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04100050 CITY OF CUPERTINO w,ri �`{ ' TI A�'•mj�p"• FOR A°T ' BUILDING DIVISION PERMIT CONTRACTOR INFL�RMA.TION ` _ BUILDING ADDRESS: PERMITN04100050 0655 SANTA LUCIA RD OWNER'S NAME: PERMITISSUEDATE SANJAY SWAMY 10/13/2004 ONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB1T MECH _Op LICENSED CONTRACTOR'S DECLARATION lob Description C 1 hereby affirm Thal 1 am licensed under provisions of Chapter 9(commencing t� with Scclien,7mE of Division 3 of the Business and Professions Code.and my license is "_oto in ME to.and affect. DRIVEWAY GATE (NON ELECT. ) z License Class C.Mo START JOB WITHOUT PERMIT/BPMFEE FEES DOUBLED i� F p Dam C*S DEC r pp'y ARshallWTSDECLABATIDN - ($104 . 76 X 2) /CONTRACTOR: ACE FENCE GATE I understand my plans shell M used as Puhiim records 3` pry Licensed Professional g OWNER-BUILDER DECLARATION <S 1 Comby affirm that 1 am sump(from the Contestant's o :License Law for the _ p O following wires a (Sacdon 1(131.5,Business and Professions Code:Any city or county K$ which requires a permit o construe,alter,improve,demolish,or repair any mmmurc that its tensed pursuant wires lhca applicant for such Permit Law Chapter l F Z Q P r 9 PP Pcrmi g . (Comm ending it Pumtion701 or Division of the eBusiness usinessnd Professions (C ode)or Sq. FL Floor Area Valuation (CommQFC Met is exempt Section and th basisufrof @eeged exeaption.Any vis Ca'Onde)or $4000 y that Section is exempt them from and Ne basis for be alleged excitation.Any vinot, of 4 0 0 0 no,u.BumSve anyapplicant for a ion(S5ennil subjects the applicant acivil Pcnel(y of AIN Number Occupancy Type no,mare roan me hundred ammra a5W). P Y YP ❑I,as owner of the property,or my employees with wages as their.sale compensation, will do the work,and Ne structure is notimended oronered fmsale(Sec.]044,Business and Professions Code:The Contractor's License Law does no(apply to an owner of Required Inspections property who huilds or improves Noreen,and whodoes such work himself or through his own emplthe oytts,ping or ithalsueent rovements am isold Withinneyot ear of completion. for sales. F!N p ■ �® however,illhow the burden op roving Oat id noneymo of completion,Ne owner. AL builder will have(he burd<n of proving Nal he did not build or improve for purpose of sale.). 1,as owner of the property,am&elusively conuactingwilh licensed convectors to /'� �t 1. MCI the project(Sec.7W,Business and Professions Code:)The Convectors Li. Nf IV LOOT _ cense Law does not apply to an owner of property who builds of improves thereon,and. l who contracts for such pojects with a contractor(a)licensed pussuanuo he Contractors License Law. ,J amexempt undo Sec. /_ flhisreuun BUIL I G Owner S •s � je K/E/R�',S�tgyO�MPE/ ANTI,, NIDECL A O I hereby efOrm/)IfdEfpeRally oip 'dry CB t olowingdeclunions: Hnvc ondwillml tain a Certificate of Consent m self-insure far as provided for by Section 37W of be labor Code,for Ne perfonmwnce,of the work for which this parmit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 37W of Be labor Code,for Ne performance of the work for which this permit is issued. My Worker's Compensation Insomnce carrier and Policy number am: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need MOW completed ifthe permit a for one hundred dollars(5400) nr lcssJ I cmnifv that in the performance or the work for which this permit is iswed,I shall not employ any Person in any manner m subject as In become subjeco the Workers Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making this Cenincme of Exemption,you should m bacoe subject to the Worker's Compensation provisions of the labor Code,you must .J O forthwith comply with such provisions or this Permit shall me deemed revoked. zt�; CONSTRUCTION LENDING AGENCY I hereby affirm that tare is a comnruction lending agency for the Performance of Cli 7 the work for which this Permit is taued(Sec.3W?.Civ.C.7 W Q Lender's Name = z Lender's Address V Q 1 ccnify that I have read this application and stem that the above information is IL 7' cosec(.1 agree to comply with all city and counly ordinances and stem laws relating m C V building construction,and hereby outhorim representatives of this city to enter upon the 4 shove-mentioned Property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against F'V7 liabilities,Judgmenu,costaendexNnseswhichmayinanywayacemeagainsl soi.City �f') his U APPLICANT CUNDERSTANDS of the gionfing,of IAND WILL COMPLY WITH ALL NON-POINT Issued by: Date �✓ r SOUR RE� LATIO S. CNAZCD Re-roofs Signmin of A,humm,comfaeor Dam HAZARDOUS M 1 1 R Type of Roof Will Ncap,Z terfuturchn IS occupant store or handle havafduus material as defined by the Ca"Muu Municipal Code.Charm,9.12,and the Health and Safety code.sc❑ctianzss3z(a)? "� All roofs shall be inspected prior to any roofing material being installed, Yes No Will the applicant fulum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit haiardnus air cnnmminanu as defined by the Bay Area Air Quality Management all new materials for inspection. District? ��yJff/� El Yes t>'�Nit 1 have read the haraNnus materials requirements under Chapter 6.95 of the Califon ma Health&Safety Code,Scemmus 25505,25533 and 25534,1 understand that if the building .�f rices nal currcndy hove a tenant,Nat it is my rcsPansihility m nodly the(w:a to o the IIdy,ITt/I/Il1fJU Input ems whit must M,mm p' rII cG of Cc Ocine Occup cy. Signature of Applicant Date wnar ser arniOnied...m I\ w m All roof coverings to be Class"B" or better CITY OF CUPERTINO c I _ BUILDING DIVISION PERD .COINTRP.CTE7RbINPORM N BUILDING ADDRESS PERMIT N04100050 0655 SANTA LUCIA RD IW NER'S NAME: PERMIT ISSUE DATE SANJAY SWAMY 10/13/2004 PHONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEEID BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 fop LICENSED CONTRACTOR'S DECLARATION _ I hereby arum mat I am Readied Ander rm,hd.oa of Cbapmt 9(Pommcnring Job Description w with Scction)OfNJ)orDivision 3 ifthe Business and Professions Code,and my license is oa lefaumrecandaffect. DRIVEWAY GATE (NON ELECT. ) 'ya Date Cm LicenaeClass Cmarasnur START JOB WITHOUT PERMIT/BPMFEE FEES DOUBLED o DELL 'SS ARCHITECTSDECLARATION ($104 . 76 X 2) /CONTRACTOR: ACE FENCE & GATE C 1 understand my plans shall he used as public records DiU ''o�; Licensed Professional g OWNER-BUILDER DECLARATION .a Z 1 hereby affirm that I am exempt from the Contractor's License Law for the a e folle,ing rrasan.(Section 7031.5,Business and Professions Code:Any city m county Kmor which requires a permit to construe,alter,improve,demNiah,or repair any structure Foy poor b,its iasuanin,also requires the applicant finical,From,to flrasignedsmmmmn �¢0 that he is licensed pursuant to the prnvivons of the Contractor's License Law(Chapter 9 Sq. Ft.Floor Area Valuation A4 1— (commencing with Section 700d of Division 3 of the Business and Professions Cede)or $4000 y�.. that mfr he is exempt Nrore and the basis for me alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of ApN Number Occupancy not mom man five hundred d.11...($50%. P Y Type 1,es owner elite property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and property who builds Code:The Contractor's,and Law docs not apply to an owner of �'_ tk�p r{ Inspections propenywsideas Bode:The teaicor',asdwho does such work himself oAn through Owner his FINAL ■,Mr/■ .we employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner builder will have the burden of proving that he did not build or improve for purpose of sale, Nova 7004 1,as owner of the property,am exclusively Professions with licensed contractorstot'sto se Do the project(Sec.o an Business and rty whoi builds ds or The Convector's std muse law docs not apply to an owner orpropeny who builds or improves Cocoon,ones BUILDING �I��I whence contracts for such projects wish a contranor(s)licensed pursuant to me Contractor's License Law. 1 oro exempt antler Sec. (nr this reason ICK TI wner I hereby afRrm IKiSYcfI+e Y4of' j,�, N DEC ')tA 10 e tl o lowing declarations: l have and will me taina Cenihcmeor Cousent to self-insure for Worker's Counted. .atlan,as provided for by Section 37W of the Lobos Code,heated performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,As required by Section 3700 of the labor Code,for the performance or me work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Cartier'. Policy No.: _ CERTIFICATE OF EXEM PfION FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed if the permit is for one hundred dollars($1(X1) or Icss) 1 cannily that in the performance of the work for which this permit is issued,1 shall not employ any prison in any manner m az m become subject to the Workers'Compensation Laws or California.Data Applicant NOTICE TO APPLICANT:If,after making this Camlicate of Exemption,yen should become subject to the Worker's Compensation provisions of the labor Code,you must ,J forthwith comply with such provisions or this permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY -[--� I hereby affirm mat there is a construction lending agency for the performance of FGme work fur which this permit is issued(Sec 3097,Civ,Cd ders W A LenName D+ Landers Address az - U Q I ccnify that I have read this application antl scone that the above information is 1y correct,1 agree to comply with all city and county ordinances and state laws relating tu �O building constriction,and hereby anthmire representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. (We)agree to save,indanmi fy and keep harmless the City of Cupertino against tF'r Inliobilitics,judgmen¢,rose and expenses which may in any way accme asainst coin City s V in consequence of the granting of this permit. 1f APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issuers by: Date SOURC RF LATIO S. Re-roofs Signaurcof A,,ha.nUConuacmr ,,//A, / Data HAZARDOUS M ERIKLS IS bSf1�RE Type of Roof Will the applicant or future buil'ng occupant store or handle hazardous material as Code,Seat bCy 25532W? ssC3za11 yS iMunicipal Cutle.Chapter 9.12,end me Health and Safety Nn All roofs shall be inspected prior to any roofing material being installed. Will the appfoanl n mture building ocsupant nw egpipmeat or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardnps air contaminants as defied by the Bay Atha Air Quality Management all new materials for inspection. District ` ❑Yes /mrNu 1 have mad me hazaNnus\terminals,cquihanumus under Charmr6 95 of me CahL, .is Health&Safety Cade,3a9uns 23505,25533 and 25534.1 understood thanirme holding does not temerity hevc o tenant,that It is my raspiest hill ty m runty the maupam ar me rnynr ntswhic mut mpriprmissu � of Cc fcztea OccupaK'S 1 `�. �h ��/ L , ? .j Signature of Applicant Date t wner sur aulhoriaed agcnl .1 h D c ' All roof coverings to be Class "B"or better *CITY OF CUPERTINO• Cf p-isz�Sv CUPEf�TINO PERMIT APPLICATION FORM APN# 7 6 p p Date: 0 ^Q 7 (Cl Building Address: ..,Mailing Address (if different from building address): Owner's Name: Phone#: 0 323( Contractor: A C_ FtF/, E G Ari License#:7f 1,p70 C -13 Contact: Phone: Cupertino Business License#: Fax: 2,s-c/)- S Building Permit Info: Bldg ❑ Elect ❑ Plumb F3 Mech ❑ Job Description: Residential ❑ DEWFUAY 61f Co is Sq.Ft. Floor Area: $/Sq t.: Cost of Project: Occupancy Group: C/ Type of Construction: - Please check this box if the project is a second-story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL . BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING _.- . BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC1000 Elec 600V<= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL ,BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING qf 2721 lof3 � � S! Yf. J (�2— WITY OF CUPERTIN( cuPERriNo PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL - BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood I MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Ap Hance ELECTRICAL 2 of 3 WITY OF CUPERTINOO s CUPEI�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee 'ELECTRICAL BREMTHEATR Theatrical Li ting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial 4,0:" s;,, a;.0 BUILDING BSEISMICRE Seismic Fee Res "°` BUILDING BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power " ELECTRICAL BTEMPPERM Temporary Bldg Permit' BUILDING, BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue J PLUMBING PPLBG - Plumbing Fee sq foot -"` PLUMBING ZADDCHG Address Chane BUILDING } 3 of 3 CITY OF CUPERTINO h �} ra. sss(' BUILDING DIVISION PERMIT Al VNTRAk1OR ATION" BUILDING ADDRESS: PERMIT NO.02060187 OWNER'S NAME: PERMIT MVgAy�, 3/2003 DSANIE: TARY NO. / 1 CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH l� E 200 LICENSED CONTRACTOR'S DECLARATION I 1 hereby of don Nal L am licensed under provisions of Chapter 9(commencing Job Description with Section)OLID)or Division 3 of tate Business and professions Code,and my[teen.is ? � in full forte and effect. eqz License Class Uu.a NEW SINGLE FAMILY DWELLING 'c Da. Contractor DECLARATION ARCHITECTS DECLIVING SPACE 3519 SQ. FT/GARAGE 528 SQ. FT. 1 understand my plane abet W used u public records FINAL EC)RyY�� j I`� ■ I E 6 G I' Licensed Professional y� OWNER-BUILDER DECLARATION tat) I botchy Maso .form o n 1 am acmpt Imre Ne Conine Co :License Law for the J U i 2Q- 2004 O O which on senna Section IID 1.5,Business and Pm.deroli Code:Any city or county S$Pi which nquisa a permit re anon,the,ellen improst,N permit t m repair any statement the,kor its...d e,also pursuant In doe lW applicant for Coach Contractor's lLitumo rile ,Law(Klement g D the, ingwitpmuan7M)of vivisnsnfthe Contsiness Limn.lew(Chapxr9 Sq,Ft.Floor Area O y $ (commencing withScnlon]000)ofDiviaion7oftheBusinessantlProfeuionsCoac)ser 13W We i But he ts exempt therefrom and the buds fm the alleged exemption.My violation of Section 7031.5 by any applicant for a permit subjects the applicmt m a civil penalty of APN Number E5)3lCsqryna� e not mora Nan five hundred dollars($500). �Y" Y TYP ❑1.u owner of Ox pmperty,m my employcu with wage u theirmle compensation, will do thework,and the aW WYre is not Intended woBCRd fofaale(Sec.7094,Business and Pmfeasions Code:Tire Contractor's License Law dose not apply in an owner of Required Inspections property who bui[dsor(mpmves Chamen,and who doesmchwork himu[far through his Own employ=,provided thatsuch improvements m nutimmuded oeofferee formle.If. 101 — FOUNDATION however,the building or improvement is mid within one year of completion.the owner. Wilder will haw Ne Wrden of proving that he did not Wild or improve for purpose of 102 — PIERS astir')' 103 - UFER L as owner of the Sac.7property,,Business udand confessions with licensee cnnvacmrs m ns Le the ns am (Sec.to a9,wnrofend Professions Coda:)The Contractor's Li. 104 — REBAR who contrcoranotepplymen with aofproperty who WONorimpro the thereon,and, 105 — ANCHOR BOLTS who contracts for projects with aeontracmr(q IianxO pursuanuo the ConfeacmYa License Law. 106 - SEWER & WATER ❑�1�f/exempt per a ,B At P C for this rouon alrcY5-03 202 - UNDERFLOOR PLUMBING "/� WORKERSCOhP noN LARA1 203 - UNDERFLOOR MECHANICAL I hereby affirm under penalty ofperjury one of the following declarations: 204 — UNDERFLOOR FRAME rJ l haw and will maintain a CeniRcate ofConam,to self-insum forwmkereCompen- 205 — UNDERFLOOR INSULATION ration,as provided for by Section 3700 of the IeWr Code.for the performance of the 301 — ROUGH PLUMBING work for which this Permit is Issued. 302 - TUB & OR SHOWER r]I have and will maintain Worker's Compensation Insurance,an required by Section 37ID of Ne Ulm,Code.for 0m performance of the work for which this permit is issued. 303 — ROUGH MECHANICAL Myworkeea Compensation Insurance Carrier end Policy number am: 304 — ROUGH ELECTRICAL Carrier: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' 305 — FRAME COMPENSATION INSURANCE 306 - HOLDOWNS (This auction need an,he Completed lfthe permit sforone hundmddollm($]W) 307 - INSULATION or Mss.) 308 - SHEETROCK e certify Nn in the performance of Ne work for which this permit rl issued,I shall not employ CaIIr0mninany manner xssmbucomembjecuo lheworkers'Campcnsation 309 — EXTERIOR LATH Lawes of Califomie.Dem Mot.1 310 - INTERIOR LATH NOTICE TO APPLICANT.If.after making this Certificate of Exemption,you should 311 — SCRATCH COAT bmome subject m the worker's Compensation previsions of Ne Lebo Code,you mut �Z forthwith comply with such previsions or this permit hall W doomed ranked. 313 — ROOF NAIL 1 CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY I hereby Nirm thatthere is a Constrction lending agency forthe performance of 502 - FINAL PLUMBING ENERGY x1 one Undorkforwhichthiapemitisssuc0(Sca3D9,Civ.C.) 503 - FINAL MECHANICAL ENERGY J.1 Q Undoes Nmc j z Undoes 504 - FINAL BUILDING ENERGklll_�7 JC IceNfyMet Ihaw need this appliationand sumtat MesWwInformation is 505 - FINAL ELECTRICAL FCOncel.I agree m comply with all city and county ordinances and sum laws relating m V building construction,and hereby mhorivereprexnutiwsofthis city menter upon the — GAS TEST �� alcove-mentioned properly fordamnify an keep hs (We)agree m Cast,indemnify end kith may in an the City of Cupertino id City 0 F I .w fq liabilities.Judgments.cosuand apenaeswhich mayin�nyway ucrueagainst uidCity WW�&Lz APPLICACNTeof to UNDERSTung oS AIs Norit.ND WILL COMPLY WITH ALL NON-POINT Issued by: 5 Da SOURCE TIO Ka Re-roofs mureApplic514 INAL PUBLIC WORKS ignan on Date III=%SMATER LS DISCLOSURE Type ofR09b2 - ROOF PLYWOOD NAIL Will the applicant or future Wilding occupant nam orhandlc haurdous matedw as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety 603 - ROOF BATTENS Coda Section 25532(e)? JJ All roofs sW be inslR rifdye Fe0aftfiBaterial being installed. } ❑Yes �]gNo ' W01 the applicant or f//inure building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit havardous air comminants as defined by Ne Bay Arca Air Quality Management all new materials for inspection. District? El Yes, 14NO Itsave mal the hu"ousmKrialsmquiumcnu underChapur6.95 of the Califor- ni.f alih&SafciyCoc.SecOms25505,25533ud2553a.lundcmwd Natifthc building dors not cuffs ll he a sena t it u my responsibility u mdl'y the occupant of the myuiremcnuw h at la: mean' aeracertifiam apancyr�^ Signature of Applicant Dale Owner ormthori.edagent Dam All roof coverings to be Class "B" or better