00080096 (2) CITY OF CUPERTINO
Eud.DINILDING DIVISION PERMIT CONTRACTOR INFORMATION:GAI Lannrl'No
��� 30 N BLANEY AV 00080096
OWNER'S NAME: APPLICoVlJO6S}j ])f4/2000
T ..THAN aC/ iI
Vita 1.. SANITARY NO, CONTROL NO.
^C Z ARCHITECTIENGINEER: BUILDING PERMIT INFO
xBLDG ELELTPLUMB MFCH
y Z
" LIG NSPDCON'I'RACIOIt S DECLARATION
ARATION
Job Description
�O a:O I hc.Poytllrn 1111 I' nvW p ' ' to of Cl,-p -)( n. cg
F �.� Wilnsee', 7nomrrD rh,em 1P pR�.�r.cr 1 d ,�y'ro" SHAPE TO COMPOSITION
S:al in fill Tela 111 1 erred. Sl S ,
S:x0 u Liccn. Cla: _C �_ Li,.p
.
w3 Dur _no
CScanwcmrACAItAIry
I nnder.mnd Ill,nlot.,hmdl he Ll.ed /
a.nnnE,menti.
w p o Lc II I
OWNER Ill it DI(1 Ct I.IIN
s� 11 ly 'll' 0 N III C 1. 1 Lw for the
(=Z Q
follo.ni,ill (Selfion 7031.5, and I I Code A y all,ol,an ly
all ,,l I........in cVcNhncl,elm pnc.du .lkh.or,epaih-InlyInalftr
Cp", I I I. 1 PPI' 11 . 'I ,ill 1 'h I.lmcna,l
�i3_ ']an honnicalp RI the n"Woll'a""file Cialfecliel Lwaa,,L (011,111-9 Sq..Ft. Floor Area Val
(cn g -lhS 7000) fD l f0 B_'m 11. 1,.: n,Cnlc)
, he , tpl lhcref nn al,hc boars lo,rbc nllcFcd e.oupuun.Any vinkntim, Y�
of Seclion 71DI9 by nay applknnl fill a onalil.uhjcnrt the apphcnn,n,a civil pallidly
Ili fill(Ter,man live Imndtad dollars 3.500). A PN Number Occupancy Type
711,downerol.Illi,and
le, n o i,V.,e n wish Wageso.of I,,, I,(S,n.WInn,
31621073. 00
Will I (I k I p .I- l l n l ' t I d ele L I f I.aril( 'tOJ4.
n.. I P r, h c TI L , I Ind ho 1 t�I,ply m an Required Inspections
offurrw,tc.)Whnbt ",onTn„11,,ienn.nndnnl,vi .n,I,wfilkmnl.elf 305 — FRAME
lghhi.owilennpleyR,.p,n.ldnn,I,, V,oV pre cah]a„,lann,y", 1 ,3,07 — INSULATION
offered for,file.II;l till,,nut having m dial ofnroving at alpha,nae yea,Of
�onlploliun,O,eown Ofbuilder will have the huNvu nfpmving hat he Did not nuil,l in
tnpawa rnrpnTn,enanl,.). 601 — ROOF TEAR OFF
❑1,a,awnerelIll properly,altleaeln.ieelyclearctingWill licen.edcoatractn,.to 60_ — ROOF PLYWOOD NAIL
mMnml the pilled(See.7044,Eminea and Prnrevsions Ced I Ile Coninal'
,can,c La,dn,,no'on”,to 111 owner nf,rolierty who boill at Flacon 603 — ROOF BATTENS
cam Who eenlral m,,neh pmiect,Will,a eonlramnrc.)Tec„.ad pnnu I u,the
ontat"ol'.Lieen.,La” 604 — ROOF IN—PROGRESS
❑I on exeTP1 ander Sec. .It A PC For In,,reamn
OW net hale
WORKER S COMPENSATION DECLARATION
Aga I hcrchy affil In undo Iwnally a1Penury ane of the tollowin,dmlaral 1,
I hove and Will ,nAllikin n Cerlifalle Of Cnnmm to sell-inwr,fm'Winker',
CI npen.alien, art provided for by Section 1700 Of the Lahnr Gale, for the
perl'nm,wm of Ilia Work for which Nle pnnnil i.i,auul.
❑ih 1 11 l N k .0 ti l l I - Ily Secttn
37011 fll Co"F`nT al the, I1' h O' lani(I,
Cllr 4" 11 XIIh9 10 IB(l11\v(lNKrli o _
COMPENSATION INSURANCE
(Thiv secOm,need not be conpleavd If Ilia peon:,IN Time h.ndrad dollar
25100)fir law.)
I army Ona b1 the pcalinmince of the Work for Will dlis permit i.i„ucd,I
,hall not entroy any person in any manner,'m m"'aero'nnnielt to,h,Wn har,
Campcn.adnn laws of C10iromla.Da¢
APPlicml
NOTICH 9OAPPLICANT.ILu]I,,Voking,his Ccnifcale of Mac aPl ii,yon should
hemi,xahlem to the Werkin,Col npencolion pl-lain,Of the LahnrCode.Yon,nus,
�Oy mm,W;d,entaplyWith.nehVneldnn.o,til,pcmna,hWl hedeemcd honked.
4 CONSTRUCTION LENDING AGENCY
> I hemny affrn,I hat thin,le n c In,non lending ugcncy rortheperm„nano, -
W of the wo,k rnr Weill.,n,panni i,I..nN(Sea.3097,civ.C.)
A4Q Lcndc,'.Na ma
z, z Lender'.Acidic,,
V O I,miry(hilt I have all the applieafnn lmdsm¢Ilii thv aheve InI..nn,f it i, -
kT+' Cti cl meat.I agree rn comply 1 111 all city end cuunry omimmm,and.m(,lawn rclwing
L) mnuilding coo.m,ctloo,:md hembyaumolize rel,csn(alive.of this city to enten option
�. (y] Neohnvomendaned popery l'o,In,,c,flon Purpose..
L (Wel ng,wlo...,indemnily and keep lmnnla..the City of Cupn(oo agaiaa
VJ liulilli,iox,jadgmenlI.mut,an pens,,which n,my in any way aver.,ogean,aid
V City in ,at.cgncn,,of the gnus un I tS,permil.
APPLICANT UNDERSTANDS WILL WILL COMPLY WITH ALL NON-POINT IssUedb
SOU CE�UNIONS. {� y: Date
�—/Y—e ora
signal APPLc'HA nn� Owv Re-roofs
I{gyAI2U(lU5 MATERIALS DISCLOSURE
alar rile appfenn,e,Nla,e na ldingyKenp,ml.taro fir 1olmly ha.:wln
n,l, arelml Type of Roof
nl defiled by(hv cfip,nin)Municipal Code,Chalice,9,12,and the Ile,dlh and Safety
Code,Section 25532(0)^.
°vc, 0 N All roofs shall be inspected prior to any roofing material being installed.
Will,henpplicalnnrinttleInulthgneentien,a.e,Onipunal nI d„r.,.Wllieh If a roof is installed without first obtaining an inspection, I agree to remove
ath—dou,Dir m.;tz nnnI,a,d,r,ncd ny the Bey Arlt Air Quahly Mall......V,
.tri= all new materials for inspection. A Leant understands and will coo 1 with
F1 W, ❑Nn all non-point source regulations. PP P y
L�Icaa'U.I
ave mad the hazardous materiae rcyairemm�d ander Chopin,'h 95 of(he
Hw11h&Safely G,dq S,,nnns 255215,35533;rod 25594.1 undenwnd Ihal
dingdocsno,.lVVflly h,w,aeown,(hal i,i,Tyrc.pn.ihllip a,notify the
of the rcyni,w.. ...whi ,mu.I fie mG prior m....lance of a Cevifcarn Date
Signature ofApplicant,tah end„gens Da„ All roof coverings to be Class "6” or better
OFFICE