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00100083 (2) ` CITY OF"CUPERTINO ' BUILDING nrvts1oN, PERMIT CONTRACTOR INFORMATION: B UI LDIN(7ADDRESS • PERMITNO° 001,00083, .. 21523.CONRADIA 'CT ,fir• OWNERIS NAME:.' - APPLICA'I']ON Sjfle/AI].1.12000 ' BE : NTO'.RICHARD A ;ET AL . f ONE: - ' - - r SANITARY NO. CONTROL:NO. t BUILDING PERMIT INFO ' wARCHITECTIENGINEER:E - ', BI ,F.LIiC uI ;' PLUMB MECH Z car IJ IBJI LICENSED CONTRACTOR'S DECLARATION - - "t, '". f - •" Job Description Oz Bk a ion ,eIhereby f mtl .I" life .adI,t d ap of Charter 7J( tmc g Im omnfl neB,l IP f car all force t � 3 SHAE JO TILF a .., (' Date am., 3 LL y ARCHITECT'S DECLARATION a6c0 Lc dP fal l Y PJ n y ' OWNER BUILDER DECLARATION uu�3 Ibanally affinnE.I a,.Sinclairf the Contractor's License Law for thef- _ rdl g .(S t 70915 13 .' d Por .Code Any all my +�q . + 0 wInch mspermit I trrat,after, p demolish,h repair any,Ifinumomy„+ nem put of I" I' 9 thea"Incentf h panniftu II 'inhi'talement 5555 that ho fi,milpnovart (he P 10 C t t L mfc (Chapter 9 ,S Ft FIOOr-Area f ,f 'cW I •Val4ajigeo Ica g "tin ,I(he fU . 3 of the B dP f: .Cd) 9' .tsl nr th h pt therefrom d tl b t the II 6e I pl A Y t k{�'+, - +.. Station 703151y a ny applicantf permit bl is the upplietato l penally - P .r of not than 1 hundred dollars($500) I J v APN 17e F p Rip Occupancy Type, ❑L a,nwnaof the rt In with we pen.Inch. "� a pn th Yr my y , resatthe r,t l£c rn ton „f. ill do mwork.and m I t hircrided or offeredrr Shia I(Sea 7014 ' Bt s c on Professions Code 're,Contractor's License Law e, t applyt ' red e OHS wI 'll ' e , 3] orh gh his pit provided four Such improvements tt intended - •F'FRM"I£! IC . I ,rm r sale.If,however m building nrnether)noQS7 `, Nr' l . ., r completion,thewerM1dd idh' the tanker fp gd1eddnlbldr ' improverfpumoaeof:t ). 5'01 '—n ROOF, } OFF' "ol 'n - rm p rear lycontracting still,license le I 'I t ° 602 - ROOF fie}' WDOD *1 ,I f on.v t the project(Sec,9044 a d P f s Coach-The C I a construct Law doe,hota,plytoattwa,,ifprilar,whn but ld.- r,imp mx.'theru - 603' = ROOF 'W ITTENS �'." , and net r h p ) f,with a contractor(s)1 el pursuant t the ' 't ' GVt4s — ROOF. ,IN—pROGP C9nl' L'' L - xYT 0 are exempt undat$a 13&If C in,this re ' yIs y� aOw th, " - .. Our _ u WORKER'S COMPENSATION DECLARATION ` s , .10 Ib by ff d penalty fP yn or he f II w ,d I I ' :. " k A•"fy t 7�1 h -'ll ', C ri m am of Consent to If f Wnrknr, Grmp :tias prolnified for by Section 3700 of the Labor Cal I the - ,a roarmance ofth k for Muchtl .p I is iSsued, r ❑ J 'll t Work,,',Cmpca I q ' dl Sc, n SO 3'!0000 ofth Lh ann 1 the,' f na onthe c3i k for Is �.I,I,chIF'p ml's ' ss J Wpp ka,,c p I I wm /p_1 V ;,,a _. Cute" P` .Pot icy No.:—I _ "t 0 O CERT IFICN ION OF.EXEMPTION FROM WORKERS - COMPENSATION INSURANCE (Thi,section need our be wnplcted if the pennh is Rif one hundred dollars .1 eenify tint In the purUrmance ofthe work�for which'his permit IS ameil,I Sandi)rat nmploy any parson in any maturer,o mem became subject to the Workers' fn Compen erma,Laws of Cabouria.Date 6 Applarant NOTICE TO APPIICAN I If, ft making this Cenificale ofFx pl' yea.ht1d z become subjectl the Workers Compensation provikimps(ifth Labor Code,YOL,latest Q O forth 'lh comply with inch provisions Of this PaTuall''I Il be dearied mI F 'ff CONSTRUCTION LENDING Aft NCY r ^ s • ♦ - ' a 4 I h r hyIhat h .t ion lending age,to,the p rfor n. - I - (if the work for which this permit I,It,t al(Sec.3097 C I,C) t {Ta Lenders Name - r Lenders Address I certify[hit(I have mad[his application and cremeat,le,iaeacullornalli n n, - 4 •W iGl"ti am n I agree in conappewith all city and county ovfid start,laws holding t0 V It,holding caratineclum,andl by authorize reparseartatis , 'thee cityl enarupon ) W the aawe-claritionedproperty tP i p T - . LL (W)agreet .a nd nl my oink ph I . IIecay orcr,ainhost - r V]' liabdl Jdg r co,P Oil expanses whieff may et any way le,ema again:Said (J iZl City of Ihegmm ng of this p I -- APPLICANT UNDERSTANDS AND WILL COMPLY,WITH ALL NONPOIN CiT' . Vin• / SOURCE REGULATIONS Issued by Dat/ •Sigwntre of ApplicaMDinen .• HAZARDOUS MATDISCLOSURE Re-roofsWill the applicant "r t building occup.a m handle 1 omni a,aal al ' Type of Roof an defined by the Cupful 6Moric pnl Code Chapter 9.12,and the Health and S fety _, •n - Code, SectioO Yen 25532(n)'. ❑No r .. t• `f - - „ •, 'All roofs shall,be'inspected prior toany'-roofing ma`,terial being installed. `- Will Ihc'appdcum Or future occupant a,, dripmento,de,ice,which 'If a roof is installed without first obtaining an inspection, f 6gree to remove emit hazardous air corearinunl,as defined by the Buy Area Air Quality Management D....let I '-, all new materials for inspection: Applicant understands and'will comply with °fm °N" :I. all non-point souirce.regulations: 1 have e' 1 rldme,m', tt radar Chapter 695 t ll _ Cliblorms H h1 &Snf yC d SOction,25505,25533ard25534 f rude ,Standth't o .4 if the lauldirigJ e. I cut readyha' tenant,that it' yresponsibility t fully file oce"Prall0theruryre ens which fluSth et prion)issuance of a Cerificato a1' Occupancy.. ' Signature,ofApplicant ` •Date• r , s own a m dzea ager,_ - • Dam . 'AllDoof-,rcoverings to be Class"B"or better :y• ' - - OFFICE . .