00090008 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. PERNHINO.
EXTeILIOPL, 00090008
OW'NER'S NAME: APPLICAHON SUIT LAB.
1099E LINDA VISTA DR II7}i SMirli Ave- !01!2000
PHONE: SANITARY NO. CONTROL NO.
CASSANDRA LEN S A,,J Tose- CA- 4sS!! L
o RCHITEC'1]ENGINEIiR: - HUILDING PERNI'I'INFO
u 08-35 — /233 n)�I;oq EIEn' n.uMIH NLCH
a
F y
LICENSED
1)CONA wen,ACTOR'S DECLARATION Job DCSCrI IOII
�O Chin 7y ufEnn ivi"bar u 3 iccnwd oil pro, int n of Chn oste.E o d o ing
� wllh Scc',ion711Ef0 nl Diviplonn nl'tbe lhininu,e undtl'rnfun,ion,Cndc.nnJ my!'¢'cmc _
6 ce "in full force and el Ret
0i Date_eI� ARCIIITIiCr
_ cndtmetor. — * NO CONDITIONS
! � S DECLARr t
�°"C 4 I understand my plain shall etc recd us pu � reaoNra. V ,
iY�¢5
w n p p� U,vnmd I'rolcvsinnnl
OWNEinexempt from
m the I<A'nON
uZ= I hcrcby.(lien thin I inn exempt from tau Grein,C s LAnyc city
o for the
F=C followinguims a.(Section constr t.sines and vex d moll h.or Any city o mecum
x p which rcyutms v permit m constmn,cher.intprova.Demolish,or mpuu any arvnure
�C$ prior 10 Its issuance,also requires the applicant for such permit u file a signed statement
dam—
that
he is licensed Pursuant to the poo isionsofthe Corrine mrsLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 7000)of Division J of the Husi nun,and rrnfecsinns Code)
or than he i,exempt mcmvmn amt eye httsis rill me alingcd exetnpnom.Any violation - . 17996
of Section 7031.5 by any applicant Ire a permit std(, ,th.appliemn n,a civil fau,hy
or nm tnnte area live bundred duuarc(5500), APN Number Occupancy TYP
01.a,owner ohne prnyvnR onto,llnpk,vel will wage,a,their sale emol en,atmn.
rill Jo the work,and the strveturc i,not intended or otfcml for sale(Sec:IDw.
Hus J'r f rr Code: In Contractor's L LlJ t apply to an
�'
equr
cd Inspections
ow eotbet n. III provided that n' uaiis sen. Ire
an n d,bp ts renrs,f 305 — FRAME
/
comp!( me Nfi 'In (he n J I, ' gthat l da fill huddler
improve for nco c.)-
3707 — INSULATION /
b1. mat me propcmy,am esausively contracting with licenced contractors to 601 — ROOF TEAR OFF _ (�
onstrun ut the prvjeet flee.nHosmcs,and lrmfes,ions code:)Thin cmtmetnrs 602 — ROOF PLYWOOD NAIL
License law does not apply to to owner of prof,eny who mints or nnpmvea'hereon, 03 — ROOF BATTENS
and who mauew fmm
or Wch project(with a eontnrW Iicen,,d per u.att In the EI
Conmacav'a Liccnvo 1,11,
01,m nxnnpt under See. .EKP,C int mi, em,,n 604 — ROOF IN—PROGRESS
G,vner Date
WORKER'S COMPENSATION DECLARATION
1 hereby thine under pewlty of perjury one of the following declarations
0 I have and will n i... a Cenitlaao of Convent In ,elbm,mc Ire Worker'.
Cn ofenxallnn, u, provided h,r by Section 3700 of Inc Labor Code, lot Ili
,etfnrmuum ut Inc work for which this pend,is issued.
have and will maintain Worker's Compensation Insurance,as required by Section
7 I of the LnMrt Colla for the perbmnanee of the work for which this permit is -
d.M Worker's Ce tion Insurance carrier and Policy number me:
41MC
ETlvrecrieW
Y / ds Irl.
Voli r No.: 2 �
CHR'fIFICATLONOhEXEMPnONFROM ORKHRS'
COMPHNSA1'ION INSURANCE
This section nM new he completed if the permit is fnr one hundred dollars
(SIM)lit k"I
I cenity taut In the p:Anrn:mce of the work for which this permit is issued,I
spanp pp not CioPloy Ii,.00'iti.,i t lie iine sttnicet o,the Workers
cnmpe,s:mm� ,fc�urott. i �r-�.o
N plica
ET( LICANT:If.afi making Ccmifcam of Emmptinn.you should
b teonte,ub o to the Worker',Cornivi non pmvi,inn,ofthe Labor Cndc,you must
O b,nhwim comply with such pro,ision,or his permit shin be deemed revsked.
Fy CONS'1'RUCI'DON LENDING AGENCY
a I hereby nlllnn(bent there i,a cun,uuctlnn lending ugmmy for the ,,Icon...v
of the wink tor which this permit it i.smed(Sec.3097.Cie G)
S Q ixuder'x Nmdc _
7 7 Lender',AJJrcss
V C I cemify that L hum read this application and state that the above information is
G•i F. correct I agree to comply with all city and county ordinances and state law,minting
Q V to huildingnmtruction.and hereby au horive rcpmenwtiv.,of tbh city,,enter upon
die;maswltimWo,id progeny rill ImN<aiun ptigm.e..
E 0. OVO agree to ave,indcnmily and keep handlen.v the CilY a1'Cupenim ngnind 1
4 h.hdities,judgments,costs and expen.ms which on,in any way acerae against Haid / aV
C,7 Z City in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WrIn ALL NON-POINT Issuedb Date
SOURCGREGULATIONS. -
Si,unn,cofnpPlmao/Co,tmemr umc. Re-roofs ' .
IIAZARDOUS MA'I[IR1ALS])ISCLDSOItE
Will lie apphc.m or rmme bold'ingoee.ln Ism or handle nar.rdo..Hina+!.! 'Type of Roof
as dcOncd by the Cupeninn Municipal Calc.Chapter 0.12,and the Health and Safety
Code,Section 25532(x)?
O Yes 0 N All roofs shall be inspected prior to any roofing material being installed.
Will(he applicant or future building rmcupau use equipment or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
nit hni,nlouv air c.unndiw,ns a,Jetiuvd by the H.y Area Air Quality Management
ni �tric.? all new matei-mis for inspection. Applicant understands and will comply with
O Ye, 0 N all non-po' source regul do .
I nose re.d he n..,dou,mared.l,requirement,ander chapter 6.95 at he
California Hmltb&Safety CalaScctions 25505.25533 and 255311 onJcrsmnJ teat
if the huilJi sour currently have.tenant.that it is my msponsihillty n,notify the
.ncura It liuimments w 'mt d •t r't to i....mc,of a ce fia to of ,
�grr re of Applicant Date le
U. sroumodecd.,car All roof coverings to be Class "B" or better