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00120031 (2) CITY OF CUPERTINO BUn.mnGBIVISION PERMIT CONTRACTOR INFORMATION: OI111.UING )DBL.'S; PERMIT NO. 001200311 ow',spR'S NAME: APPLICATION SUB DATE: 2 F - fnrlF_ 12/05/2000 IONS; SANITARY NO. CONTROL NO. O.0 ABCHI'I'I: :NGINIiCR: BUILDING PERMIT INFO kC F BLDG CI.CC'r PLUMB MECH Nab I_I I_I I_I I—i E. LICENSED CONTRACTOR'S DECLARATION >- 11mAb no mal l aa,licensed nader Job Description OZ_ Ya pmvixiona n(ChCode 9lcomn,eneise F_r,� wits S«dors lIXxB afOh;>ion3anne Bsmes and r,orew.mna arae,and n,yh«nae ax mwuh,reca f HOT TO HOT K :)am c CLiaa < Lica_ G a U Uulc_f z S DECI or — u3.0-� 41111 'S OI:CI.A rOM1 SH'ol I understand ity pians hall No meds public record. d Licensed Professional g r i pWNLR BUIL Dlilk OCCLSRAI'(ON G7 II Ly nilia(I g rh til In jr I.so :L wlmlb. g . S station u JI r.' acrd Any,awhir ts pc oa s he, p J I.h epair.Y baemm Brian t issuance. Leorcyu Ili applicant f h I t signed statement 3 (limn licensed P nail thev ors I rratt rcLis u Section 7 D s 3 fol 1 n d P o-Co1e) Sq. Ft. Floor Area tion ooh ...ad o tr.' h II l vs,rO,1 iryhr, •170 0 or Sa7on by any ma BsuImrndl oned.dhna,plirmlm a cvllornahy ormormore itin tee hundred donna ($s(an. APN Number Occupancy Type 0[.asminronheprnpeny.nrmyemployee.ximwage.naheir.nleeourpeir,shon, 3751 804 1 . 00 will do the work,and he structure is nal intended or offered far.ale(Sec.71W, - Hmine.s and Proree.imis Cade:rhe Ca rmamrw License I.aw docs not amply m an Required Inspections N pnmeny who bnikk or impn,vew me w,amt who doe.rael'walk himsdr or Through hew Own employees.prouded that such m improvecau are nm intended or 305 — FRAME offered]Or sale.If,however,the building or iniproven enl is old wimin ane year of 307 — I NSLII_FlT I ON completion,the owner-builder will have the burden of proving that he did not hard ar mpmvclarpurps,.cof.me.). 601 — ROOF TEAR OFF ❑L.,owne ofinepmpeny.:,mnxd...i.e comraeli„gwidruan.edeomnterorao 602 — ROOF PLYWOOD NAIL Lpmt ten rho project(Sat.7W4.Bu. mrd Prura.. s tale:)"Tc Con(metor'a cce,lawaansma apply man(wwrolr property wlin lands,or improve.menean. 603 — ROOF BATTENS and who contacts for such proj«rs widr a eammctar(.)Weaved prooem to the a ContemrsLicense,"%'. 604 — ROOF IN—PROGRESS 01 ant esenia Omer See. .B&P C Fortin,reason Owner Dane . WORKIN S COMPENSAI ION DECLARATION 1 hereby ulBr under pcmihy of PrOvi,one of the following declarations: jhave and will mainm'm a C.er iricate,Of Consent m self-in.urc for workers Cmnponmian, uw pmvidal ra by Scwioa 3701) a1rhe Labor Cade, tor the ' Perlia a;re orlhe work I'o,which Otis permit is i...ed. 01 have and will maintain Worker's Comry:n.olion Insumnce,as acquired by Section ]TIB of the lanor care,for the penin is nce of the work far which this permit is issued.lily Workerrrs Co/{ni,anssaattiiioon)�inwanae carver and Policy nuralar am: Currict t/�—T11f:LLA'll lIN()Ir li%�'A1 I'��O FROM9 ZN t�� COMPENSATION INSURANCE 32 Frus section neer not be completed if the permit is for one hundred dollars (Sla)nr lees.) I cun'dy rnul in the Imdommncc el me work Ga whish this peril is ..d,1 .hull n a lrPl iny I �o Ipa � keri Camps 1 I Cal a D a Apra { NOrICI C eft Ili n' f l7verrai i, ,in should nee, Ir theWorkers C P P rhea b Cm y rust ' O Innh .,nnlrwm.och P,dao,s or the prio�I shall be ducned evoked, Z2 E' cobs rRum[ON LcNDING AGENCY a I hereby aBir ohm there is a con.waion leading agency for the performance of the work far which this porn is hued(tie.3WO.Civ.C.) L A Lender's Name z Z Lender's Addree . U 0 1 ucnily that I have read this application and wum thin the aMxe infimnautor is la. [.. correct.I agree to comply with all city and county ordinances and state laws mlating 0 U to building construction,and herebyauthoriee representatives of this city to enter upon ry) he ubrvcmentioned property For inspection purposes. G (We)agree u,save.Indcmmry and keep harless lbs City nF ce"lin........i _ m rud,ili ic......ha nls,c,......d ex,row,,word,may It wry way u ni .....au said U z Cry in eonseyuen«el�ihc gnliag ollas wnnil. ' e.. c . APPLICANT UNI eOANDSAND.W CO PLY WITH ALL VON INT / Ca RI:OuI IO�NS/, �” Ir Issued by: Date �t7 rec; 47 all�'ar: .Or L Data Re-roofs IIA%ARDOUS MN]'[TRIALS DISCLOSURE Wdl me applicator hlmre hooding occaparu saom(it laradle haaadon.mmereal Type of Roof as defined by the Cupert))ino copal tele,Chapter 9.12.and the Health and Safely Code.Seaoon 25532(. 0 Yes `%No All roofs shall be inspected prior to any roofing material being installed. Will tire ahplienm(it hionebnlldbrgoccnPanluse eOrtpmenta,devlccwhich If a roof is installed without first obtaining an inspection, I agree to remove mil h:vnrdau.air connmwaQ\ re liner by rhe Buy Area Air Qouhty Man egen rat e)i.lrielo Ye, `,No all new materials for inspection. Applicant understands and will comply with all non-point source regulations. I nate read the Ira.ardnna mmeam..requirement.under Chapter 6,95 or me Cnliforniu Urchin&Snl'ety Core Scetione25505,25513wW 25534Iunrursl:nid Thal _ it he hording docs nal emnarly have a mmm�, len r iv my r,%Irrasihihiy n.notiry the e occupant("the reyuiremans which nrusl I prior m;seater of.Cuniricmc or °"apo°`y' f nature of Applicant ate � / )r All roof coverings to be Class "B" or better OFFICE