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00050019 CITY OF CUPERT'INO - .- _: PERmrr NO. BUILDING DIVISION PERMIT „CONTRACTOR INFORMATION;R�; ,�y�y� se.4✓' 4 u .4'fi"' X-iL. .4ub .._J_r.4� Nut' P'ti �'.+'V tJ. �„✓(�) HUQ;AIOADDRESS: f' ) 44SANITARYNO. OWNERPLICA ON SUHMtCfAL OA' N/C CONTROLM ARCHITBCrlENG1NEER `' �.;';�NAi :r vt�e�Pva riil�-'a'BULDINGPERM IT4NFOl^. NOTES C Job Description i a i; �oo P: S.q.F[.Floor.prea Valuation _ �. W a . APN Number Oc upancy Type Required Inspections ' JAL ':Dgd � Q > z ; o > U . w Cn Cn Re-roofs Type of Roof All roofs shall be inspected prior to an yy roofing material being installed. If a roof is Installed without first obtaining an inspection I agree to remove all new materials for inspection. Applicant understands and will comply with all non point source regulations. Signature of Applicant 1 Date All roof coverings to be Class`B"or better APPLICANT'S POSTING COPY CI eu5 oFrvc mvisiorlNO C©NTRACI'OO R I F g0 i TION: PERMIT NO. PERMIT ()0 0 S-010 1 C, tARCHUECT/ENGINEER RE SS: , SANITARY NO. IC NSU 1 AL DATE A RATA 4 i: ( 222.4 .yam O (ice/�'( �� I \ NIC CONTROLp G( ��ViD Y7� - OULaINOTE.FT.Rh1IT'jINFO rvrG� LICENSED CONTRACTOR'S DECLARATION c z=p^p I nembY.firm mu I.m rcwed morel pm.;.iena er cn,plex 9 frommeaing Job Description F',nCW wish Sccrim anda)acDivision3ofda Baiass ane Profwiom Cade,aM my littnu is - x^ in ifull force wf Rttt. - Qil If y U Lienee Class ConM w 3 LL rr Dale I"S DECL sy O d ft ARCHTIECse DECLARATION 1 understand my plans sMII m used as public raorda i i❑O Licarued Professional IuS OWNERLDDECLARATION (: m, - 1 hsrcby.(Sero on I am exempt form Ne Professions Co License Law fm the ❑ following mason.(Saban co LS.Business,aterandmis.de sid Code:Any city a county .. rL which rtquues a Permit w construct,eller,improve,demolirh,or term any ewcnue S Ft.Floor Area Valuatio ,norm its issuance,deo reside s the applicant for acb permit m file a.red amcmer, q' Nu he is liceaed Wamnt to Ne prov sof Nc Conmawra License law(Cheptu9 �/ (Fammmudngwlthsadan1000)arD�..�mn3nfuteBuaina,..mm�nfaainmcna)« - APNNumber `Oane e than,be is eamWl therefrom and the basis for Ia lalleged eaemptim.Any violation of Occupancy Y ']Ty P Sam.703I3 by any epplicam fir.pemuil subjects;the applicant to a civil per dry of -r7^l / —Q / not mom Nen rise handled dollar 15500). _ / V ' Las came of the property,or my employees with wage,a their role compemedm, Required Inspections �Il do the work,and Ne ahmcwrt lira intended a oRertd for ado(See TOW,Hartness and Prefesslom Cade:The Contractors Liceou law doer owl apply to an owner of property who Wilda or improves thereon.and who ams much work himself or through his own employers,provided Nu such improvemena one not intended ce oHcmA fee - sde.If.however,the buildingoronshow ant is sold within oro yarafmmpli ion,has .1toilder will hale the burden of proving in.,M did not build or improve for pose of ale.). ❑L u l the of Ne peoperry,,Business and pronating wed licensedomormo'. - conrwci the project(Sa.'IOOg Husinsas and property wed oro Code:)Therm therem'e Li- cense law does nut apply m a owner of property who builds or improves thereon,ad " who contracts for such pro)au with acomnnogs)licensed punuamw the Connector. i License law. emesempM usna. & �CLrS _ l� .BPCfm Nis eau Ow Owens .X . ' Dee WORKER'S COM PENarUon DECLARATION - IhertbY affirm under pindsY of perjur,ury one of Ne fallowing dalantiom: - r 40 k I have and will main in a Certificate of Cement to self-insure Be Workms Counties. ation,a provided for by Section 3700 of the labor Code,(room penfomanm of the - oh far which or Cpe.fo is issued. ❑1 hove aM will maintain Wooster Compensation I...a sequined by Sectbn My of thea Co penafa0rcperfmmaae and work for numbrahis permit is issued. MY Workers Compensation Insurance carrier sed Policy number art: Carries Policy No: " CERTIFICATEOPINFROM WORKERS' COMPENSATIONSATIONINSURANCE (This action need not becmnpleod i(the parotin is fwone hundred dollen($100) or las.) Loy my Kar in Ne my tronuweof thewmkfm which Nis the Woe ro'Co dndh net employ ay parson in aY menar n a to become subject so the wortrn'Compcn- ' .tion laws of California.Date Apilw E NOTI - + NOTICE TO APPLICANT:r s dor making this stems o the Exemption,you should , Become abject m Ne Workers Compensation provisions of the Labor Code,you most , Forthwith comply with such provisions or this permit.hell be damd rtvoked. - CONSTRUCTION LENDING AGENCY Q I hembY aRnm Ow Vert isacummwdon lsndingsgcay for the penfnrma rd .. Z due work for which this Permit u issued(Sac.3097,Co.C.) ' E,a lenders Name . �i Lenders Address W 01 certify Nat 1 have reed Nie u,licdion and sale Net the above information is 0."0. z cmorm.1 ague to comply with dl city and county mdim ne.and aate laws relining o building construction,and hereby vu0orim representatives of this city to enter upon the e about-mensioned property for inspection purposes. li [r (We)agree to ave;indemnify and kap hamrl.the City of C.pwi.agitimt t•,) liddllues,judgnumais osu ardespeve.whwhmry in any way acmeagaiml said City } W iAPPLIC NT ofDERthe STANDSif this WILL. a V [� , APPLICANT UNDERSTANDS ANI.WILL COMPLY WITH AI,I.NOK-POINT- , .0 4 ,SOU HRECUTATI Permit NS. � a 1'�y J=�?—Go Signalman of ApplicanVCommince Due HATARDOUS MATERIALS 81SCLOSURE Wilde' pplicantorNwmbuildingcompanamnimhandlehuladommaurial Re-roofs - - a defined by the Cupertino Municipal Cade,Chapter 9.12,mad the Heahh and Safety �- / Code,Section 25532al^ Type of Roof. /,/ F 0 i.. ❑Yes KNa Will Nc applicant or'Nture Wilding occupant ere equipment or dimcas which All roofs shall be inspected prior to any roofing material being mil hacontamicontaminationsdous so contaminations as defined by the Bay Arca Ab Quality Management installed. If a roof is installed without first obtaining an inspection "M`yOYes IfNNa I t lee to remove all new materials for inspection. Applicant 1base reed Na hazardous mumds mquiremenn under Chapter 6.95 of the Cali. un a tands and will comply with all non point source regulations. fomu HeaINKR Se(cty Cade,Satire 25505,35533 sed 2553..1 uMelatand Nat if the . builiingda na currently havca¢nat,Wtilis my rtspomibilirymlwtify Ura.caper - sS,�•���0 of Nc ret Nth myp be m!l ryimof a Csnililie of peay. �l� //L/��s= �"r/� Signature of Applicant Date Dwncr err euUronxWar err auUroaxed ag� pale All roof coverings to be Class"B"or better OFFICE