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00120008 (2) CITY OF CUPERTINO ` - -- `" ]BUILDING DIVISION PERMIT J '� CONTRACTOR INFORMATION;° BUIL DING ADDRESS: - e PERMIT NO .' 21-�'Z:�1�51��llGk! l�',• .flt.!:i!-i"i,t:' .ilaMl=S R(lfle=`t N(� Ih171t :�r7trnrnn ' . 1, OWNER'S NAME: •` • .. APPLICATION SUIT DArr PLOTTEL. GARY A. AND..CATHY G ' 4.01.7 'LAURELGI_EN CT1,2/04/2000 ' PHONE: SANITARY NO, CONTROL NO. } (1408) 723-2874 4 ' ' ARCHITECT/ENGINEER: "y - v BUILDING PERMIT INFO ' t�-�:❑ BLDG ELECT,(. ''PLUMB MECH <a LICENSED d a CONTRAC TOR in DECLARATION Job Descn tion Fz„� 1 he by ffrm I licensed d I i.' nes yrCbapt 9 nn,coc tng mhhs uyEm oe m force 1ySHAKETO 30 LB FELT, patw Iicnn - ' +. - E• Dat yj= Contractor q,��_[�1 _ Y 3°•m ARCHITECT'S DFCLARAT O 1 understand try Pr „tidinn J p bl I: i, uml Fie p O Licensed Poll O"ERLLDER DECI ARATION n i= I h yaffirm that I am exempt f [lie C t t 1' Law for the .' s ��S¢ toll g av n.tsar nA131'S,❑usine eP fsstnreCde Any,,lymetaty f F D wh b tamflovau permif t -vinumad,chat.r lmP -d m I''I -p' y crc n: ' prof t 1 y the applicantr I 'permit fl 'S Im d:etment that he ix licensed p I t thepu)—i f m c r l I L (c�pter9 Sq:Ft Floor Area ren b-'Ins I "70007 of 1 fib B : II f.. .calm ' - t , , Valuation or hot he iseeearmE r adth-basis fthe alleged e oulln An,violation _ _ $12000 or Section 7031.5 by any applicant for a permit subjects theepplicaut to it civil penalty orn l one meet Five famidied d.1lars($500) - APN Number - '. - Occupancy Type - •, . - 111.alo.eliol thepnpart,b'inyctmltl win,wagesasBrit solcconpetemmn, �'�5G�'.;094. 00 _ will 0 he k d the t t : t ineanded ,,offered l (Ses.7044, - "Btsair,, adP esti Cure: I hCimmuctmr,Liamo,La.does not applyt Required Inspections rp pony Whoh Ik p e d 'rd h 1 9 -workl' li - ' ,,,fhom,h his own employee,provided that tch:n,mm,cm t ,ol ,tended or 30511 —•'FRAME - offered for vale.If,however.the building or impnwemma is sold within one year of X7 INSULATION - completion,lheowneolaulder will have the burden of proving that ba did vol build or impmvefe,mPasem.1c.). ., 601 ROOF L ' - ' " - TEAR OFF ❑Vas owneroflhc property,am evclusivalYcomrund,with hccme ronhnaore m amt uI project S 7014 B .'t ss d l f . cod ) 11 C Imors 602 ROOF PLYWOOD NAIL . ice " I raapply no n ,er,rproperty l builds r op thence"' 603 — ROOF BATTENS ane h t t for such porects with ontmuor(s)l ,sed;purs,a,t to mo Contractor's License Law. . - - ` 604 —, ROOF IN-PROGRESS 1]1 am oxclnptradial sal. R h P C fo,Ihis reason _ ,. , ..• , - Owner Date - WORKER'SCOMPENSATIONDECLARAHON, I hereby alfin,tuderpren.11yorperimy( aart he fialloxi.,d f *•^ ' .e ° I have and will lnumnia ,C,udlente of Consent to elf-irranod for Wialecir's --Compensation,t Ib),ided in, by Scene. 1700 l dic Labor CodCodo, for )a. ' 1 pertaadaa�aoc mfmd workl hi,hthsr i is J r ^ - ElIh d 'll biaimaiaW A C.rhpancuion fies,romse.a,tenuredbyS t o v 9700 f the Lab.,Code In,the part' 1 I k for ishich this porm t© a ' 'ssud My Workers C pL/t hesitance carrier ant)Lal y number an. in PbIfivClurier..J./q/.LC I(! LXEM!'TION Fk�. (0 CRS COMPENSATION INSURANCE. ' rrh ern need not he en npleted ir the permit is for hundred dollars- - , - �•,J (S100)er I wnpl mat In the an in arwncerr the work far which this permit --v issued,1 _ - spall nm employ any person In any nwnncrsn;is m hccante subject m the WnFkces' s•'� Gnnpcnsation Lnwx of Cali[orniv.Data ' Applicant ` NOTICE Q� TOt oche NT R kl Sa t fl -pi n you should c s become hl theWorkers Can'pt nposisi at he Labor Colnurt Q forthwith It v'knnsor alis prsntelwll be Jiemul revoked. ^F CONSTRUCTION LENDING AGENCY t •t 1 b by which t d n it(Se, letd'Cr,6c,y f al p rnm,anee of 'Nto,ame hieh lh p t said(See,109].CAC) a � Limiters Name / t; y I„� Limiter',Address Icenfyto Ina Iall cry n� I PI meal b information _ - 0 Gr. U maned 1 agree to won,a with hereby city and,oem t curve, and style Io ca,,,,,p.n U mbullding cnnaWdion.anAyforanwhodre representatives ofthis city In m¢r neon " W thn ab c o rd d l P rely t and purposes [r d (Nig t nit lnxpe dA watch may City TCupertinoag'Inst _ n. y City t 1 e6 r t J expenses 1 nay in xvY y ga nst sail r r ,Z. City q sc ofineg DSA Dmlxp mt SOURCAREGUWRSTANDS AND WILL COMPLY WRH ALL NON POINT ._yam/ ©• soukc REcui}nvoN��l- - t, �y O� Issued by: �.C! � /� ` Date Signal Appucanuc ct Fir-'` Dene Re-roofs . HAZ DOUS MATERIALS DISCLOSURC it W II the.tppfcmt arlmorp huddin,oc,ulaintstoatrh II 1rzmeous material. Type of Roof to defined by me Copenlno Municipal Coda,Clmpmr912,and the Heafth and Safety, , Coda SojInat 255920)'!El Yes All roofs shall be inspected prior to any roofing material being installed. - ` Writ to alit ' future building' p ' qu'I n! -d which If a roof is installed without first obtaining an inspection, I agree t' remove •mitt I t t JI Ihy theBay Area Air QaltyManage mem _Emilio' all new materials for inspection. Applicant understands and will comply with . °Y °" all non-point source regulations. 11 dtl sh I narcosis q banner695 IhSadtyCa :255025513tnJ255rlrhc Clir t411t / ^ tha andin,does ancurrently e tenant,ei p Irl'he occupant of are, y ' pts hich enlist be tprior o'ssuofaCen fent . f ' - - omnp t y r Si ure,ofAppll t a- Date own numod,edm n - Dale I All roof coverings to'be Class .`B•' or better n ' OFFICE•: