00080155 (2) CITY OF CUPERTINO ,
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMITNO.
10163 RIEDEL P6c
OWNER'S NAME: APPLICAI ION SUB DATE
_ ^„-r/._1911710
PHONIi: , SANITARY NO. CONTROL NO,
OWp ARCHi H:C OHNGINEIiR: BUILDING PERMIT INFO
Ii1DG IJ.EC'IPLUMB MECH
�nLI.ICENSEDCONTRACTOR'S DECLARATION Job Description
m" I belch,
nfl am le,1'am fiece,,d under pe viviers of Chro,9(cdm elism,
0v_w wilt Section71g0tnf Division sof the Bloinrsnnd l'rofcasiom Gdc.and my limns - -
n full force and Be
�0�u On'en1q �'�C — Lie."—�—�j_�� REROOF 30 YEAR ELK PLYWOOD 30# FEL
o a Sc Date�y1 COltlracml Ifdd " J "
aQG neclurrin"sDrcL.1R:—Y NREW VENTS
C }; I unJen,:uJ Iny Phan.hall be used as public record,
w i o c Licenwd End..well
I)WN,am axemptR ol'the RATION w�
ic I hereby.myon that I nm BUILD.fmn,the RATIO r.License haw for the Y
F].a lollowing reason.IScction 7 1.5.Business and Prmexsions Code:Any city or county
2 O which requires u petrel It can.truct,liber. mpmve.dunmllxh,or ropair any volatile
5� onto its issuance.alsorequires the applicant lin Such pvoldi to file a signed ga,encnt
e. — bnlheisteen..dpursuanttothe provisions afthe Contractors licenwLaw(Chapler9 Sq. Ft. Floor Area a ion
(,I arieneing with See,inn 70m))of Dlvisnn 3 of the Bullous.end IOafes.inn.v Code)
or that he is exempt berefmm and the basis for the alleged exemption.Any violation '
of Section 70315 by:toy applicant lin a pmoit subjects he applicant n a civil penalty
of nal none than five hundred dollar,($50(u. APN Number 110
piniC6 M6
01,us owner of the cry,or my crq,leyees with wages as their sole v,mperodbm. rCO9tVUJl¢L�t IId�
will do the un k,and the structure is not intended or ofe,ed for w1a Sec.71144.
Brines,and Profession,Code:The Conhador's License Lax does Bat apply to an incl Inspections
r of Drapery Who hood,or imitators hereon.and who docs such work herself 31.621059.V9
fir through his own employees.provided that such Inalinnen®nts are aol inicaod or
oBBred for sale.If,however,the building or imp overem is sold within ane year of
t„Ilnplo'mn,me owr,,hmhter Will have me harden of pnnving that he did no,mold or 305 — FRAME
pn oc ro,Purpose of.me.>.
❑1,r ownar of ma properly,a,"axedn,ildy.omrneting with oecn,ed contmetnr.m 307 — INSULATION
ona,am he pajecl(Sec.70,14.Btxhrs and Prfo,dn,v Code:)tee Contractor, •601 — ROOF TEAR OFF
License law docs not apply m an owner of pmpeny who builds or improves Braman
and Who mmacls for such Project,with a contractor.)orIn
ceed pmstmat the 602 — ROOF PLYWOOD NA I I_
Contmeoi,Licenw Ww.
0 l am exempt ander Sec. .Et&PC for his reason 603 — ROOF BATTENS
Owner Dare 604 — ROOF IN—PROGRESS
WORKER'S COMPENSATION DECLARATION
I hereby u0mt mule,penalty of perjury one of She fallax'ing declarx,im,
40 L have and will n torlde a Croilica c if Consent mI .ell inose I'or Worker'.
Campcn,mlor. as Provided for by Section 3710 of the Lulxn Calc, for the
performance or the work for which this permit is issued.
01 have and will maintain W..kef'.Compsm"tian Insurance,a.dquind by Section t
3710 of the Labor Code,for the perfnre:mse of the work for which this permit is
issued.My ns Con t�p,efnvntinI Insurance call mand Poli�c'yS.....fiber the
Ci,,i,r 9 �.I11�Pal icv No.: ��Il4t
u t19CA'rIDN OP li%EMI"PION P M KIiItS' 1
COMPENSATION INSURANCE
(MIS Section need not be em„ple,ed it be permit is for one hundred dollar,
(SIM)fir less.)
I eerily that in the perfmn:fee of the nark Ion w ;ch IMs permit is;.sued.I
shall net employ any person in. more e,M1 e zobject to he Worker, t
Cantpenwtinn Law,ar .nl;lin a tc _
Applies.,
NOTICETOAPPL r.after mal, It is Cenifcate of Exemption.you should — -- — - .-
heannle.nhject a,the Worker's Ctso,sm dioo pnrvisin ,of the Lubar Code.yon meq
Q Q forthwith comply with such provisions or this peonil,hall Be Ji revoked.
Vi
CONSTRUCT,)N LENDING AGENCY
> 1hereby difren that hem is a construction lending agency lar he pcnmalems,
of the work for which this permit is issued Sit 31197,Civ.C.) ,.
6. C, Lendm'x Nance
D z Lender's Address
C.1 Q 1 eenhy Phut I have read Phi,application and atdo As"the,hove infra...."ion is
corrta.1 agree to comply with all city and c mmy'midermsex and stale laws relating
Q V to huduhrg co..stnetion,and herebyaothoave mpmanMm
r,auve.os coy enter upon
the ubevea.d,tinmvl propel far Inysct;on pa"es"'. -
[,. C (WO agree n,save,i dcmnify and keep banal...he City of Capedmo,gains
W fablli,im,jedgmmr,costs Ind expe.,es which may in any way accrue against said
V z City in coewsEenec of the grading of this penult.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale --22—J�
SOURCE REGULATIONS.
Signature nfA,fcamVComnehr Dam Re-roofs
HAZARDOUS NIX]IRIAI S DISCLOSURE
Will the applicant or more building occupant s,am or handle hocolmo Indedal -Type of ROOT
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Gde.So,,
2553210? ONn
All roots shall be inspected prior to any roofing material being installed.
Will heappticala is mold bulldimg oclolood lose e9tdpnent I"device.wh'leh If a roof is installed without first obtaining an inspection, I agree to remove
no hmeNous air con
iuminoms as defined by life Bay Area Air Quality Management
;grmt7 all new I trial' or inspection. Applicant understands and will compo with
❑Yes El No all non- of t (cc -S Mations. /
I have rend the e,Quo.., ,li ials 55.2 533 a under Chapter 6.95 of the
t
C'nlifnr Ihlle.r hSlay(;docsgmlona 255quiremenand25534,lunJcn5 o the V
Bible th�fimhlm rad rr((BY hale a mnant,ton i ,nY ralxe,ibil;I m ramify hecci - eali , iefi most baon, oras is> anco fir: Ceemer°ecy' X Ira re o Applicant ate
owl anal ori,—J,•e„t , - � 1 L All roof coverings to be Class "B"or better
OMFICE