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
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IJ IBJI
LICENSED CONTRACTOR'S DECLARATION - - "t, '". f - •" Job Description
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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
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SHAE JO TILF
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(' 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
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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 . .