mune ew.ardaaa rlmcdar Type ofRoof
Is defined by the Cnpereno Municipal care.Chapmr9.12.and It,Eeadot ami Safety
Code.Section 255321.1"
0 Ye, 0 N All roofs shall be inspected prior to any roofing material being installed.
Wm the uppreurtt It rin bending aenp"un(ow:eg.ipmama daaia.wmelr If a roof is installed without first obtaining an inspection, I agree to remove
emit Cascade.,I.,Yn niturna d,an deinnd by the Itay Area At,Quality Mamgemem
Umncl! all new materials for inspection. Applicant understands and will comply with
O ves [],No all non-point source regulations.
I nave read the naiamous materials requirements under Chapter 695 of sue
califomit,Health k Safety Calc.Sections 255)5,29533 and 25574.1 If If That
ifthebuilding,i,�,n,,,, o-nllyhaveaenan lea it is my I"I's,hili y a noefy,he
x...panl of rhe ngldmo is which tont h rat,pear c isannac of a Cenifcete et
Oce
Signature of Applicant Date
Ow
—;rum tscengnn Ah_
— Dam All roof coverings to be Class "B" or better
OFFICE