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00060144 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: 00j'©i BUIIAANG ADDRI PIiRMI'I'No 2'0' /o Lei- DINER'S NAME!: I'PLICAIRoZ/V Sly t UA'IE 4/ A YI �4LL Sl F i��7;Le2E� ��''Js is/G /0 Ill I e-4 LO rnjj ) SANITARY No. C(YVIRM No. (, 'ARCIII'I'ECT/ENGINEER: PlION1!a ///��r BU I IDI NG PERM I'1'I N P(1 4�w / -3&f,- 3(`_ 02 BLDG ELIC' PLUM I Wl Cl GKZ Y w INSPECTIONS DATE INSPEC. 'I'O ARRANGE INSPECTION .1011 DESCRIPTION CALL 777-3228 MONDAY-FRIDAY 24 HOURS RESIDEMI'IAL: Gan BEFORE REQUIRED INSPECTION.JOB ADDRESS p SFDlL ❑ KI'T'CHEN REMOD131. H i FOUNDATION/PIERS/ILD,S. AND PERMIT BARE NEEDED WHEN PHONING. [I ADDITION ❑PLUMBING Rh,PIPIT o — Ul?R GROUND F=C O MULTI-UNIT ❑S'I'RUC'I'ORAL =mss¢ PAD/SET BACK-CERT RESIDENTIAL_COMMERCIAL._OTII17R MOIJIFICA'I'ION F GARAGE;$LABS/PREGUNITE RDO INTERIOR ❑CHIMNEY REPAIR HALI0Iji1_IRF;'IRF.p Caoj ABOVE HAS ❑ SWIhIMING POOLS FOUR NO CONCRETECONCRETE11N'I'II,ABOVE BEEN SIGNED ❑ BATH RIiMOUEVRIiPAIR O DI3MOLI'I'ION as UNDERGROUND/SLAB ❑ YE IIye:-Imulenlund Ih:nxClangAndm%emhlyi>mjuimd. ❑ oAprrHEE/R ^' m PLUMBING NO Initial LC.B.O.p ELECTRICAL COMMERCIAL,: i 3$ DO NOT POOR FLOOR UNTIL ABOVE HAS BEEN SIGNED EXISTING ROOF COVERING p NEW BLDG/ADDITION ❑ DGS10LI170N PLUMBING Numhcr nl ❑ TENANT El FOOD SERVICE MECHANICAL 'existing coverings IMPROV I:MFN'I' ELECTRICAI. 'Ila be renun'ed- 'Ib be n:Iamed ❑ O'T'HER FRAMING VENTS INSULATION PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED TYPE OF ROOF COVERING ROOF SHEATIVDIAPHRAM ECIS'I'ING> PROPOSED: PLUMBING ❑ Buill-Up Ronl ❑ Bulh-Up lion( , / TUBS&SHOWER PAN ClAspholl Shingle 'X A.sphL7uh Shingles ID MECHANICAL. Wood Shakes ❑ Wax(Shaken ELF.C'1'RICAIA'OOL BOND ❑ WuoJ Shingle,, ❑ Wuod Shingles FRAMING/STAIRS/E.EGRESS ❑ (')the,(Speedy) ❑ Olher(Specil'y) • INSULATION/VENTILA'I'ION Provide I.C.B.O.Report No. COVER NO WORK UNTIL A130VI:HAS BEEN SIGNED Provide Mfgr.Insmllalion Specs. EXTFRIAL SHEAR/1{OLD DOWN INTERIOR SHEAR/HOLD DOWN INSPECTION SPECIAL. INSPECTION REQUIRED ElDATE INSP SUEFTROCK/SIIEETROCK SHEAR Ex ITRIOR LA'I'N/%V-SCREED SHOWER LArH NO TAPE.OR PLASTER IINTILABOVE IIAS BEEN SIGNED SCRATCH COAT SEWER/WATER TEMPORARY APPROVALS OCCUPANCY FINALS z PLANNING 777-3308 z O GAS TEST F GRADE(P.W.777-3354) Y > FIRE g L C HANDICAP Uz U O fiLliC'I'RICAI. O F PCUMBING 4Us' MECHANICAL. r h ENERGY U 7_ VISUAL FINAL ONLY BUILDING OCCUPANCY OF BUILDING IS NOT PF.RMI'M UNTIL BUILDING FINAL.IS SIGNED BY BUILDING INSPECTOR. CERTIFICATE OF OCCUPANCY❑ I'RE-INSPHC'I'ION: PLYWOOD: IN-PROGRESS INSP. DATE INSP. ' ( L GAIT I" INSP. C C-- DA'I'S '1'FAR OFF INSPECTION: BATTENS: FINAL: 1,31�0 -� 7l/L�n7C INse �J-� DATE�1INse Dan: wsP,_ Derr: NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION CITY OF CUPERTINO - nuu.DlNc mvlsloN PERMIT CONTRACTOR INFORVdATION; 00 (�j'I� BUILDINGADD;1S3 Ey.. Q� PF.RMITNO, 2� l� Z-i OWNER'S NAME / ` API'LICAETI St' HONE: /! �fJ 42?1,P-4 L•t�L.r7� yJI SANITARYNO, CONTROL NO. s c E, a_�.F c a 2�og ARCHITECT/ENGINeLR: PHONEp BUILDINGPERhIIF INFO BI.DG ELECT' PLUMB MEE711 00O m— INSPECTIONS': . }�; 5-` DATE' INSPEC TO ARRANGE INSPECTION ,JOB DESCRIPTION au�i CALL 777-3228 MONDAY-FRIDAY 24 HOURS `ITIAL: Kn a u BEFORE REQUIRED INSPECTION.JOB ADDRESS 0 SFDWID y i FOUNDATION/PIERS/H.D.S.'} O A DWL G KITCHEN RF-PIPE z y AND PERMIT ARE NEEDED WHEN PHONING. G ADDITION ❑PLUMBING RI>PIPE Fa=r UFER GROUND ❑ MUL9'1-UNIT ❑S"TRUCTURAI. a'e z j PAD/SET BACK-CERT MODIFICATION pz a RESIDEM'IAL_COMMERCIAL_OTHER_ O`u GARAGE SLABS/PREGUNITEII\ AItUOUS FIRE AREA O INTERIOR G CHIMNEY REPAIR g .� I }� -'POUR'NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED IMPROVEMENT a SWIMMING PUOL° a< OYES If 1nnJercmnJ IhnluClmsA mnFa...enml J G BATH REMODEL/REPAIRG DEMOLITION a 6 p p UNDERGROUND/SLAB ,�. y n reynive . G OTHER PLUMBING ¢ ELECTRICAL NO hlitial LC.B.O.M p,�. COMMERCIAL: i 3_ :DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED EXISTING ROOF COVERINf. C NEW BLDG/ADDITION ❑ DEMOLITION PLUMBING G TENANT G FOODSERVICE MECHANICAL Number of cxirting mvcrings IMPROVEMENT ELECTRICAL To be rcmovcd To be orwined G GTFIER FRAMING VENTS INSULATION PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED TYPE OF ROOF COVERING ROOF SHEATH/DIAPHRAM `(IC'1'ING: PROPOSED: PLUMBING G BLIN-Up RnoF G Built-Up Roo( TUBS&SHOWER PAN G Asphalt Shingles X Asphalt Shingles &,eA r . MECHANICAL Woad Shakcs G Wood Shakes ELECTRICAIJPOOL BOND G Wood Shingles G Wood Shingles °RAMINGISTAIRS/E.EGIt ESS G Other(Specify) G Othcr(Specily) INSULATION/VENTILATION Provide I.C.B.O.Rcpoa No. COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED Provide MI'gr.Installation Specs. EXTF.RIAL SHEAR/HOLD DOWN INTERIOR SHEARIHOLD DOWN SHEETROCK/SHEETROCK SHEAR INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE 1?ISI' EXTERIOR LATH1W-SCREED SHOWER LATH NO TAPE OR PLASTER UNTIL ABOVE.HAS BEEN SIGNED SCRATCH COAT - SEWER/WATER TEMPORARY APPROVALS OCCUPANCY 11000 FINALS Z PLANNING 777-3308 O O GAS TEST UO GRADE(JEW 777-3354) C FIRE p. HANDICAP (_) ELECTRICAL O F PLUMBING U MECHANICAL U ENERGY U Z VISUAL FINAL ONLY BUILDING OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. CERTIFICATE OF OCCUPANCY❑ PLYWOOD: IN-PROGRESS PRE-INSPECTION: C INSP. DATE INSP. DATE/`H \, INSP. DATE TEAR OFF INSPECTION: / BATTENS: FINAL: —J DAT G"- 1 DATE//,1 /•.�°. INSP. `�<-/ / 3� -) INSP. DATE INSP. �.1 NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE. PROVIDED FOR INSPECTION _ POS IIbI CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDINGADDRP_SS: 'fiRMll'NO 20103 LA RODA CT SIGNATURE ROOFING IN 00060144 y OWNER'S NA MG: APPLICATION: 11D4! GALLI JAMES G AND CAROL 1190 MIRA LOMA WAY 0�/�� /2000 'NONE SANI'T'ARY NO. CONTROL No (800) 644-7410 Q O zo ARCHITECT/ENGINRER: BUILDING I'r;IN11'I'INFO LDG BELECT PLUMB MUCH Z'Jz LICENSED CONTRACTOR'S DECLARATION Job Description l2 o I hereby a1Erm mat 1 an,reared under prorisinnc n(Cramer 9(cummaoing p r^mF-;Ji with Scetinn 7IXNp al Divisionrill he llunine,,and Poowie.,Cade.nndmy license art S,fJ infaur,rccodellie', REPLACE SHANE ROOF WITH 1/cCDX AND 40 —00 u License Class Lia.tr Dam Contractor S u N ARCH TfEC .1 DECLARATION C 1 undasumol my plan, I ba uveal as prml,,,e,L rd, of aC ILicensed Profeaiool e mOWNER-BUILDER DECLARATION I archy aflinn that 1 hill exerrt hon,the Cnmraemrs License Law for the C following rcaam.Swum 7031.5.Buxinos and Potessioi Code:Any airy or county ' which mmar,.pe it t,,conanor.der. p dennualid,our,mir any upoplaril i 3 m Prior in if, also rv, thepplwirtf Leh pcnot file so,madolarmanno m,th Ipu t d f ,of the( t t :i I (Chiper9 Sq..Ft. Floor Area V�•1I❑y$Lt at�❑ temnmenny with Section 711W1 of Or 3,f the lb,n„ oand Indo„gas Code) or that he is exempt therefrom and the reads for the alleged exemption.Any violation of section 7031.5 by any applicant for a rymilit subjects me applicant o a civil Penalty or not more thie,live nurdmd douars($500). APN Number Occupancy Type OLasowncronheproperty.ormyemployees with u twilicirsole con,vo tion, 36934031. 00 will do the woA.and the.structure is not intended or offered for sale(Sec.7044. Basila.,and Profr m.,Code:The Gmractors License Law doe..not rpply to an Reg�ired Inspections w r of pry Who brad,or uproar,menta,.and wbn ,s doruch work him ll 305 — FRAME ' n thoperough his own employee,.provided that such improvement,am not intended or offered for sale.If,h,mever,the holding or improvement i,sold within ora year of 307 — INSULATION nn,pleion,the owner-hui de,will have the hander of proving that he did not build or ,rep oe lot parpo..of sale., 601 — ROOF TEAR OFF 01.as owner onnepm,arty.amc.cw,ieclycontmcdnswitnlicensed cotnmeorsto 602 — ROOF PLYWOOD NAIL caramel the project(Sec.70,14.Business and Professions Cud,)The Contractor's Liecn,a Law doe.,not apply man owner of pmpctty who build,or improves merdm, 603 — ROOF BATTENS Commeto„�u"ensemyNurn project,wnM1 a anmmero ,) Iian.ea pursuant m me 604 — 'ROOF IN—PROGRESS ❑1 am exempt order Sec. .B&P C for this rector ' (lone Date WORKER'S COMPENSATION IIECLARAI'[ON I hereby affirm ander penalty of perjury one et the following declamttons: - ] 1 have and will muinmin a Certificate of Commit to self-insure for Worker's mpensmion, u, provided for by Section 37W of the Labor Code. for the pc,f..marre of he work R,r which;his pcnnit I,head. ❑I have and will reunion Worker's Compersdion Inwrrom.as required by Section V 37M of the Labor Gde,for the Performance of the work for which this permit is O Issued, v Vo m,CCS.. li m Insurance Barrier and P4lie number n/' C� FIC(•A''IF[TfMfT �ON '�f/ 7WORKE/O /O� COMPENSRTION INSURANCE' (This scaion need not be completed if the permit is Ibr one hundred dollar, _ (SffO)or leo.) I ceml,that In he Sulbtnanm of the work lin which this permit h i,.rd,I Shall nm employ any Person in any manor so as u,become subject m the Workers' Compensation I.”of California.Date r AnalicnnI hnulA NOTICE'1 O APPI.ICAN'r:11;artier making ih'r Can-fir Me orlixemptinn,you s Lacon subject to the W'mrkcrs Compensation provisions of the Labor Code,you mit C) 0 timhwim enmply with such pro,siom or this pcnnit shall be deemed revoked. z F CONST RUC'HON LEN DI NO AGENCY �i 7 I hereby.Minn that tbcre is a con,tmoinn lending agency birds perN on, a mf the work for which this Pearn is issued(Sm.3097,Civ.C.) h. A LeMcr',None z Leader's A lure„ U 1 anify that I have read this application and state that the above information is 4. [.. rect 1 agree to cmmply with all city and county ordinaries and state laws adding _ [) so aoll g :t' tion Lead h M1y railof'e"ale'ematic,A'll-.city lo ,tar upon he rens t d Pr,arty for inspectionp p t.. a (W )a,.I ,are indemnify andk ,harmlesslifeCy ofCaptain.ag+inst tq liabilities.judgment,cost,and c pe : x which may n any aY ,last se.d C•.) Z Cry in con,cyrence of me• to ,g rt mis per I. /^ '� APP NT UN STA AND WILL COMPLY WITH, NO'POINT ,��1 sof ., ecu�l� 6�� �d Issued by: Dale SIL nm Appreant/conttu or Date Re-roofs HAZARDOUS MAI'IiRIAIA DISCLOSURE E me r"liumo or mom hlyrildinC occupant store or handle hvadim,aamdal Type(if Roof i l Sm i the Cupcnino#Toni it,!a'code.chapmr 9.12,and me Hemet ane sarey 0YeF All roofs shall be inspected prior to any rooting material being installed. "',f ineapplicantor(Imrebuilith �� paf,,n.,tmequipmentordevice,which If a roof is installed without first obtaining an inspection. I agree to remove emit h:vnndous air coutnfmaon as ddinae y Ana Air Quality Maigemant Diadae `� all new materials for inspection. Applicant understands and will comp y with ❑rad o v all nO -point sourcregulations. 1 nate mad me nar.ardoax material. tayairemmt,node enamor b9 of me California llcalth&Slimy Coda Scnium25505.^_5533 and L5534.1 understand thal ifthehildingd,e,mrcuren0y vesummi,doditl.snty rcsry, ihibtyt nosily the (/ r me re. n ma.a bo,rte poor m naxua of r C rd"ith,of {I °cup" a re of Applicant r Date raumoml a$mt � All roof coverings to be Class "B" )r better OFFICE