00100168 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. PERM T NO.
-N'N17R'S Nftbhl: 64 Vogt AV APPLICATION SUB ON LE
I`11UNE: SANITARY NO. CONTROL NO.
c
Il ARCHITECTAINGINEIiR: But LDING PIiRMI'PI NFO
6 BLDG ELECT PLUMB I'll
New IJ 1=1 C—J CI
o�hz LI CENSEDCONTRACIOWS DECLARATioN
_' InerenyauhmthtalLamnaensenLWerpm,i.aon,Enrchapherv(cEnhnmm�dng Job Description
F_Cu, with Scction]INN11 of Dlvision3nftha Bu,incss and l'rofcssion Cshdc.and mylicenu
e$] n full tixre Buil died!—'3 a� 'Lr'
'ow< %;.'c;,,ac;Iss. Lica TEAR OFF SHAKES INSTRLL 7/0 PYWOOD AND
u.,�, Dam�0=2s=Co c,�nnncmr_ _ v
E0 ARCIEniCT'S DECLARATION - 6'G—:—S IDENT IAI_
S I understand my plane.%hall be used as public records
�r
vo l.ittnsW Pofes>;moil _
o that l imBUILUIiIr m the CompaoN
I hereby o(Enn that 1. nusin from She fe,ov em at is Any c Law lin Inc
H?Mfollowing limon.(Section 7031.5.Business and Ymfcsium Cattle:Any city orc.any
witch applies e. ill :S h.flat inpirme.demolikh. p Y wclure
prior t .d hitapplicantl hp ', 11 g dada nen
�� mal i '......with
.;Lith III til e h License Ln misCof' Sq. Ft. Floor Arca Valuation
(mm t he ingis a wdh Seaum]rm and
he Bion for
the alleged Ih exx andmp Professions Cada
of Shutio is.11.5 b therefrom and the bels for the tsthe exemption Any violation
A I,,,iion9113 70.11.5bylauchedt it for aprnnit subjects me applicant macivil Penalty
Ennhnt,hhamtalnnvanumo-maEnlla,lsslal. ANN Number Occupjl�y,�Fe
❑1,m owner of the properly....Iny employees with wages m dird,-le—pip:nxaerm,
will do the work,and the xaumure is WE intended or offered for sale(Sec.]IW,
Bu%nes,and Pmfessims CWe:The Comme m's License Law does not apply to an ,4245007. 6quired Inspections
of property Who bund... 3 limo es thercon.:md who does such work himself
rstl.mugh hi, mpluyec,.Pre sided Ihal SLICIIounoverwins
nor anc]or
offered for sale,If,however,the building or improvememis sold within one year of -
completion,the co,macbmider will tae the burden of paring that he did not Build or
impose fa,urpocofola.I. 305 — FRAME
171,use nwucr of the propery,L xclusively c,ntmcrong with teamed conduct... le 307 — IhISLILATION
construct the project(See.70a,L eu.ane,..and Pmlt,xim„C.alc:1'Ne Contractor's 601 — ROOF TEAR OFF
Lions I�w does on appy m an unser of pmptny who builds or improves thereon.
and who contract,lir such procars with a comructarxI Rcen.ed pumutut tu the E02 — ROOF PLYWOOD NAI L
Omnucmrs License Lw.
❑Ialnaxann,lumlerSee .xLE,PCfar this odoon 603 — ROOF BATTENS '
Owncr WORKER'SCOSIPDNSA'rIONDECIARATION 60A — ROOF TN—PROGRESS
1 hereby uillm hider a Ce ofclufret fury one sentll following dcc lumtu..f
1- 0�-rfiurmaacc
1 wave oud will maimnin o Cbnilitote of Conscm m.el6inwre for for helnpcnsatiun, he pnwided for by $halon 3issu til theIrMr CWe, for the ofShc work fur which this pvrmih is issued.
]I of :he will maimninor the e sSinn a work
as which
thi by Sen is
3]1X1 of the L,Mn CWe,far the performance1.u'r- of She work for which this permih is
number carre
I: I, My N'nr Conu��Brenta,'on In,urence camcar and Pat sly 000HEVE J
Canicn F 1•EMPINo
IO
CI!R'TIPICRI'ION EN NI ION
WOItKL'lls'
COh1PENSAI'ION INSURANCr:
This section need not be completed if the permit is for one hundred dollars
fS I Ixp or less.)
I certify that in the ierlomunat of the work far which this permit is issued.I
,hall nor employ any ppoom in env nu user m as a,WvmE abject m the Worker,'
Compensator,laws of Califomfu.bate
Applicant
NOI*ICP.'I O AI'I'I,ICAN'1:1L alcor making this Canil lane of Excinpion,you should
become subject In the wodars Compensation provisions Entine IaMn CWe.you must
Q 0 fnnhwith comply with such provisions ser this pe.,it,hall be created revoked.
H ^ CONS IRUCTION LENDING AGENCY
a ] 1 hcnrhy aftinn foul laute it a comhmcnon Imurn,agency Iia tic perlionnmce .
of the work for which this Penni,ix iwucA(Sec.31Y17,Co.Cd
0.. Q lender's Name
Lander',Address -
V Q 1 Gundy Iba 1 lave read this upplicntion and stn d than that Ell vc Ildonnnliun ie
la correct.I agree to comply with all city and county ordinances and.%ata laws relating
Q f, to building esmtmniun.Land hereby uulhn,ine representatives of this city to enter upon
the aMvo-mentioned proacny,for impaction purposes.
F„ q, (We)a gree ms ave indcmni fy and keep harmless the Cityur Cupertino against
h liabil ars,ludguana,asp and cxpetnes whin Buy in eery way accrue aftiono,Lid
U Z City Ia annryuanm of the grnotarial his panuih.
APPLICANT UNDERSTAN D II ,COMPLY WITH ALL NON-POINT Issued b Date
SOURCE REGULATIONS. _ Ili Y•
Sigmnuram Aln,liallntrcantmclur y `-' Dale Re-roofs
HAZARDOUS MAI'LRIAIS DISCLOSURE
win dhe applicant Enr future wilding uceasam time ornamne ha and.a,material Type of Roof
rex defined by the Cupertino Municipal CWe.Chapter 9.13,and the HE and SEE
Cade.Station 25532101' /
❑Ye.. GYN All roofs shall be inspected prior to any rooting material being installed
Will the applicant or future building n¢vpant use Wuipmtm or devices which If a roof is installed without first obtaining an inspection, I agree to remove
nit hazardous air contaminants m defined by the Bay Area Air Quality Management
Di%rice all new materials for inspection. Applicant understands and will comply with
Elson "" all non-point source regulations.
1 have and the mordou,material,requirements under Chapter 695 of She
'theboilding lth dpw@nolcur Code.Svea boo ,that it
and 2553J.lundentand that /O—q
upm,A In,es not currently havcamne,over
i>my r Ifunce bilitymnrnify the ,l _. /7J�� 0/ G-
cerp,am til the rap huts h' t M,mcI prim m Ixmmna of a Ccnilianlc of
h ams
Occupan
uy. ,
`Q ZSR Signature of Applicant Date
Owner or authorized agent Date All roof coverings to be Class "B"or better
OFFICE