03040110 BUILDING DIVISION PERMIT h CONTRACTOR+INFORMATIO ,
B2'pP 2tF'§tOFIELD DR GEORGE LIN & XIAOMIN YU PERMIT No.03040110
LIN '& XIAOMIN YU PE11MITIssr6$A/7'22/2003
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMRINFO
BLDG ELS PLUOMB MEOCH
E300 LICENSED CONTRACTOR'S DECLARATION lob Description
I hereby affirm that I am licensed under provisions of Chapter 9(commencing p
Sj with Socimn 7W0).f Division Sof Ne Bulineue"d pmfessione CodO.md my license it
hfell force and affect.
BATHRM REMODEL F1��LE®
License Cls Lica .
a, Dam Contractor
ARCHITECTS DECLARATION
1 1understandmyplansshillWreed.public numm. JUL 15 2003
ya
C t�, Licensed Pref.sionaI
Ag OWNER-BUILDER DECLARATION
<f 1 hereby of on that I am exempt from the Comnnor's License Law for the BUILDING
O O fallowing mason.(Section 7031.5,Business and Professions Cc&:Any city or county �
$ which mqulros a permit m Construct,ahee improve,demolish,or mpair any mrature
prior m its i.utome,alm mquims the applicant forsuch permit to rile a signed statement
0
ih I he is licensed pursuant to the provisions of dic Contractoes Licanno Law(Chapter 9 Sq. Ft. Floor Area
jr $ (Commcneing with Section 7000)of Division 3 or the Business and Professions Crab)or
Will he u exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil pen.ity or : Occu ane-Typenot mom man fw hundred delta.(1500). 3 SB3 DOI®$r 0 0
1,.. ..of the property,or my employees with wage.so Meir sole COOCK a lo^,
will do the week,and the.wewm b not imended orotTexd for sale(Sec.7W.Business i0i _
and Profesaio.Cade:The Conloolm,Lt.=Law does not apply in an owner or 10 2 - PIERS d Inspections
property who builds or improves hexon,and whodoe,such merkhimself or through his
own employees,provided hat such improwmenuare netimmrdW oraRered for tale.If, 103 — UFER
however,he building or improvement is mid within one year of Completion.he owner- '
builder will have the burden of proving that he did not Wild or improve for purpose of 104 — REBAR
.k.). 105 - ANCHOR BOLTS
❑I,as owner of ct properly,am Business
contractingfesss with Ilaneed ennuacmn m
conic Lathe project(Sea.to(an owner
of dnartywhoomcode:)The
timmr'.U. 106 — SEWER & WATER
=ensehwd"ofrsuch Papply ma,with. ofpropenywcensedurslda;or Improves hemon.and. 202 — UNDERFLOOR PLUMBING
who enceLacontracts for such proXcu with a convanor(s)IlConsed pursuant m the Conuscmts
License Law. 203 - UNDERFLOOR MECHANICAL
1.m exempt ander sec. .e&P c for this n,.on
204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DEC R i ZZ 205 — UNDERFLOOR INSULATION
hereby afEmr under pemlty of perjury one of he awing declaration: 301 - ROUGH PLUMBING
❑lhaveendwillmainuin.CeniriamofC..entmmlr-insumforWodes Compen- 302 — TUB & OR SHOWER
satin"..provided for by Section 3700 of he labor Cade,per the performance of On, 303 - ROUGH MECHANICAL
work for which this permit is issued.
0 1 haw and will maintain Worker's Compe.atio"Ins.rsocO,.required by Section 304 - ROUGH ELECTRICAL
3700 of the labor Code.for he performance of the work forwhich this Permit is issued, 305 — FRAME
MyW.,kee.Compensation l.u.na anitoand Policy"umkr,.: 306 — HOLDOWNS
Cerner: Policy No,: _
CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
or less.)rna section nand not x compmmd If Farrell It ret one hundred dotLers ;JOB) 309 — EXTERIOR LATH
I ceniry that in hO performance of the k rot which his permissued,
it H I shall not 310 - INTERIOR LATH
employ any Personin an nnerm a of--tCOYO thev�artyy'r�Pe.,tian 311 SCRATCH COAT
Law,of Califar�
tifil
App =an 313 _ ROOF NAIL
N A ,aftermeking u Exemption,you should 501 FINAL ELECTRICAL ENERGY
W momply with
hCoonorthonprmiitshalofhclaWnooked. ust 502 - FINAL PLUMBING ENERGY
,�' foMwion comply wit ft . "s C.a.or this Permit W deemed xveke.
Z O CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I humby affirm onto then,is a consomction lending agency for the perfurmmm of 504 - FINAL BUILDING ENERGY
Y > he work for which this Permit 1,broad(Sec.3097,Civ.C.)
A ^tl°'''Name 505 — FINAL ELECTRICAL
0 z Under'tAddress 506 - GAS TEST
;.7 Q 1 centry that I have read this application end Nu hal he shove Information i,
y F comn=L I agree in comply with.11 city and county ordinances and,tax laws relating to 507 - FINAL PLUMBING
V building convection,and hereby auhorirempmaenmivesofthis City mOmerupon the — FINak AC
4 above-mentioned property,for inspection purposes.
(We)agree E.row.indemnify and keep h.rmless the City or Cupertino against
=r h liabilities.judgments,co.uand expe.esWhich May inanyway xcmeagainst.idCity 5
J Z in consequence of he flooding of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: ORKSDa[e
s0 CATIONS.
AA "y '2
Re-roofs
Signature of ApplicanVConm
HAZARDOUS MATERIALS OISCLO o E Type of Roof
Will he applicant tar futon,Wilding aanlax
cupx or heMlc Health and Sand
.defined c section
hO Cupertino Municipal Code.Chepmr 9.11.and he Health and Safety
sanies z5532(.)?
[:]Yes All roofs shall be inspected prior to any roofing material being installed.
�y"u
If a roof is installed without first obtaining an inspection,I agree to remove
Will he applicant or fmun,building occupant use equipment or devices which ,Pi
emit h.rdou,at,..numinanu.depped by he Bay Arca Air Quality Management all new materials for inspection.
District?
C Yes IAN.
1 haw noodle h...We.,malceials tcyvixmcnu under Chapter 6.95 of he Califon
ids Health&Safety Cnic,Sections 25505,25533 and 25536.1 understand that prom Wilding
do.not eunently haw a mmm.Net it u my n,spo.ihility to nadly the occup.t of the
mquixmcnu which must be,
mm priortoi.uancc ora CeruOcax or = err Signature of Applicant Date
O cr tar authori'rctl egcm Date All roof coverings to be Class"B"or better
FROM Domino Computer East Hay PHONE NO. 15106536267 P01
12X36 SLIDING WINDOW OLD WINDOW
- i
24X24X36 CABINET WITH SINK U-)
OLD TOILET
54X28X15 RIGHT SIDE SMALL
TUB I ��
NEW WALL 4", NEW 30" DOOR
?'. ..... OLID DOOR 6OOZ �i S 21da —
�� OLD DOUR MOVE TO
KICHEN SIDE 12"
1.?
811p A U� 91B1$ JO 87U�!I P .,• ....,
us 10 uogef,§7 Fg 1a --
u@ 99 91 �o ML-U.
110 I9naa`d0
—_.—.
S -d j4-PIe4 a910N
!1l0Bds PUB veld slyl 10 8uldwe11yn
oulliBdnO 10 4 ''1de0 SulPll 9 991
1 uolsslwis Us 11 1no91iM ewes uo.
11919119 10 sa8ueyo (ue a
un s!a!Puesaw!1 le qof a uo des el
II?
d su0•ges1lloa 11 Pue .1 , 1 4 oq
Id 10 1e9 s191
a�No1s
MID
leu
Ro NI310 S.0 oN1183 fao •
Alru�muva tom AU
Q3/iOaldcdf
FF1J� Ognlm Campster East PaY R(]I£NJ. � ISI%5]6Zdi Cgl
1
1
12X38SLIDING WINDOW OLD WINOOW •
I
24%24X38 CABINET WITH SINK �•.,
f\OLDTOILET
61%32X28 RIGHT BIDE SWILL
/ \\
TUB
NEWWALL<" q NEW 3P'R '
OLD DOOR
1 OLD DOOR MOVE t0 -
KILHEN BIDE tff
1.
<'r I
_.... ��
OLD DOOR
•
_ OLDWINDOW OLDWINOOW
I
OLD TOILET -
5'6 `.„ l 316:. .
.I. OLD DOOR
EOOZ 9 Z dd
........ 0L DOOR /. ' OLD DO
1) OLD DOOR .
OWOR-BUILDER VERIFICATI09
• 1. (Check one) I or my immediate family(parent,spouse or child) will perform:
A. _ All the work authorized by this permit
B. _ A portion of the work
C. _ None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work(complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
• — $
3. I will utilize unlicensed person(s) othe ily to perform all or
portions of the authorized work. I understand that may b an employer(see reverse side). A
Certificate of Insurance covering workers' compe ation ust be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City hone Number Type of work to be
performed
.........................................................:...........................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Owney:4nature:��-' DX-) Z L o-o 2
Z -7-)- g- S r o f;6(or tl Y C��CW'-" of �( l`o/to
Job Address: Permit#
• Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
ffilCity of Cupertino Building Departni
CITY Of 10300 Torre Avenue
CUPEI�TINO Phone: (408)777-3228
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being,performed by someone other than yourself, you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection:
If you employ or otheiwi'se.engage any persons other than your immediate family,and the work
(including materials and other psts),is$200-or more for the entire project, and such persons are not licensed as
contractors or subcontractors,,then you may be an employer.
If you are an employer,you.must register_with the state and federal government as an employer and •
you are subject to several obligatic ris utcludjiiig state and federal income tax withholding, federal social
security taxes,workers' compensation insurance, disability insurance costs, and unemployment compensation
contributions.
There may be financial risks for you if you do not carry out these obligations,and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service(and,if you wish,the U.S.Small Business Administration).• For more specific information about your
obligations under state law, contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit, erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours, •
Building Department,
City of Cupertino
Printed an Recycled Paper -
(�,apibv) CITY OF CUPERTINO •
cfr3 0 ( l
• CUPEIRTINO PERMIT APPLICATION FORM 6 � 0 o
APN#
Building Address: / /
Zcz � Co f�gfGt dJY , CGt,� Yt .,itio , CA,
Owner's Name: Phone#: 91
figa'F -
Contractor: O he License #:
Contact: Cupertino Business License#:
uildin Pennitlnfo:
BI , CA
-;-)) C91,
ascription:
Residential [� �; /S'a(�, Con arc ❑
Sq.Ft. Floor Area: $/S4-.Ft.:
Cost of Project: Occupancy Group: ^ ?�
2 :a`a v ov V
ype of Construct on:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILER1 Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> IM 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 <= IOOOA ELECTRICAL
BELEC1001 Elec 600V > I OOOA ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
�� �6
1 of 3 ��
ame, CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pb1g 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 rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Ligbting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace 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 I Pole/Platform Fixture ELECTRICAL
2of3
CITY OF CUPERTI•
CUPCITY OF o . PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial 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 Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
3 of 3
CITY OF CUPEwrINOOOR' , +Nw`hF•%Qh RMA�T'IO" N
BUILDING DIVISION CT = t
PERMIT
BTI"2?DI1§tbFIELD DR GEORGE LIN & XIAOMIN YU PERMITN0.03O40110
RWff6 LIN & XIAOMIN YU PERMIT IBS'RA7t2/2003
SANITARY NO. / CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
+Oo LICENSED CONTRACTOR'S DECLARATION O O O
1 hereby,affirm that 1 am licensed under provisions of Chapter 9(commencing lob Description
.� with Section 7000).(Division Sof NC Business and Professions Code.and my license is
Ieranm to.Class erred BATHRM REMODEL
LieenClea Lie.M
e y, Dam Contractor FSl
ARCHITECTS DECLARATION
1 understand my plans shall be used a public records
'ark LicensedProfmaf.nal JUL 1 5 2003
i OWNER-BUILDER DECLARATION
2 m 1 hereby affirm that 1 am exempt from thc Contractor's License Law for the
00 following reason.(Scdon 7131.5.Business and Professions Code:Any city of county gU1Lp'�
m which requires a permit t. m conetrvet.alter.impoon,demolish. repair any structureG
-¢i prior to its issoanec.alsu requires the applicant fonuch permit to file a signed smement
-xa that he is liccnscd pursuant o the provisions of the Commons License Law(Chapter 9 Sq. Ft.Floor Area $yel@#on
ZF0 (commencing with Section 7")Of Division of the B usiness and Professions Cork)or
that he is exempt therefrom and the basis(or the alleged exemption.Any violation of at u w moi,
Section 7031.5 by any applicant for a Permit subjects the applicant m s civil penalty of 3 893 0101®tr 0 0 Occupancy Type
nal marc Nen Ove hundred dollars(5500). P Y YP
❑ 1,as owner of the 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
sod Pore cions Code:The Conuscmrs License Law does not apply m an owner of1`940119d Inspections
prupeny who Wildsor improves thereon,and who d.,..h work himmlfor through his 102 — PIERS
ownempmyees,providedthapuch improvements are nal intended.,offered fora le.If, 103 — UFER
however,the building or improvement is sold within one yaw of completion.the owner
builder will have the burden.(proving that W did not Wild or improve fur purpose of 104 - REBAR
`"I`')' 105 - ANCHOR BOLTS
❑h as owner of the property,am exclusively contracting with:)The
eCconactors 10
consmn the pmjen(Sec.7W.Business and Professions Code:?The Contractors Li. 106 — SEWER & WATER
cense law does not apply to an owner of property who Wilds or improves lhemon,and 202 - UNDERFLOOR PLUMBING
who conmcm for such pmjecu with a co rfacmr(Q harriedpuamnt to the Commodes
License law. 203 - UNDERFLOOR MECHANICAL
m
I aexempt under Sec. B k P C for this moon
r �� 7 204 - UNDERFLOOR FRAME
ow r WORKER'S COMPENSATIONDCCEgari ZZ > 205 - UNDERFLOOR INSULATION
PIhereby affirm under penalty.(perjury one of the owing declinations: 301
II h — ROUGH PLUMBING
avaand will maintain a Cenifcate of Conscnuo salGinsure for Workeri Compete 302 — TUB & OR SHOWER
scion,u provided for by Section 3700 of the IaWr Code.for the pefonnanca,of the 303 - ROUGH MECHANICAL
work for which this permit is issued.
❑1 base and will maintain Worker's Compensation Incersna,as mgofred by Section 3 04 - ROUGH ELECTRICAL
37W of the Labor Cole,for Ne Performance of the work for which this permit is issued. 305 — FRAME
My Workers Compensation Insurance carrier and Policy number am: 306 — HOLDOWNS
Corrin: PolicCERTIFICATE OF EXEMPTION FROM ROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
leas.)(This..It.need net Wcompleted if the permit is for one hundred dollars(SIBt) 309 — EXTERIOR LATH
nr
I[miry that in the pc,runnance,f the,'.g,,T.t�k�rte which this Permit is issued.I shat not 310 — INTERIOR LATH
employ any Person in anvwtlnncr snugseFof ubL,Wyo the 9 Vg25,am.u.n 311 — SCRATCH COAT
Lawsca CaliforhiyJYlITJ �V YJ
App can 313 _ ROOF NAIL
N TO AV ,after making thts _ Exemption.you should 501 FINAL ELECTRICAL ENERGY
hcc suhjccuwithsuo the rhrsCoonsortionprovitioulWdeeedrevolmd. must 502 - FINAL PLUMBING ENERGY
� z fo: $Obmply with sucker's Compensation
or this permiuonsof be Lab ror Code,
Z ° CONSTRUCTIONLENOINGAGENCY 503 - FINAL MECHANICAL ENERGY
I hereby alrum Nat them is construction lending agency for ftperformance of 504 - FINAL BUILDING ENERGY
L' the work of which this permil is issued(Sce.3097.CN.C.)
Jill Landers Name 505 - FINAL ELECTRICAL
3.D z nderkAddmsa 506 - GAS TEST
C) i cenify that I have read this application and sole that Ne aWvc infofmatiun is 5 0 7 - FINAL PLUMBING
y coned I agree to comply with all city and county ordinances and sure laws relating t.
Ubuilding construction.no hereby autharin,minasentacives of this city to enter upon the FIN L MEC ICAC
above-mentioned property,for impceuon purposes
6. (We)agree I.ave,indemnify and kap bumlea Iha City of Cupenino against' O — FI
N liabilities.judgments.costs and expenses which may in any way seem[against said City 5 NG
Z in
of the
Or
his Permit.
APPLICA`NT`UNOERSTANDStAND WILL COMPLY WITH ALL NON POINT Issued by: C WORKSDate
50
CC=ONS.
L Re-roofs
7S1,tumOfAp,dcapVCOntrkmr mHAZARDOUS MATERIALS DISCLOS E Type of Roof
Will Ne applicant ser future building occupant nom or handle hazardous material
fined by 0¢Cupertino Municipal Code.Chapter 9.12,and the Health and Saff,
,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes on
Will the applicant Of future building Occupant sere equipment or dcvias which If a roof is installed without first obtaining an inspection,I agree to remove
ha'-minus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Districl?
❑Yes 9No
1 have read the haatdo,smaterials requirements under Chapmr6.95 of the Cali(or
nia)lraltb h Safel,Code.Sceu.han5(15,25533 and 25534.1undersund that i(the Wilding
Jas and currently have a tenant,that it u in,mu'rubbility m notify the oaupern of the
mquimmcnu which musk met poor,issuance ofa Ccrufcam or a cy. Signature of Applicant Date
O cr or authori'red agcm Date '
All roof coverings to be Class"B"or better