01040023 (2) - CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION �'', '
RUILDINGADORESS: .. - PERMIT NO.'
r-RANBERR01.04 =
OWNEIVS NAME: - " .APPLICATION SUR DAPF. '
04/06/2 01
ile PHONE'." - .•^a4 F :.* SANITARY NO. CONTROL NO.
ARCHITECUENGINF.ER:, - "`!4 BUILDING PERMIT INFO
t- ❑❑ �RLDG. IiLEC'I' 'PLUME MECH
�Ztt • 1=J IJ " �I
LICENSED CON'I'RACIOR S DECLARATION
ION
'zo In nyrr In.,I" two nma 1 P Icnm 9[emme g Job Description
O Z H Ow 1h1 s f 700 f roe Eu n and feu, nn - '
arealelax Once"` If $ a 2— INSTALL. ASHPHALS -SHINGUS
50,u Dale Chair
w 3µy RCHITECT'I D. L '
its .1 undenartd my , h 1 he reed s pu lie r ^ • i
w
�P O Lic I P t ssional e' 1 ',p." .. ••.
OWNER D
to I thereby"ff that I t pt front the C t h Urau Law for the _ -
foli 6 'urr(Station 703158 iae,,endI fr,,iwa,Cudu Any it,ia,ahrey -
4S0 .whiclir�(jpernii[tocoiisit,i,il1 cJcn l'.h xrcparany s,...one
ie Ow
prion to hs statute.also neonatesthe'rrl t for seenp n to filea sitirsd strarthent p
mall I' :rdp n x" lh p fd C t I rsL n. La (Chapler9 - Sq. Fr. Floor Area Valuation
-fcomnenunywm Section 7000),4D'vtsot Jof me Bud te. rdPnressl°ns Code) - ,
or llnho,,teserriptilhorefinno undflu,basis'for Ih lli yt An,vel don' , -+ ' -
o1'Section 7031.5 by any ipplitathefor a ,rnut subjectsmeapll'applicant Ity _
nr I atnre men I ee.n L rd dollars($500). ! APN Number Occupancyype -
❑I,it,owner°f0rpn,prny,or ni',wrdr,eo,Cvilb wages as mdr xnlc a,mPensmian. - _ 'will d (lie k and the structuret intended or offered for sale(S 7044 -:3620A048arRuaine. I Prore"nur,Code I lue Canni.......cr " rapply loan, a Required,Inspections _
fP prty Whobuilds pr cth i h d I kl-n.ell _
orIn aid,his own eanna.,o..lIhiiodidiol. ,h" p t fit Idnr - ,305" — _F'RANE e
offered for: If,he m h ld ng " ,prow neat sold :Inn one year of - =,
throweta ll d I M1tva,he ba Nenof r t
teav'ngA ,n a{ nlhnnenr 307. — I"NSLILAT'LON "
"tnp el I ,P f I J: '
,01w nn n any.ho exclusively g Iy mi a t amsm ` .601 ROOF TEAR-
,OFF.
roan, hm p i tSet 044,marr dP .I . :Code) rC h cher', 602 ROOF F'l_Yld00D NAZI_
L,,.,e e 1 aw Laos t n etpl>m no owner I pre piny wb°hadds r'mprrves m
,hcon,
and who corhawla
pfor such poecti with Itexed furter,lhe
Co t :C se 1' 603 ROOF BATTENS
0 l mit exemt hurter -
"
See:. ,R&P C for this reason 604 ''-: RQOF IN—PROGRESS .
owner Dalca' _ ° _ •.
WORKERS COMPENSATION DECLARATION`
I hereby offd ish.any Of'I'I'Lloy one ofah follow in,d edeffelithoo '
❑ 11 re andw'it] , urn a Cenificane of Consent ¢ dUnt,hre har WLrs ''
Cihnfro,atunt or provided f by Se,fi.0 3700 or the Labor Cede, for he
wrortranee ofah a k for whichthis 1wrinit,N issued. / C
t ❑ d II ,
h o, k C p t ales mite dhySimon
6�
3'10000 I d Lob Code,to,the prularano,o of tire work f n I m. per a is ^ ��
Iv'no yW kers G}��fp :I nlnmru P
y
e olymt-hcr�
yr V P°IaNor�
CURTIFICA'HON I L N FROM1WORKCRS'
COMPENSATION INSURANCE -
(Thi.,,flan need not he completed if the foa nit is for ane hundred dollars a e l
't$ulO)ar
1 ectufy that in the pedormimee of the work for which This penult Is issued,I _
shell nor motley any person in any nmarn, ,,as to heeamc xrbjml in tire Workers' - - -
Coro,ionaturno Le,vsofC 11 na.Dl e
" AEfl ei t,
NO'I ICH 1'0 APPLICANC If.aper Irking,n a Cent erre of E,whra on you should - ^
h-on"cub)em l,, INWorker Cton"ohistio.p of the Labor Code,you mus,
Q.O fonhwitb war ply with nel,in rv'xtons or h x onion,sort be dee ned revoked -
r
aZI a U
E+ ws CONSere is.,[ON LENDING AGF.NCV
IkI,, worm the,percixs wated Sue, 0d' ,hereby -
n ,n e 4nhw edrtmenrn
gager y
icy
of Leader's
work one wh,ch the Prrtnu s ssurd(Sm.3097,Civ.CJ
dl Q Lender's Name _ • -
zi.Z Lender Address
V 1 io,fify(but Ilarveread flu,a,,hr,l a end mahehat the abovetf nl "
W. um.dI. y t ply th511dy ty d' and Into s relating
C.)
I,,wakfir, ormflinirand thereby onflun IZO rearfrut;Ltiios of,hsety to enter upon _k
it-herbaria, ody fin,in"et,florppurpose, Is .t. ,• ..
r)tereetu na'o'radionaryandkeep fo nstheCItY f Cupertinoagainst _ -
V z -,y hma s h es Ifrn Y n my y agwinsr.e'J
wRe gef I permit. 7
APPL[C ER$ DS LC., ^nfPLY WITHALI P(fINT
Issued by: Date
nppbcumdlon n +Oahu
'Re-roofs
- DOGS MATERIALS DISCLOSURE f _ _ x • ,.
Will tl pplke h None b'Id g°culaint sr000rlandleh : d ai ml Type of Roof
CodeI ned by Ihn 32(n)" ,Me 11 Nol Crdq Chwpmr9 12 and the Ilealth e ttl Safely
' Crdc,section 25532(N" - ' e • . . - �'
°'Y` °No 'Allroofs shall be inspected prior to any roofing material being:installed. a•_
Will mea plicwm nr lar ohulldingnem,pmnuse eq°innem nP devices which .
Ip roof is installed without first obtainin ah inspection,l a ree to remove"
emith d ,. td na'e:dr dbyt Bey Air Quality ,. g P g
�'�e' h all n ,materials for inspection. Applicant understands and will comply with
°Y °N all non rce 7
ad be h 1 "hednl 4 t. d Ch fr 9t f the
Cvlif f,yL 25505255E a,o 2omit 1 d 13ths
a n ' re. Irytr hgn tll rsny p bIt h I
cera e
it
wka. m pr opto ss ralaLen' cme of
- n e ane -
a,0, 0 na re of•Applica .' `, Date, ^
er ,amar.ed,;• - - " Dehp. All roof coverings+to be Class "B"or better
t'
.