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01050177 (2) CITY OF . CUPERTINO 'BUILDING DIVISION CONTRACTOR INFORM F01054177 BUILDIIN/G�ADDRESSi PERMIT NO - � ��� C..UIV 2U . ,��ah•!-m3' k.;^ rY�"u�N'.G'".G7`«f�.rJj/.r.�C'r.�/"u-'S��1'' , OWNER'S NAME: ' ' ,y, APPLICATION SUB HATE. . Y +I U jos a63 PHONE; - SANITARY NO - - CONTROL NO. ' s W' L❑i'00 ARCHITECT/F.NGINEER: - a BUILDING PERMIT INFO T P E d •BLDG " ELECT MECH Z t, 1-1 �I 1_1 1-, i1CFNSFO CONTRACTOR'S DECLAR14ION ,a PEMOV.E y'„F ' 9 y. I hereby offirren yI�I am licensed unde 77 sacl/0l p3l 9(rourneweed, I: aozEI ihS NEW ,nll^F'EeTQ'ET” P u Is 1 III ff . Class Lac kVale Connector ARCHITECT 5 DECLARATION wv�yy�� es d YVI .I Iln _ e I bl' J OW NCR BUILDER DECLARATION /O e h hl fl II 1 train n 11 r thet io 1 L' Law 1 the LLL which 'g (S 1 7(RIBusinessdP f:' .Cdl Any an r Ie ❑ wh h l p 1 I trial. p 1 1 n p any , in pr i t 1 .❑ ppl If hp It fl y d.Wl and ' -555 mmn .I dp pursuant 16 th provisions nn c t , License La (Chapter 9 Sq. Ft:'.PloonArea - � 1IUal I , (con..eneng withSel 7000) fD' 3 of(he R dP f: :CraI - or th l h ,v pt lh -f d the ". M1 f the alleged Vf .Any v ds, a ♦ '` �^ Sectionof �any applicant for a or of I morc� 5'ban h ndred dallars($500) t. hi d;the ppl' a dvil'p penalty - APN' h ^` FStJLt1 B4.J Occupancy,Type. '°1,as owarror the Properly,or my mnploycer with wages as a,alrsnle...ln oe,dimr, T will do the weak, ,ad dre structurer manded ,,off e for a (Sea 7104 p st $, - Bu. " d Profession,t C d Th C n1 ', 1' L e pply m an L QI 1,tp"'i,,FOi) llfd}I€(I.Q115�JectIODS . "- ow fproperty Whobid. improve,Ih d J 1 kti..salt '^ rm 'ghn: plv .p aaort,aah imp rme t mendedor f 1,0;3 .. PJ ERG idle,oder ' If,h over,the bully ag, r npnof mv' Id within one your o1 t' ' rler n m owner nu warty"u h..emenamen ofv ovi gll,find be didam buena' !".103 _L1rER,y mpr r t mrI ), - Ir. , r g 'e r n:J t �t A'—vl04w -f.REHAR� r c, t l e , t p (s 9044Business der c e i Th cu, e ';.AJ;IOHORa BOIrTS t - conduct Case does not apply in r property n n I N or imposes mercom d whso,cvantforh p jects with a anI wn.(.7 r 1 p . nn1 t me .n it�fx, SEWER. .8 .WATER] 't C t dances License a La - '°°I m xa,nplandar$a B&Pcfor ntis' awoa. -e, �'.. 20e^.-, = UNDERFLL)OR.F!LUMB,1.NGj:,, ownar - Dale ` F,1 r'03%,�^- .IJf nbE-'RFLOOR.,,,MECFIAN,I:CAb_+,waI,; - ' WORKER'S COMPENSATION DECLARATION t ,u: ws1:1ND.E'RF L00,R1y,;R9ME'Sy,✓j ' I heby at d N rally f ry f the following 1 1 al : 1,o205 e UhIDERFLOCR .,T,NSULATTONr�i ° 1 have oil will rrairdlij, ' C fRl fC am:If' for Worker Compensation as-d...;aw for by searon 37Bthe Labor eae, for, be c. vUCH ,W11IMHiT'Nh , peffmaraireeat the work fur whch did. . i,lslsnued, _ n c40, xrA TLIHr & ORa,'SWOWFR4e*l+, ., °il et I r" w kf c npansarua[nsuran y " dbyscti,n, r. ' ?f(I , - RQULRWx�MECWAN,I„CALz�.- -, 3700 of the Labor Code,for the worn neoea of the work for which this permit is _ issued. lrwnrke.,ca paraaagm,aran,eaarrarandrnrner Policy are: p 04ryrr§Rf141GRd;ELFCTCR.I,CAL..^4 Carrier "eofir,M - t „054.1 'r•FRAM&'r . CERTIFICATION OF EXEMPTION FROM WORKERS' . . e - r COMPENSAl10N INSt1RANCF. \' ..�Pk IZIFi F�k. WCI,.DJ.I(aINC�v� (Th' -act need nm be cont Icled if the l s for ona hundree Jnll ;o a - .($Hunnne.,..l p °`nn +�.ve.n0axr-,W.TTNS,UUAT�[:Or N2r, w�48, SWEE;fRCC1' fyml atopc,f rma,o orlfor which this pe tales dl � E �TER,1'ORzI AT S C,hallt npl r r p serum,aobject t .n worker, tt�309 W - :'t f tC II Date ^ Applicant Ap - ,x14 SNTFRT�R I ATW . a >"..' NOTICE TO APPLICANT It, ftreadinglh Crouton, rE Y h Id z, he m n m w h 'ate Lhon-rC J r .t r!'; 51„1r_ $f'RRTI Hart"Itlf�Tw,. _ hannwitn comply with such provisions n this permit aban be d - w Evoked. 4 - CONSTRUCTION LENDINCAGENCY w'aIh .by H th tth I. I leading ons, thaperforn tr,. ; " t`�-stT' 54nt w' 'F�IIVfraL,-ELEGTRICAL.�SiE'NERGY;i ly p ' i��e work eru a�,e holo prat ais"natd(set San,e"..ei 50cta:�r FdTNRLiPLUH&I NG.,ENERGY ,.,-46 Vz0 IzJ :Aae . 7'S47rx FxTNRI W I ' 504„, INfal-�+,MHFt MI A1)NS,NTGG AIE.N_EFNREf�YRpGt�Y nrrmlt I '1 anconsb cir information 'IT Wien11 g it,comply with all city and couirfy ordinancev atfw, relating � "vM. . ;O r� tobuilding con,arection.unit he by authorize I nTi e. flhis city m enm upon �_ be b tent dpull f p 1 tl * . 5fD5i , +t+FINAL-1; ELEC7IRSCRL,{r.;,. . LF. 51 .nanite', dg rae tt .t Id ry dknpn may inlnnywayaCity of ct,ardu againsro °aidjr(�AR TE9I 1 v 7a Cita sey,aaaeoftn g.m,agorthis Perit f'ft5(�7 „FINRIp PI+UM$;I�NG : APPLICANT UNDERSTANDS AND.WILL COMPLY WITH ALL NON-POINT Ia I� SOURCE REGULATIONS Issued by: ,; _ ., rzzw C Signature ofApprc'INc t ,dur Data Re-roofs 54kOo w^FI p �gty - ' HALARDOUSM\TCRIAIS DISCLOSURE "C.^n,. weln ppl a I f n n' a , I x rh el n m material ' Type of Roofr 1511L1, ,r Ftil Rl(t1L F'LANN�I ISI t,�v - as J f d who C pe I M pal Code,Chapter Y 12,and the Health anJ Safely i v :°Si514,I- T.Ful NALpL1HLNIC'fW�RF,Ss,?ka„y Core.S d w o C.pa) °v c No All roofs Q,lge'inspected prior to any roofing materia] being'installed. Will to applicant t maturing secapa,l use eyu p t d s which If a roof is installed without first obtaining an in I agree to remove ..I ha d t - 1. d C d by the Bny Area A Quality M nagemenl _ - ' Dol I all new materials for.inspecih Applicant understands and will comply with' °Y' °M1 all non-point source regulations. 1 have d the hea/midutis materials requirements under Chapter 695 of lhc, 'r s t Cal"fo H ITh&Safety Code,Sections 25505 25533 d 25534 1 Ind 't d thdt ' if the-'capital obuilding d t um which tenant,e ,air , . y rc p of a to Cor cat the oOcc p' 1 of requ'r t wh ch must n ,al pr nr to'ss a of a een'rcate of ���•C� " "'� Signature of ApplicanC� 1' Date - - Z All roof.coverings to be Class "B”or better ow II ad..ea agent � - Data - - - - OFFICE� -