00120118 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACT_OR INFORMATION:
BUILDINGA „ .+" PHRMITNO ,.
Ctj'(TONWOOD I)R EAST"MRN CONIRACTTI\l L;, 7'iVC 00720178
OWNFI25N h1', APPLICATION SUB DATE
1J.'9/2Q60
I V INGGOOD 1.41,8* DOUGI"AS ST - 12/7 9/2Q00
PHONE: - -- - SANITARY NO. ` CONTROL NO..(408) 9 -1—` 000
t
0 RCHIIEC I/ENGINEER: - "' _ ,BUILDING PERMIT INFO
a t�
of I "s, • BLT -ELECT-,' PLUMB MECH'
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Z S y (beach,
- LICENSED CONTRACIOk S DECLARATION . 706 Desarl tlOn ..
OZ ❑ II hY H Intl I' J J p : sof Chapter 9( me 'ng Description
Cyt with I 71HHI) fDivision' 3af lbeBu dPror . .0 1 ryl' - `
�x �. ai pnf and «el. Is SHANE TO• COME) ROOF''
,dC ,Lia mom, L M
cb g,� Dam I C t..at.,
ARCHIFECT S DECLARATION
0� 1 d .c 1 Illypl plane J M1I' J.
OWNER BUILDER front
(h ARAl10N
w I heathy 0- Out l pt f m Ih C I t f tb -
C ¢ I,hi q (Section]ITU5 Ensure, 1P f e C e Y an r ofny
x❑ ' h h t, p II e, n ,h p d 11 p nY.valre �( -
� I q he c,plicautI IIt its bwdCh I t _
mash with
n d p . nl Contractor iu � Cod 9 S Ft Floor Area ^�' alai 1 -
s
(awn g crucial
t "IOW] 1 e 3 'he H :' d Professions Cdr tI'. -' . �T -
nl t h e pl Ih f J tb h lot lse 11 g l pt A y b JYJ ')
of Se u0 7031.5 by y ppl¢co for p I h3 t.thepl Itcant m a I totally ,
er, -APN Number '�Qccupancy Type
❑1 f m property. ratty employers with 6 :their nP f
:sF197 t0?0, 00 JJf P:,
ill U thek and theI t Iintended offered for le(See,1614 - -
But .:and P f.. Code fn c 1 t r r I 1 t apply t - _ Required Inspecntions;.
rp p tv wl b II p _e me A ha
J n workn a 'a+ 30� FRAME
rthrough h'. pIY 'totaling' atht. h' P l: t' r td r
Be d to, cle.11 however the building or ounprouscrincon'. . Id wahir at year f • - 367 -- .INSULAfION .
saplCn,me owner hu mer w'd based nrdenafprtvng that he did not build or _ „ .'
mproveforpurpe.cafoilr.). 60 1 . ROOF' TEAR .OFF
01,al owner ofu property, 1v contracting withratn d iaCtnran 60 '' — ROOF':' PLYWOOD WTI..
Hco t t.th project(S 7044 B d Professions C b ),Th C unduat s
ite Lae .nTapplyl ofproperty wn houlds or jTdoesm n 603' — ROOF BATTENS
and H c t is f h p afters with a< r aunr(sl.l c d pair-live,a the '
c w 604 ROOF TN—PROGRESS
.OI nntnt",Sec. ',Bk PCfm misrc: n.
owner awe
W dPENSATION DECLARAINON - -
1
yr penu Yo p Jtry o,co gJ laradons, �. .
0 1 nava and will,maie,ain'a Crefficam of Consent m self-insuro for Wo,ker', e
coopeausatprovided tor by Section 37W f the Liter Code, for,the .
-rf e of(lie work fwhich this parentiIins W, r ] - -
01 not.and will nadroun Workle r Compensation Insurance,as acquired by Section 7�
3700 of the[,fiber Calc,for the per6rirunce of the work for which this permit is. -
ssueJ,My Worker's Compctvation I....ance wirier and Policy numbetvva: so
�Carrler: r Policy Nu.f- -
CERTIFICAT ION OF EXEMMON FROMWORKERS'
COMPENSATION INSURANCE „ , ,
(Thissutlon need not becompledul ifthe permit is parent hundeeddolntrs
($I Wry br I...
I certify but In be performance of the work for which this permit is Issues[,1
mull d pl y p r y o t l .ubjwt 1.me Workers ' r
CantinAir. „pSeL1 q__C1
APOIc I �9�..-rill
NOTICE 9CIA PLIC 1 pair. Ih' Celfl bf�xemptmn yrn sh Id4111 ,
bco II tt th W 1 rt pIf lnc Labor Code you must '
Q Q formwtth corply with such provision.or this crinif shall be deemed revoked. d'
.F ►
CONSTRUCTION LENUINO AGENCYy t
herchy df....[hit there is construction landing agency fnr the pe
rfomance
of the work for which m s pe idit I Issued(Sea 3097.Cie C)
Larder's Noone
Lender's Address, t r'
t t
V 0 1 certifyIn[Ihave read On, pd t d.late but ah.,"inforniction is '•
W �y
cooled.1.'ree,to ply with II tiny not county indoneence,.,ad cle Is,,chain, 1 - -
0V to building con,bactiou, adI by aund i,c re,refentinotolif do,all,doer,,upon
�y Tp] the above olenl coned pr P ray for inspectionpurposes.
�y ow (We)agree to .,I,andonard 1, ad keeph I..the ClY pCP r ga t3 t
fr Ln l shift 3 lg t t 1 p which ay in- my way accrue ritual load
City in consequence of the grunting of th is pernei t, k i s .
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL
/2 -IANON-POI
NT
su'ou kro0 , Ised6y �•- f Date
sgtt ati Date rOofs RD(US MATERIALS DISCLOSUkI
f ` ,
Will ihppliciiitorintbuildiiig«cupaiitstomorhuadihazEiMinornal `
a,dor eamr m c p rt o Mrmopsl tact_ cb'w 9 Iz,aha m tieahn ann sof ty, ..�'Pe of Roof
Coda S I 25s32(a) . • Is
❑Y T _ _ ,
- , All roofs shall be inspected prior to any roofing material being installed: �+
wd Je'v11 t l t e n iia g p r .t�q,pn I 1 lien If-'ainof is installed without first obtaining an inspectim ;I agree to remove
amitn aJov,a,camm�eral,a,def tedbytha Bay ArwArQualty,M.babemed, - t
Di.tritta - all new a, clil -materials foi`inspebtion. 'Applicant undefstaitds�and,will comply'with
°Y all non-point source regulations. +
Ila,readth hatleallail r,taliallyart,under Cl pt 695 Mlhe"
vhf" 11ahh&Saf tyCodc SoSelect,25505.25533and 25534.1 unallablandt1at al •`
-fille Idildingdoes not currentlyne t arent,that it Is Illy re,onsibilliyt really th
ccup t ofthe retry con eon whch must be do P,or,to tai e f a Certificate1
Octaipare - ignature fA t� '-' '.Date
f2 l 'moo .
neroraatneriae at Dade' AlLroof coverings to,be Class["B" or better . ` .
OFFICE
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