00070193 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
IfU I LUING AUURESS: 11IMS11'1NO,
WNEaSNA7 98 SQUIREWOOD WY AMERICAN BUILVINUT<. :
10 1
amt:: HU SHAD—CHIN P 0 BOX 33e SANT IARY till 1 ., c . 'D.
a 7. ARCHITF.CUENGENEER: (408) 741-112 BUILDING PERMITINPO
O O nLIIG ELECT PLUME MECH
W
yid
S=�__ LIrl hat1UCONIRA wide,lDIIiom,of I'ION fob Description
Iherby0)ofmai I'nn3 ofthe Bunderprn Prafixof Chase,9(commencing -
withSminn 71X1(11 of DiviciunJof the Business and tiro@scions Cwde.eel my license
.¢m is in roll tone anJ effen. _��/
ce
w I-ir.a,. ,�e�9X &
yaLL Da'° =0a Cn""""r A 4 .B 1Q REMOVE COMP SHINGLES. REPLACE WITH SAME
ARC fII'IF.Cr'S DI!CLAR I)'
a~u.O 1 mWelxmnd my plane."hall be used n.x public record,
pO Licensed Pm&ssionll
o�y OWNFR-IfILDER DECLARATION
oKJ—m I hereby affirm hot 1 am aucram from the Connector's Licence Law for the
a following moron.(Section 7031.5.Films,and Protections Crede:Any city c,totally
0 when requires It permit construct, h p demolish,or p any structure
ce 3 re poo I n. I q to ppll If suchpt permit 11 signed statement
- but he i,listowdpwwamI he n : l Ille c n t License (C. Sq. Ft. Floor Area Valuation
(,I uniawin,w'll Scia in t 7000) if Diviki t 3it he Rsnadire. .Code)
or that he is except therefrom and the basis her the alleged enxemption.Any violation
of Scation 70315 by any ap,l...I Er ii wnj.ms Ile applicant w a anvil pmol ly
orustle,mthan live hnndrmdeumx(s5an. APN Number Occup e
❑1.asuwnet of the propeneormy employees wine wagcx ax hour sola on., Bion.
will du me work,and he ca,,mra is net welded or uttered for sale.ser.nw'L 3F•�2r,0''4. 01d{uired inspections
Business and Proreom cciGide:The Cnntecmr'c License lam secs not apply to aaG
n
fr of property Who builds m Improve"Ihercei,aad who dosc.wch work birl-If
through els own croplos�howeVief.t provided hat nipo in)pm t is osssold ere sol intendedyew or — 1.
awn,la for We.If,ar mode,
the building or lmpmvameal n sell widda one yam nr 305 — FRAME
co npinioe the nwnprbuiller will have the hmden ol'pmving tem he tlil nm mild or `+
imp ....m f ' ) 307 — INSULATION
13 1.as ownerollnepropernr exclusively contlacting vanticca,ad claturaclois III 601 — ROOF TEAR OFF
t tat project(S 70TI if d P f Cmr:)931 C I a)r's
L601
Law does not apply to an owner of p pony 'h build- I t mon _ O
and she contracts tut such projects with a.eat r(s)rixnO.d pai:nl a,the ' 602 ROOF PLYWOOD NAIL
vamu
G110 ra"oris 104o,a COw' 603 — ROOF BATTENS
El1 ant exempt under Sec. .R&P C for this reason
own.. Dam - 604- — ROOF IN—PROGRESS
WORKER'S COMPENSATION DECLARATION
I hereby a01mt under penally of perlury one of IM1e following deelau0nm:
.'0 1 have and will maintain a Cenilicae of Conceal m self'-moor. for Work,% -
Cnn)pcn, I, it, provided ht' by ga91on 371X) of the Labor Code, for the
performance of the work for which this permit is isu.IT
❑1 hove and will nramem Worker'°Cnmpan,ain I lmunnce,ac required by Section
9701 of the IaRrz Cade.for the performance of the work for which this pvocir is
issued.M,Wmkw',C+mpanwvo Invuan "loci".andel policy num(hJr/me:
Carrier: /p �. YNn.:. 1J_7TJ
CERI IFICAIONOF EXEMI'i'[ON FOM WORKERS'
COMIENSATION INSURANCE
('Illi,section need not be annplcted If the permit is lir one hmtdmd dollen
(510(1)...lets.)
I certify that in the peromin a of ILe xnr mor which Ihlx...ran is issued.I
µhall ani ealploy ally persalt in any manna 1 =tf�Wlact le av Vg� v
Compemution Laws of Califamla.Dam- I?/ y�/ST/ 00
Applicant �-,r
NOI'ICETO API'LICANT:If,thmr making his Ccniliewa of Exompuon,you should
Mame subject to the Worker,Comlwnwtion provisions of the Latin Code.you must
O Q forthwith comply with such p loisiom o,Ila,pro nit shall M dcmmN msesed.
z CONSTRUCTION LENDINGAGENCY
1 hereby anises Ihm then iso"nonaction lending agency lin the pertolloame
of Ih,work for which Ihic perms Is owed(Sec.31197,Civ.C.)
Q bander'.%Name
= 7 Lender's AJdess
V 1 certify that 1 base mad this application and slme that the loci information is -
i. [.. eorren.1 agree to comply with all city and roomy ori intm e,end slam laws mlaniag '
O r, enaildhtganaamem,n.and hereby mnhorlm repmsenmtiery of this city to enter vial
y 4 me:wove-mentioned prop ny for inspection proposes.
ty p„ (We)amea to cmc.Indermify and keep harmless the City of Capertloo against
W Ilubililias,Fit gnmas.coeu'and expen,cc"which nary in any x'aY uceme agaima sail —
(ss sem City in cnmeynenc.'f the gvnling Of mix pcnnin. �
SOPLI pUNDF1L5(��/j/�SANDWILLC NP.YW�IATrHALLNON-PoINT Issued by: DiIIC
sib noweld ..seam am Dala Re-roofs
Is
future
Mding R1Als DISCLOSURE
wt1l he applicant m fame budding occrpaal emm or Helm°ha,:waax a,aledal Type ofRoof
m defined by the Cupertino Mulc,Cnapler 9.12,mW the I Ieallh nal Safely
Gale.Sooninn 235321:07
❑Yes niciAll roofs shall be inspected prior to any roofing material being installed.
Will hcal,prleant or future hudding occupant use cgaipmant or devices which If a roof is installed without first obtaining an inspection. I agree to remove
emit hamrdom air cuntaminano as&fded byte guy Arca Air Quality Management
Disya7 all new materials for inspection. Applicant understands and will comply with
?Ya all non-point source regulations.
1 have read the hazecdouc nonracial., ,,.Iranian,,node,Clulacr 6.95 of the
ifthe to
Hwlth&Sutcur Code.avena teant.tht it
and 255Jd,iundemmnd that
if the..ii lit the xanalcuact wnaveal Ihetare, it is ser«.lnce III a lnnmifyme
oecrpanl ur me m9aimraems tan' xt M me prim m lxsraaa ur a eeniE<eie of
Occupaar
8_ Signature f App IG ret Date
Owner
Dam All roof coverings to be Class "B"or better
OFFICE