00090007 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
HOLDING ADDRESS: C PERMIT NO.
�xTe/z/o2 JOL!/T/ONS -Z�c
OWNER'S NA41887 WILSON CTe ^
M'PI.ICAI ION SUB DAI'17
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1
48 )NE, SANITARY NO, C(1N'I'Ree.
3,410 �/o ie CA- 95 /Z
°sz ARCIF I EC'DIiNCINr;ER: BUILDING PERMIT INFO
O O ELIiC1' PLUMB MI CH
- /2.-33 j T 1
G F m y LICENSED CON'1'RAM WS DECI,ARATION Job Desc (lore
O 1 ncrehy alrmt ilial 1 am licensed under provb.n,m ut Cnapecr u tcmmneaciny .
r__:.°i with Se<Ilod7(XXB of Divizion3 o11he Business and
Profession.Code,and my license
_mE3
is full fnrcc and,flee' �_ Lie.k�r �03_ r,
�Xa 1i'modCla.. e3 S INSTALL 30 PLILND FELT 1/2 CDX PLYWOOI
° Dale_9r� SO,lmelnr
it"
v neclurecr's DecT. 'B
I understand my plane snail be,used asp reemd, OF CELOTEX AMBASSADOR .
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a ia6°° Ucen.ed Nof,,au al
_ clWSER-BUILDER DECLARAION
tali =w 1 hereby affirm that I am caempt from the C.romea is Lemu a Law tar the
following rwxm.(Section 7031.5,Raciness and Professsioa CNe:Any city lir county
r2 O which pe nit t t , It r,' I 1 aisM1 P y stmeure
i3 Pr lir Ica y ,M1 .l plica tf hP lira ......J.tu,nien .
mere 1 ma
licensed rat nnther t ta
n% nnec rvL La (Ch:lpter9 Sq. FL Floor Area Valuation
(commencing with Scared 7(100)of Division 3 ofthe Buamus and Professions Curl
lir that be Is exempt therefrom and the basis tier the alleged dxemptier.Any violation
rel Smtirn 7031y by any applicant lot a I,cool object, he,applies..,h,a civil pcnmy
of not more man Five hundred dollars(S5(e11. APN Number Occupa$cyST�ee
01.as owner Orme property.or my employees with wages as their sold compenx:nion.
will Jo Ibd work,and the elmld re is oro Intended or offered for evle(Sec.7194.
id,ind,e all rroreesimns code:Tnd Comtacto;,Liancd 1-ow does met apply n,an - Reuired Inspections
awns f p peny WhoIw laimprove,m d nod ern k himself 32649018. 0v.
lir through his and Toothed th t such impoommets are not intended or
offered 1,11 ifle.If Nnseve, he h 'Idmg...im,motmoral is: I I evithad adyes of q
adcove,II -h IJ 111 be I Ip : gthll do] Ibrder `
i fpm r n mn.epr l ) - 305 — FRAME I�
01, rmernpe.7 1 I%,lycontracting 'tnlcd : hcontractor,ss 307 — INSULATION 5
11111111103d p 1 ei, 7loa It ' ol IP f -C 11) TheC t rope
.ade 1 d mrtsuct the puny x01 p n rens 601 — ROOF TEAR OFF
dna who eommeu for eadn rn,iem%team a dammeagM licensed Featured m m` 602 — ROOF PLYWOOD NAIL O
0, ratnd%Limnde Law'.
❑tiro,exampr render 5%v. .Bsrcfor this reason 603 — ROOF BATTENS
Owner WOR KER'SCOMPGNSAI'WNDGCLARATION 604 — ROOF IN—PROGRESS -
I verhy abut nnddr penahy(if per jnry.... of mu oil—ing dedannions:
1 have and rill maintain a CenlBcme of Consent to%elf-insum for Worker's -
ompcn%ation, a% provided for by Section 37W of the Labs Cale, for the
part,nn:med oI the work for which this permit Is i.,%a,il. '
r4',u."`(���lry
ave and will maintain Worker's Cominn.oaon Insurance,a%required by Section
of the Labor Cale,for the performance of the work for which this perma i%
d -(e carrier and Policy number ar:
ONs lry No.: -EMPTION FROM IV(1R KERS'
COMPENSATION INSURANCE
(Phis%wtiun need lien he cantpleaN If tire permit is for rend leadned delbnx
(SUIT)lir less.)
I cem y that in the per,i,nnance,of the walk for which this permit is issued.I
%boll lint crop any pets a u Hint Iw. .%ah,ro ,,the Worker:
C.I ....ai ,....1.. 1/ r ya"
NOl'1APT%LICANT:V.nI¢r making phi,Cenilicate ofGumption,you.Should
bYn,a obs d b,the Worker'%Contpcnc:nion provisions of the L,ha Calc,Ynu must
Q OI(im with comply will,such provisions or this permit shelf be deemed revoked.
H14CONSTRUCTION LENDING AGENCY
5: hereby nfGnn that there is a narmumion lending agency for the perfrm,ancd
of the work fr owhirl,this permit is......I(Sed.91197.Civ.C.) .
%i Q Tender'%Name
Q z Lender's AAdmss
U Q 1.,Tilly that I ha,e read this application and state the,the ahovd in@,maaid i is
W F.. cornet.I tiger to comply with all city and cumn,oNin:n,ee%:bad state laws rel:ulng .
Q [) to building conswmion.and hereby authorize mpmoduatives 01 this city to enter upon -
:=7 the ale ve-mentiancJ pnrpeny far impectimn Pter,orl.
ra Ql (We)ugrcem ood.iMenmi fy dna keep harmlev,the City of Cardi inn agai.,I
F+ eA Iiabilitio,jmdgmmns,eats and mpcnttx which may In any way ncena again%,said
U z City In cum,yuence ofthe granting men,pdrnil.
APPLICANT UNDERSTANDS AND WILL COMPLY War ALL NON.POINFF Issued by: Date
SOURCE REGULATIONS. c
Signature mf ApplicenVContractur Dat= Re-roofs -
IIALARDOUS MATERIALS DISCLOSURE
Will the applicant or future building remnant.Same or handle bemeade,moadal Type of RooZbeinspected
s defiled by the Caperton Municipal Code,Chapter 9.12,and the Bealm and safety '
Cued Section 25532(¢)7 No ,
All roofs sha prior to any rooting material being installed.
Will the applienm lir tenure Wilding occupant use equipment or de%ices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hr,arom%air emnamil a is ac duGnnl by the he,Adv An Quality Ma a,mom
oi%,rid;l all new materials for ins ,.tion. Applicant understands and will comply with
Vikincl?a\'=a �N° all non-poi t source r
I nave read The hamrdous material,equlrennm,%under Chapter 1%95 of the
California llrvlth Yr Safety Code,Sections 25505.2553)and 255341 undre,li J,hut /
ifthehui11 d slim cuncmlyhave tana� .tha lismy rc%proddiity m notify the -
s Pam of r yuimme ys.b' vet/f issuantt of a Ce -rtat of -
cdapan' /_ Si I' are of Applicant Date
owner mrireJ agent Fie
All roof coverings to be Class "B" or better
OFFICE