01020036 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
HUILDINO ADDHI?SS: ...zRMI'INO
220738 SCOFIELD DR CRL—NEVA ENVIRONMENTAL SYSTEMS01020036
OWNIiK'S NAME: APPLICATION SUP DATH
NEWMAN MARJORIE R AND WILLIAM 1053B SHARY CIR 022/07/2001
lIION17: SANITARY NO. CONTROL NO.
-j (925) 687-9980
ARCIII'FLCUENCINHIR BUILDING PERMIT INFO
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PLD(; I;hEC'I' PLUMB MLCII
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S? LICENSIiDCO "RACE OR S DECLARATION '
0Z_o Ihcmbyamrtn that l ataM Job Description
licensed node,post,knsrr Chapin,9(oommencm,
F:F-w with Section 7allp Lit Division 3 ofihe Huvinueeand Pint,mo,Code.mah,limine
�xad i,nimm�nen;mdetg4 . 9 73 OVERLAY WITH SHINGLE
Y 6 Lit C _ I.ic.N .
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Care 41"�O�QContmanr�
a O G ARCURIiCI"S DECLARATION
S
m g 1 understand my plane shall be used as public neo
W. p ip GccmN I'ndecumul
S e OWNER-BUILTHR UFCLAItn'1'ION
I� 1 hereby atlimt that 1 am exempt from the Connector License Low for me
following reason.(Section 0031.5.Business,and Pmfcesions Care:Any city or county
`S G x'hich requires a permit to conxwcl,alar,improve dentol ish,or rtryir any structure
ad
eda.3 c� prom t I. y then ppr of aFennoto fl t d:tatement
meth i I, '. , II d I tin c t I IChalna'r9 Sy. Fl. Floor Area Valuation
(eon ,gwmnSeori 7aXp lOi,ma l rthe m: n I ." I,CNei $5000
or that he is exept tc
hretio
lrom and the basis for the alleged exemption.Alt,„,man
or Section 7031.5 by any applicant for a permit wbjecu the applicant in a civil penalty
or not mom than five hundred dollars APN Number Occupancy Type .
1,ar,orc,ifno EnllL,ar iOry II yeIs ith a,their I ,anon 35910001. 00
'tb,It dohi,work. 1 d ,t icalled in vilOned lo,:' (Stc,7044.
eu,ine,and Profession,ache the C,amnor s L,mW Law Josh no,apply matt Required Inspections -
ofpmpnnywho Wild, ,,imirnne,thereon.and Who Doc,such work Marvell 305 — FRAME
or through his own antployeses.provided that such imprnvemmns am not intended or
nnercd for.do If,however ate building ,,impmxement is slim widths rote year of 307 — INSULATION
n„vnpl,fl n,the ow ner-buildc,will have the molmt of proving that hn did not hand n,
pr...rIt pnm„aenraale.t. 601 — ROOF TEAR OFF
❑I.er,owner ofthe pmpcny.amcmusivlyentoW,nngWith hcen.edemnmemt.m 6022 — ROOF PLYWOOD NAIL
Liconstruct the project(Sce.70,W.Business,and Professions CNet)"rhe Connector's
censeL,wdue,mnmplym:mow'neroflout itysibsbuildsorimpmvesthemon, 603 — ROOF BATTENS
and who convects tit such croiens win a command,) named loolead n,ate
Cnntranory l.iem,x Law. 604 — ROOF IN—PROGRESS
❑I inn erentpl under See. ,a&PClor this reason
Owner Dene
WORKER'S COMPHNSAI]ON UECI.ARArLON
I I by it1hor rid,rI 'by 1.1 factiany line alII tiIhnslo,f1clanatilml'.
❑ I have and Will onifl(am a Certificate i Consent t worker's Y_
Comte I provided r M1Y Section 330a1 of the Labor LedCedc. for the
ferfinloance ofth k lor whichn:rennit is issued.
h:me and will nainano Workm s Cionlanisation Insurance,its'eynlmd by Section
/t9gI nl'the Lubar Cale fort the petlornuu,c of the work fur which this permil is
issued.My W',rkets,Cnn Istranion surance mole,and Policy number ate:
carne ���.t onicyNw:kae3o57Y433
CERI'NICAI ION OI'17XITmIYION FROM WORKERS'
COMI'FNSAIION INSUNANCB
Tbi,.reel inn need not be cotnplmed if the perndl iv formal hundred dollars
IS lap m Ins.)
I certify that in the performance of the work lot which anis permit is issued.I
shall not enn,ky any pesos i r anyni: ,n ao as ,,hcennm subject o,the Workers'
Contpcnsmio I Laws of Califnrntw Data
Ainiblart
NOTICE TO APPLICANT':If,after making this Certificam of Exemption,you should
become subject m the worker',Compcneation provisions of the Wb,r Code.you must
O 0 forthwith comply with such provisirns nr this Petr shall he Deemed revoked.
z r
PIn BUNS'I'RUC'1'I ON LFNDI NO A(➢:NCV
' I hereby affirm Inas then I,.,construction lending agency for the perli,rmance
of the work for which this permit is issued(See 3097.Cir.C.)
b Q LcmIcr's Name
O z Lender's Address
U O I certity that I have rend Ilii,L""a,miun and num:Ihm ih.alk—intnnnall on Is
correct.I agree to comply with all city and mwny oNlnmtces and state laws relating .
O IU to building construction,and hereby authorize tepresemutive,rfthis city or enter uaor
the above mentioned property,for msl,ecaon portholes. _
ry (We)ug,mm save,indemnify and Amp hurnttess the City of Cupcoinn against
to hahllaicv,jim"rents.ants unit cep:nww wloan may in any way accrue regains said
U SOURCIilin UDIIIIScgnintingmWILLntit. ( Z-- 7- ��
City in cnumy..ma"of
SOURCANI'UNDEHUTA DWILLCO 'LY WIIHALI,NUN-POINT Issued by: Date
LA
2-- 7
Applicam/Cnnvavor [)are Re-roofs
IIAZARDOUS MA'I'IiRIALS DISCLOSURE _
Will lnea"li'l o,11 am buildingteutent.tote rI,ifle m Aerbn.,material Type of Roof
as frilwd by the Ctynnlm,Municipal Corte,Chapin,9.13,mW the Ilmmli and S:de(y
Oda Sanion 25532m).-
°Yes All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future buildiogoeeupanl use cgtM1pmnt or devices which If a roof is installed without first obtaining an inspection, I agree to remove
cont b/ardou,reit cmu:unit:tm,'as deilncd by the Bay Area Air Quality Mi rn-at
Dicier: �� all new materials for inspection. Applicant understands and will comply with
°tan all non-point source regulations.
a I have rcai In,I...ri material,tryuirententn under Chapter b.95 of the
C'aldomia Ilmlm&S:dmy Code.Senior,25505,2SS33 and 25534.I 1 dervard'hat
It the building Jho or rnncntly hm'ea,cvant,that it Is niy responsibility to notify the
ccupam of c rcyuimnienl,which nniq be incl prior In iuuvnen of a msil"am of
OCcupar - 2 Signature of Applicant Date
avenin or a�nna.�t age,,, �f—` All roof coverings to be Class "B"or better
OFFICE