04060073 CITY OF CUPERTINO x "
BUILDING DIVISION PERMI Cell 'TI TdR INI!,C RMA
BUIL DING ADDRESS: SURENDRA SHARMA PERMIT N004060073
20309 SILVERADO AY
NER'S NAME: PERMIT ISSUE DATE
SURENDRA SHARMA SANITARY NO. CONTROL NO.
( 'ONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 0 0 0
LOO LICENSED CONTRACTOR'SDECLAKATION Job Description
I hmrcby affirm Har 1 am licensed under provisions M Chapcom
mr 9(commencing
n,
Section Ag11B of Division Sur the Business and Professions Cam,and my license is
efeumrseand effect. SHEETROCK GARAGE
mLicense Clms Lick
Dahi Contractor
FF ARCHITECTS
DECLARATION
K 1 understand my plans Shall he uud ae puhlle rcrnNs
DyU
G Licensed Professional
OWNER-BUILDER DECLARATION
I hereby reaso affirm on 1 1. mxempt from Nc Cocoons Co eA License Law for Nm Y
q O following reason.Permit
t ](131.5,Business and Profession Code:Any city or county
m which requires n permit ne construct,alter,improv,h permits or repair any swmum
priorasits issuance,also requites the applicant the Contractor's
files Lov statement
Asa that(commencing itpumoemto the 7")ofDivisionftheContractor'sndProelaw(Chapter9 Sq.Ft. Floor Area Valuation
tt� that he I,
(commencing with Section7") basisofrth Il,,mncamept Pro An,vi Code)or
y 3 Net Section
is 31.5 b therefrom end the basis for the subjects
to applicant
to Any l violation of
a.,in. this.56yanyapplicantfor a.($50rmhsuhjectstheapplicanttoacivilpenallyof .&I er00 Occupancy Type
not more Nan 0w hundred tlollars(5500).
0 1,as owner of the property,or my employees with wages as their Sole compensation,
will do the work,and the swclure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Cade:The Contractor's Liam Law does not apply to an owner of q P
property who builds or improves Nerean,and who does such work himself or through his
awn employment,provided that such improvements are not intended oraRered formle.IL
however,the building or improvement is sold within one year of completion.the owner.
' builder will have the burden of proving that he Nd not build or improve for purpose of
sale.).
0 1,as owner of the property,em exclusively contracting with licensed convectors m
consumer the project(Sec.7044.Business and Professions Code:)The CantracmrE Li-
cense law docs not apply to an owner of property who builds or improves daemon,and.
who moment for such projects with o contracmr(s)licensed pursuan0o Ne Convaclor'a
icenx Law.
Its 1 am exempt under Sec. .B&P C for this muop
net.1 Dae d IGL
Rf k FKTS EI O CLARATION
11mebyaffrrmuwm;mmItyo(pe onmofthc following drearsrion
sation,
I have end will maintain a tion 37W of me La l toCod imur tfor Workers ce of the
work(at provided for by Section 3]00 of the labor Code.for the performance of the
work for which this permit is issued.
0 I haw and will maintain Worker's Compensation insurance,as required by Section
37M of the labor Code,for the performance of Ne work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section treed not he completed if the permit is for one hundred dollars(Sim)
or IC15.)
I worry that in the perfam mer,of the k or which Nis permit is issued,I shall or
employ any person in any mennerao ss o ec�me subject alMWorkert'Compinsioun
Iowa of Ca'fo ia.Date
Applicant
NOTICE TO APo the .IL after eki pr vi r marc o cmpriaod you should
bot uhjccty the Worker's Coons Or this provisions steal of themed rCode,you mum
.,,� forty comply with such provisions or this permiuhall be deemed revoked.
z,�O CONSTRUCTION LENDING AGENCY
'rr I hereby affirm Nat there is a conswction lending agency for the performanm of
the work fur which this permit is issued(Sec.3097.Civ.C.)
Lender's Name ,
] z Lender's Address
f)Q 1 certify that I hew read this application and mile that Ne be.information is V�
f correct.I agree to comply with ell city and county Ordinances and shire laws relating to
0V building construction,and hereby allthofM repmsenmtives or this city to enter upon the
,�a W shove-ms,judgedpropertyst for inspection whichpurposes.
{�a (We)agree to save,indemnify and keep harmless the City of Cupmrino against lee -
is r/) in
judgments,coarsing of this permit. may in anyway accrue againstsaid City
(„) z A APPLICANT
or live granting o(this permtr.
r'+ APPLICANT UNDER TAN AND WILL COMPLY WITH ALL NON-PO NT Issued by:
SOUR EGUL w`6
Re-roofs
Sha re of�plica 4 mi rU mi r Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hamrdous mariner
u defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
ode,Section 25532(.)?_ All roofs shall be inspected prior to any roofing material being installed.
❑Yet iQNa
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by tho Bay Area Air Quality Management all new materials for inspection.
Disvict?
❑yes V7Ni
I have mad the haaardmra meterialsmquirements underchaptorri.95 of the Califor-
OmHcalm&Safety Code,Sections 25505,25533 and 25534.1 understand diatribe Why,
does nor currently a m rte Nat it is my resia niluilly m notify the occupant of the
amen c0tvhi m' ctpriormissuanceofaCertifies o(Occuancy. Signature of Applicant Date
G U
amain a Date All roof coverings to be Class To or better
;V . PITY OF CUPERTINO
o W0 6 0 7,3of PERMIT APPLICATION FORM
CUPEKTINO
APN # 3 �07 3 r-v Date:
Building Address: 20303 �` y �, Mailing Address (if fii fferent from building address):
Owner's Name: Phone #: 1 �7e�— 203
Contractor: _ ® av 6 w�Q License #:
Contact: cs.uY2 N dtei �k,� ' Phone: t�G S� Cupertino Business License#:
Fax: 9' Id -)4'36
Building Permit Info:
Bldg Ele Plumb ❑ Mech ❑
Job Description:
Residential Er Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: 2 Fila o Occupancy Group:
Type of Construction: _ 71�1r Please check this box project is a
second-story addition: ❑
Project Size: Standard CT� Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> SOOK to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILERS 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
14-- z 51,11 E
1 of
e J
ZiakTINO
OITY OF CUPERTINO
CUPEPERMIT APPLICATION FORM
Quantity Fee 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
BRENL PPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT _ Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Mise 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 MECHANICAL
BREMREPALT Repair/Alter Heatin MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2 of 3
CITY OF CUPERTING
CUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
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 Inspection BUILDING .
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM . Temporary Bldg Permit BUILDING.
BTEMPSVCS Teftip 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 PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
3 of 3
:} d Y r vw Y4' s ^"c��rc � 4 w vy. i,fa }, ✓�
%F
' i -151 s
RESIuDENTIkAL PROJECT COVER SHEET '
f e!ll&
• CUPEkTINO a e� µ " 4 4 f } l k~ � 4 $t^y.�5r
A aA. rwm. r b.:,..h �C�1 ffi.'d�'kx. G2.-. o �'.'w1.-K�.A.. ,
Assessor's Parcel Number:
Name of owner. 57 / Q'Y�1'! &4Z 44—
Project address. eQ 0.9 Si /✓Cyq-.A O ��—
Contact person. f`4.7hMPhone. 4a*, 996— 2036'
Fax. 4gn k— 2 ,r4-- :5 A !9
Net square footage of lot. 11D D
Existine Pronosed
Square footage: First floor: O .SCJ.fre
Second floor:
Garage: i
TOTAL:
Are thereat least two 10 foot by 20 foot clear spaces inside the garage? N
• Is privacy protection planting required for the project? Y Q
On what floor(s) is work being done? / s
Brief description of work. Sh e c-'71-w ck 7x-,C Gf M eol Yr,
Code editions:2001 CBC (Y -N)2001.CFC (Y-N)2
RK;bVEb
2001 CPC (Y -N)2001 NEC (Y -N) JUN ® 2004
Effective ll/l/02 CITY OF CUPERTINO
BUILDING DEPARTMENT
Plan Review Process Work Book Page-8-Revised 4/28/04
'uc en :.S'h �ygx.+st 3 r[&y ly ti'tiff �, r7y{,R_F �¢r x i ,ys kg
yf'.>
" COMMONLY MISSED PLAN CH}ECK IwTE'MS A wry
ra' £
R �
ao n h sr Mei r r y r •r,' a ^ ,R vs' ,�q„•y, .�y "� i rC r. a r w,i.'>rz !tav 1 f 4: & 7s y y, r w+.'.,` tii
CUPERTINO y ext- LS� "r"u2� x $N�xa kd . .n} a+ •.cb 5 rna ..:a P.•N lr xe„s at
The following rtemss6all he included,on the plan set.
Pldnning:
1. Fully dimensioned site plan.
2. Fully dimensioned floor plan and elevations of entire house. (Not just.area of work).
3. Scale of all drawings indicated on the plans.
4. Assessors parcel number.
5. Privacy protection measures (landscaping and window alignment). See RI ordinance.
t4:`'f'1•�dw,tL�m;%.°;/re f'3i ]11
Structural:
1. Note/or detail shower lath paper requirements and backing. (UBC CH. 25)
2. Show all header sizes and supports. (UBC CH. 23)
3. Show location of all hold downs and anchors. Note on plan all hold-downs to be installed
prior to foundation inspection.
4. 'CF=IR and XV-IR forms must be incorporated onto plan sheets.
5. Show all post/beam connectors. All beams etc. must have positive connections. (UBC
CH. 23), ' s'
6: ,Note that glue laminated beams must be certified prior to frame inspection.
7. Read soils report and/or soil letter. Record Soil Engineers finding/recommendations onto
plans.
8. Show note that pad height and set-back letter to be delivered to City prior to foundation
inspection.
9. Confirm with note or detail, egress/ingress window requirements from bedrooms. (UBC
CH. 3)
10. Show 18” by 24" under floor access, and 22" x 30" ceiling access. (UBC CH. 23, CH. 15)
Plan Review Process Work Book Page-9-Revised 4/28/04
NECEIVf 0
JUN 0 S 21304
CITY OF C RTIN®
BUILDING PARTMENT
r
rpu �
r
77
axe :4. 9...,', *,� +� ♦ �' ,�. w,.,M a ,.0 �R'.. I
C
F.
PROVED
IN ACCORDANCE WITH THE Crry
on
CUPERTIN i N
dARCO , cv
DATE _ lM%w /fid o
v
SIGNED
This plans and specifications MUST
oekept on the
lawful job at all times and it is urt,
make y es or, alto
nn same without written gpormissioRrInDM
adons
• the building Dept., City of Cupertino,
The stampir�of this plan and specifications
311ALL NOT be held to permit or to b3 ar,
approval of ri ;aon r f any4roe�srom
rd Jnv v;
�_3ta Law,
• Project: Sheetrock the unfinished garage.
Details:
1. Install insulation on the sidewalls and on the wall above the garage door. Put
sheetrock.
2. Put another layer of sheetrock on the existing wall (between the garage and
house)..
3. Install 2"X6"X22'joists every 16"to support the sheetrock on the ceiling.
4. Install sheetrock under the joists.
5. No additional electrical work will be involved, but all the appropriate holes
for the outlets, switch and garage door opener plug will be mage in the
sheetrock and wall plates will installed upon finishing..
6. The door to the house will be in compliance to 302.4 code to provide 1 hour
fire resistance.
Codes: All work will be done according to 200t CBC (Y-N) 2001 CFC (Y-N)
2001 CMC (Y-N) 2001 CPC (Y-N) 2001 NEC (Y-N) codes.
r
J1;.10 c, 2�"4
CITY OF CUPER nN NT
�Illtn,MG OEPAP
ONWR-BUILDER VERIFICATI94
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
c�c cu vauacu
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer(see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City . Phone Number Type of work to be
erformed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side) f
Property Owner's Signaftdv- �24 �k 6 / 0` o
/
Job Address: d 3 O S ✓elk'- Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Delartment.
•
City of Cupertino Building Department
CITY OF 10300 Torre Avenu®
C O P E kT I A 1 O 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 vourself 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 otherwise engage any persons other than your immediate family,and the work
(including materials and other costs) 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 obligations including state and federal income tax withholding,federal social
security taxes,workers compensation insurance,disability insurance costs,and unemployment compensatioo
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 maybe 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 verificationform 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 on Recycled Paper
CITY OF CUPERTINO �§ ,»ada.T*: .a;+ ,.ayt'�,.4e:�; :� 3
BUILDING DIVISION PERMIT CONTRACTOR INFORMAT189
x s . "�•.�, •n m�{ ,u r ,4sPw ,,.> '.
BUILDINGADDRESS: SURENDRA SHARMA PER"""0 4 0 6 0 0 7 3 -
20309 SILVERADO AV
OWNERS NAME: PERMIT ISSUE DATE
Adk SURENDRA SHARMA
IRVE' SANITARY N0. 2,12 CONTROL N0.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDO BLECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION O O O O
p I Mrcby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description��
`uf with Section 7M)of Division 3 of the Budrcm aM Pro(casiam Code.and my license is -ate A
I.failClass
SHEETROCK GARAGE
5 z L fail t Cl aAnd
anderrLM.N
Date SDECL JU
ARCHITECTS DECLARATION 6
1 understand my plans e1W I he used u Public recordsL {J 10 p4
O
Licensed Professional 184/
OatNE&BUILDER DECLARATION 1mv
f 1 hereby (Soc than 1 e.5 cacmpt from the ConuanCo License law for the
i O O following reason.Permit
t 7 o str Business andimprove,
de Protection Code:Any city or county
u,$fl!w which requires a permit to uirewcL alter,improse,demolish, fila
repair any xrocmre
,,w pdonn its issuance,nalso
uantto ms provision nt ofthesuch permit saimnos Law(Chapter
o
that
mmincanxtl Sectio 7000)the ofDislomnfNeConusincts llcenxlaw(CMper9 Sq.Ft. Floor Area Valuation
$
(commencing wish xNon 7000)duDrvhkon 3 of the egad cssand on.Any vi ladon oat f
tat he a cacmpt therefrom and 0e buts for the alleged cxmpuon.Any violauan of
Sectios 7031.5 by any applicant for a pump subjects the applicant to a civil penalty of 3 erO 0mA...than to.hundred doll..($5W). Occupancy Type
[11.u most,of the property,a my employ=with wage As their sole compecon lon
wit)do the work,and the stromure isnot intended ora@and formic(Sec.Troia,Business
and Profusion each:The Contaxrors Liaise Law does not apply to an owner of Required Inspections
property who Wi Ids m improves thereon.and who dos such wank limsel f o r through his
own employee,provided that such improvements are not Intended maternal foraale.IL
however.the building or tmprovemem is m)d what...you of ampjames,the owners
builder will haw the human of proving that he did not build or heinous for purpose of
ale.).
❑1,as owner of the property,am=elusively contracting with licensed contractors to
construct the pmject(Sec.lobs,Business and Plefeukons Code:)The ConlaxbYs LF
cense law does not apply in an owner of property who builds or improve thereon,and, ,
who contracts for such projects with a mnaacmKO liccmed pursuant o the Comnctoes
4kenx
[t37W
�—I em exempt under See ,B&PCfar this mutat
= ,...s.q�Dare d c
iR IiOA DECLARATION .
1 hemby Man under penalty of pe one of the following declmmmn
have and will maintsin a Ceniftcme of Consent to stir-insure for Worker's Compere
n,u provided for by Station 37M of the labor Code,for the performance of the
far which this permit I.issued.
have and will maintain Worker's Compensation Insurance,as required by Section
of the Labor Code,for the performance of the work far which this permit is issued.
Workers Cirropm ation Uncommon carrier and Policy number art:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' '
COMPENSATION INSURANCE
of 1=6) as
(This ction ed not be completed if the Paamit Is for ane hundred daiau($IMI
�
1 mostly,that in we Performance of the k of which this permit is)ssued,1 shall not
employ any person in any manrrcran ga c�me aubjcet to the WmIncn Compensation
Laws of Cehfoanha.Date
Applies p p,�k j�II
NOTIQQQE TO APPLICA .If,otter ki Is'7Cc�i iciim o cmptjon,you should
Me njcct 0 the Worker's Compensation previsions of the Lobar Code,you must
.7z faM comply with inch powi.i..or thh Permit sial)be cameo rovnkcd.
Z O CONSTRUCTION LENDING AGENCY
Fw I hereby alarm that there is a coauuminr lending agency for the perfarmena of
!Yi Y the work(car which this Noah Is issued(Sec.3097,Cl,C.)
Q Lemia's Name
.1. Z Landeri Address
V Q 1 certify that 1 have read this application and sok that the above infotmauun is
cortect.l agree to comply with W city and county an inances andante laws relating to
Q V building conswniaa and hereby anreariae re Preservatives of thia city ro enter upon the
V) ahavcmenuanW Pmpertt fadepeeuon Pugexb
G (We)agree to now,indemnify and keep huccom the City of Cupertino against
V) in
gence of the
costs ad efpena=which may in any way emcee against mid City
V Z in consequence of the Canting of this Permll.
APPLIC NT UNDER AN AND WILL COMPLY WITH ALL NON-Po Issued by:
SOUR EG U \a\O
kA
Re-roofs
Sign rest 0ca on r —no
RS MATERIALS DISCLOSURE Type of Roof
Will tho applicant at future building occupant store or handle husAous material
As defined by the Cupertino Municipal Cade,Chapter 9.11,and the Health and Safety
Cad
SectionY.zs53zar �'�—''"" All roofs shall be inspected prior to any roofing material being installed.
MY. y�tvo
Will the aPPRcantor ffuture building occupant we equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t haostal us air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
strict?
❑Yes 471Su
I have mal the husmau materials regmremcnh under Chapter 6.95ofde Calif.,.
nka Health&Safety Cade.Seedmh25505,15533and25534.1under dwifde building
does not cukmm)y a te t,Net it h my responsibility a notify the oo:cup n,of Ne
reyulremc hi m ctpriorWusuumcofaCenif/ic7amofOcc anay. Signature of Applicant Date
U �
mak a Data All roof coverings to be Class"B"or better