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05100021 (2) CITY OF CUPERTINO ,s ^8Y@m.'sr* �t�,.,TQj0. ""INFO �-��•t �ni7� ONq� '; BUILDING DIVISION PENT CONTRACTnR I1Vk'OR aI�LY st9' Y&,rrk^y� :".." fix.M..l '... BUILDING ADDRESS: ANAND & LALITHA CHERIYATH --I'A� 005100021 OWNER'S NAME: PERMIT LSSUEDATE ANAND & LALITHA CHERIYATH AM 10/05/2005 44 ONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 trop LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provixl.ns of Chapter 9(commencing Job Description ZZ with Section 70M)of Division 3 ofthe Business and Profession¢Code,and my license is °?ro in full fast and cffca REMODEL BATH (MS/HALL)NON—STRUCTURAL Licence Class Lie.la n yen Date Contract., YY ARCHITECTS DECLARATION C U 1 understand my plans shall W used m public records 51 no t, Licensed Professional 5 OWNER-BUILDER DECLARATION ? E I hereby affirm that I am exempt from the Convector's License Law for the no following reason.(Section 7031.5.Business and Profcaiona Code:Any city or county 2� which squires a permit to cnnswa,alter,improve,demolish.or repair any swctum $8000 _iy prior m its issuance.alto requires the applicant for such permit to rile a signed statement ESC that W is licensed pungent to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation eF$ (commencing with Section 7000)of Division 3 of the Business and Professions Crnk)or Q that he Is exempt therefrom and the bmis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects she applicant to a civil penalty ofeF Occupancy not mos Nan five hundred dollars;C1300). -3 AP14 P Y Type ❑1,az owner Of Ne propcny,of mY employees with wage as Noir sole cOmpenadon, willdo diew.d.andtheswnore is nmimmndedoroffered fgmd.(Scc.7(kW,BdxMg, Required Inspections and.Prefessions Code:The COmmctor'a License Law does not apply m owe ns an ner of Q P property who builds or improves thereon,and who docs such work himself Or through his Own employees,provided that such improvements are not intended oroRered for ale.It. however.the building or improvement is sold within one year of completion,the Owner- builder will have tite burden of proving that W did not Wild.r improve for purpose of sided.as owner of the property.am exclusively convecting wish licensed contractee to eOraswet the project(Sec.7051.Busir m end Ro(erri0m Code:)The COnsracmr's U. . cense taw does not apply W an owner.(property who Wills or improves themen,and, ' who contracts for such projects with a eon iansim s)licensed pursuant in the Contraemh Clem.IJ W. ❑I am exempt on gSec ,B&PC for this reason Owner / Daaa O ORKERS COMPENSATION DECLARATION I hereby grim under penalty of pe jury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Worker's Co tina- ation,as provided fm by Section 37M Of dte Tabor Code,for Ne peRonmantt Of the, work for which this permit is issued. ❑1 have and will maintain Worker's Compensation hom anee,as requited by Section 3700 of the labor Code.for the performance of Ne work for which Nis Femur is issued - My Worker's Compensadde Insumae carrier and Policy number as: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (TNs section need not W considered ifft permit Is for One hundred dollars(SIM) or less.) 1 certify Nm in the pcffum,antt of Ne work for which Nis Permit is issued,1 shall not empluyanypers.n��tpray mFiV aztoye�(,TO cb LioNOWorkeri Compensation Laws Of Calireamr t� f 5'� DS I VS Applicant --.-ootid a NGTICE TO APP CAM:H.afar making this Certificate of Exemption,you should become subject tu the Wertefi Comp.nation provisions of the IaMu Code,you mug .,O forthwith comply with such provisions or Nis permit shall M deomed revoked. '�� CONSTRUCTION LENDING AGENCY [-+ Ihereby affirm that them is a construction lending agency for Nc performance of Q'. the work for which this permit is issued(See 3097,Civ.C.) ILI Q Lender's Name 0.D z Lender's Address U 0 1 certify that I have read this application and sum that the above information is u, — cosecs.1 agree to comply with all city and county ordinances and sum laws slating to 0U building convection,and hereby authorize reprcmnutives of Nis city m enter upon the W aWvcmemionedprop ityort fond cx encs puryh may a tF^+ y (We)agree m save,indemnify and keep harmless the City of Cupertino against rd, in equnce of tu,esuang of this esmit. mayin any way accost against said City V z, in consequence of she granting Of this permit ^ APPLICANT UNO STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale SOURCE REGULA N j ° ' 0 S — Re-roofs S,gnamre Of Applico VContracmr (Date HAZARDOUS MATERIALS DISCLOSURE Type of ROOF Will the applicant tar(mus building occupant stem or Week hazardous material U defined by the Cupertino Municipal Code.Chapter 9.12.and dm Health and Safety Cole.Section 25532(a)? ❑Yea All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous aI,comaminanu as dprincd by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes I have sad the hvalloes materials mquifcmentt under Chapter 6.95 of the Calif., nia HcahA&Safety Code.Sccdona255(15,25533 and 25534.1 undergand them i(the Wilding ' docs not commonly have a mnam.that it u my mommig clay m notify the,occupant of the syaifemen¢wnf. era =etpvier missuance of,Certificate.rCost, pancy. Signature of Applicant Date (ml l�5 Owner or authorized oS.rizea agent D,a All roof coverings to be Class"B"or better CITY OF CUPERTINO m 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31630027 . 00 DATE ISSUED. . . . . . . : 10/05/2005 RECEIPT # • • • . . . . . . : 31507 REFERENCE ID # . . . : 05100021 SITE ADDRESS . . . . . : 19850 MERRITT DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ANAND & LALITHA CHERIYATHMADAM ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2444 RECEIVED FROM . . . . : LALITHA ANAND CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY ANAND & LALITHA CHERIYATHMADAM ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2444 TELEPHONE . . . . . . . . : • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- -------- -- -- --- -- --- ---------- BPERMFEE VALUATION 8, 000 . 00 147 . 96 0 . 00 147 . 96 0 . 00 BPFIXTURE UNITS 7 . 00 63 . 00 0 . 00 63 . 00 0 . 00 BREMFIXT NO. FIXTURES 3 . 00 3 . 60 0 . 00 3 . 60 0 . 00 BENERGY PERMIT FEE 147 . 96 71 . 02 0 . 00 71 . 02 0 . 00 BREMRECEPT NO. OUTLETS 4 . 00 4 . 80 0 . 00 4 . 80 0 . 00 PPERMITFEE FLAT RATE 1: 00 38 . 37 0 . 00 38 . 37 0 . 00 BSEISMICRE VALUATION 8, 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 --- ------- --- ------- ---------- ---------- TOTAL . PERMIT 406 . 29 0 . 00 406 . 29 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ---- --- ---------- ----------- - ------------------ OTHER 406 . 29 M/C TOTAL RECEIPT 406 . 29 • �^ CITY OF CUPERTINO O7Y OF PERMIT APPLICATION FORM CUPEkTINO Alk APN# l / 3 2 Date: Building Address: Mailing Address (if different from building address): l `i $So Mem ++ ciriVe- ef+)Po C A 1996 0^r (cxzo ,, Owner's Name: F}ngn d C-J)(2T%q oL 6 ,no�cllgm q Phone#: iosLA-L, 4 °g - 446 - iii Contractor: Q co rLicense #: vz•r b GLI l dei! Contact: or Cupertino Business License#: Fax: Building Permit Info: (jQcc�odell�ir�� h0.n6tQi bald, QVj hall-wadffi, nod-k} �� 14Y Bldg D" Elect lr Plumb [3� Mech [4� Job Description: Residential 21,— Commercial ❑ ASq.Ft. Area: q.Ft.: ct: gpOO . 00 Occupancy Group: struction: 2mack LO+\9 0� a{hToamg Please check this box if the project is a ra t24(oo-r6 and tlB second: Standard ❑ Laze ❑ Maior ❑ Quanti Fee ID Fee Description Fee Group BAPPLOTHER OtherAp liances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3. Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX T r1/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Ener BUILDING BENERGYADD Ener Add Multi BUILDING BINVESTIGA Investi ation fee BUILDING 715 ° �/ I of a6 �� E.- CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEPTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING IMF BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pi a PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units r— 10,000 cfin MECHANICAL BREMAPPLI A liance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc A azatus ELECTRICAL BREMNRAPP Rem Non-Res A liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT R air/Alter Heating MECHANICAL BREMRESAPP Remodel Res A liance ELECTRICAL 2 of 3 SOry OF CUPERTINO � CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sigris, Marquee ELECTRICAL BREN=ATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG — Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3of3 Community Development • 10300 Torre Avenue 1, l �'�' Cupertino CA 95014 SS"" y Telephone(408)777-3228 CITY OF Fax(408)777-3333 SUPEkTINO Building Department JOB ADDRE S-�, o PERMIT # OWNER'S NAME: An moa Ebj ai?AMQAM Hnv— PHONE # lems- 44,6 - W7 GENERAL CONTRACTOR: Qs 6c�i I cA e�( FAX # I am not using any subcontractors: 4j::w- to 0 5 101' Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting • Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock • Tile /o�oS�OS Owner/CcrntractorSignature Date LONER-BUILDER VERIFICA'DN 1. (Check one) I or my immediate family (parent, spouse or child) will perform • A. ZAll the work authorized by this permit B. _ A portion of the work C. None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to vc cu uauacw • 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be erformed ..................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Owner's Signature: "p`' Date: 10 6S Job Address: I TRSD MPrr,+4- dy'wp. L!27 es+ino , rfl Permit# Any changes to the information provided on this form shall be submitted to the City of Cupertino Build • D_partment. City of Cupertino Building Department CITY OF 10300 Torre Avenur C' I P E kT'N O Phone: (408)777-3228 Dear Property Owner. An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself,you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract,ydu should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family,and the work (including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as contractors or subcontractors,then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding,federal social security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensation* contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. if the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor,only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit,erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors State License Board in your community or at 1020 N Street,Sacramento,Califon-da 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, • City of Cupertino printed on Recycled Paper z � � s � Jell Ir tee— C v o pg v t R 74 LZ ^' O n o tb 0 Z (� p CD v J O IyT i ! to OD _ s Ufj `' 0 n w CITY OF CUPERTINO BUILDING DIVISION Pi;RMIT N CONTRACTORINF,ORMATIO '"•- 7am3a?*'k'.... .,,SK w..•s i'-§::sJ.-�.rt5s.-:.. SJ"' •T .t BUILDING ADDRESS: ANAND & LALITHA CHERIYATHY.OW005100021 850 MERRTTT ng :R'S NAME: PERMIT ISSUE DATE ANAND & LALITHA CHERIYATH AM 05 2005 NE: SANITARY N0, CONTROL NO. ARCHITECVENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH t� 0 u00 LICENSED CONTRACTORS DECLARATION !� I hereby affirm dist I am licensed under provisions of Cbapur 9(commencing Job Description with Section 7M0)of Division 3 of the Busincas and Professions Code,and my license is to mufencemdeffec REMODEL BATH (MS/HALL) NON-STRUCTURAL 'g: License Class Lk.N ^=0 Da, Contractor {� ARCHIL W use DECLARATION �'��®a ® z (undersand my plans shall beused DECLARATION ATIONrecook, i(RR■■Ni >yU s G Licensed Professional 3 OWNER-BUILDER DECLARATION iI hereby affr that I am exempt form the Cmdractara License Law for the Noy 2005 O o following memo.(Section 7031.5.Business and Profcssiom Calc:Any city at county V which requires a perit to construct.alum,improve,demolish,or repair any structure $8000 _Zt prior or its lssrmce..).requires the applicant for such permit to file a signed sumdrem E thatheisliccnudpursuamtothepmviaionsnfthc Commmor's Limnxlaw(Chapter9 Sq. Ft. Floor Area \� fa V$lUatlon zl" (commencing with Section 7000)of Division 3 ofthe Businessand Professiam Code)or C p! y that hecat exempt therefrom and the basis for the alleged exemption.Any violation of ._a 't Y U p;s• Section 7031.5 by any applicant for a permit subjects de applkant m a civil penalty ofOGGU not mom than Bae hundred dollars(S500). er IJaraC y Type Lmowneroftheproperty.ormyemploycmwithwagesUtbe velecompenaadon, will do the wart,and the sternumis notimended of offered formic(Sec.7014,Business and Profession"Cade:The Contracrs tor's License Law donot apply b an owner of Required Inspections progeny w ho builds m ins proses thereon,and who does such work himself or through his own employees,provided Nal such improvements are not intended proffered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving thn he did not build or improve for purpose of salt. .as owner of the propenY•am exclusively contracting with licensed contractors to consumer the project(Sec.7044.Business and Professions Cade:)The Conuacmr's Li- cense law does oar apply man owner of property who builds or conow s thereon,and who contracts for such pmjems with a commemr(s)licensed pursuant to the Contractors License law. lam exempt un Sea .B&PCfmthismason Dau WORKERS COMPENSATION DECLARATION 1 hereby afEmt under penalty of perjury one of the following declarations: 1 have and will maintain a Ceniric,te Of Comcnt in adf-insure for Worker's Compen- sation,M provided for by Section 3700 of the tabor Cade.for the pciform roe of Ile work for which this permit is issued. ❑I have and will maintain Workers Compensation Insurance,u required by Section 3700 of the latter Code,for the perfarancc of Ne work for which this peril is issued. My Workers Compensation Insurance carrier and Policy number aro: Cartier. Polity No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (ibis section need not W evoupleld if the Permit isforonc hundred dollars(SIM) or Mss) I cmify the in the performance of Ne work for which this porn b issued,1 shall mt employ any pct inany manCCet r�14 bject tits Wmrkeri Compensation laws of CalifomalD AI f Of15 (V Applicant �_ NOTICE TO APP ICAtfTaf.after making this Ccrormate of Exemption,you should became auhjMl to Lou Worker's Compensation provisions of the labnr Cade,you mum J z forthwith comply with such provisions or this Permit shall be deemed nookcd. z CONSTRUCTION LENDING AGENCY [—� I hereby aRnm But there iso eoomoninn lcndin,.g ucy l'ar the perforanee of Ch 7 the work for which Nis permit is issued(Sec.3097.Civ.C.) 1 Q Landers Name ]z Lcnders Address U Q 1 certify dist 1 have read this appliested end sure one the obese inforauan is IB, L correct.I agree to comply with all city and county mulONtts and able laws Rioting to 0 U building convection.and hereby autharim reprematuvm of this city to enter upon etc ahuwctmentioned property for inspection purposes F y (We)agree to save,indemnify and keep harmless the City of Cupertino against i,IZ in sunce ofs,Start and expenses which may in any way accrue against sand City U z in consequence of Ne gaming of this permit ^' APPLICANT UNDFFFFFF��ttttttSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULZN�. l O� C)� OTI Re-roofs $IBnazale of APPh UContracmr Del HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant tar future building occupant amm or handle omemir us marcrial caned by the Cupertino ❑y" a+fG Municipal Code.Chapter 9.11,and the Health and Safety .Sc 255J2(a)? /' All roofs shall be inspected prior to any roofing material being installed. Yes If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant contaminants Wilding by Bauseequipmentor deviceswhich g p 7d. hamrdom air conuminens u d recd by the Hay Area Air Quality Management all new materials for inspection. District? p ❑Yes I have mad the hvaNrwsmalrialsmquiremens under Chapter&95 of the Califar ealth&SafctyCodc,Sections 25505.25533 arW 25534.1 undersand thmirde building oat currently hoc a Imam.that it u my rceyomibilily,b notify arc occupant of the iremenu wMe oat met pdarwieaasae an eertifcal arm apancy. Signature of Applicant Date [ US LOS Owner or,athariud agent Date All roof coverings to be Class "B"or better