00060131 (2) CITY OF CUPERTINO
BUILDING mvtNu3� I PERMIT CONTRACTOR INFORMATION:
1641 F54
BUILDING ADDRESS. PEHNII'r NO61 1EN .
IG55 FORMAN AVE jAF./P0/PL7jL7jVj
OWNER'S NAME. APPLICATION SUB DArli
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HONE: SANITAR\"NO. CONE ROL NO.
BUILDING PI RMI'IINFO
O O BLDG ELECT PLUMB SIECH
se z ARCI I I'mcrikNG(NEER:
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s.y- LICENSEDCONTRACTORorf', II,it Chatter WOOD SHAKES Jq")(L.L3'IlWOIITILE� ICBO 2@93
OO:v+' heron Iran that stn I¢'cltaCB Oticr - I'Chtt air9(cummeneing.
R—❑ Y u Provtsinns o p,
with Scclinn 9lNNi)nf Uivinin i bel{usinos and Pmfa.ians Cndc.and my licens<
a,jai f is in full force and eRe<� 3
z c c a I.icensc C `r _ _
ARCHITECT'S DECL\R N
t:—O 1 1 undemmind my plans shall be used x%public records
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t�6q p Licennu Prnfcsnionn
c OWNIiR-BUILDER UIfCLARA'I'ION /
=m I hereby of orm that 1 In exempt front the Cmunwlm,Limme Law for the
F Z a li llowing reason.(Section 7031.5.Business and Protesaiorm Code:Any city or emmy
M O which Icqu ins u Pernut m nntWn4:dtcr.ingnuve.dctnol ash,or repmr wry it Oct ore
4110110101
coq $ Her In its isncamr.alsomquim,,hu applicant fait such pennimo file a signed nhmorrad
c. that he is licensed pursuant to the pants nitons of the Contmmors license Law(Chaptar9 Sq. Ft. Floor Area Valuation
(commencing with Section 91XX))of Division J or the Bmine,and Pndesdnru Code)
tr dmf he isopal thuretman
tn A the basin fir the alleged excttpn'o,Any olad
Of Sestion 7031.5 by any applicant lift a permit subjects]rte applicant to a civil penalty
of net mom than Five hundred demo 6500). A^ um er Occupancy Type
❑1,us nwnaf of The nro,erly.or lily employees with wugus ns thew nolo cutn.vio,Thou,
will do the work,and the structure is not intended nr offered]Or sale(Sec.7044. .3
105
Business and Pmfa.im,Code:The Contractor's License Law Jacs not apply to an Ppy1(rP��lJ ispectlons
r of pmpony Who IN Ids ar int)voves thereon,aia1 who does such work himself 3@7 — I NSl H I 1 V IV
or Ihmugh his ownem,doyv,,provided that such impruvemems un nit Intended or
offered for sale.If.however.the building or impm.eomnt i,sold within one yam of 601 — ROOF TEAR OFF
completion,the mvncr-laidde,will have the III ofpnrving that he did not(wild m 602 — ROOF PLYWOOD NAIL
tnpamIc ha.arpow of salr).
❑La.nwner nt the pmpeny,am exew.ivey cn..hard,w ith licensed cnntmnor.a, 6@� — ROOF BATTENS
Lnnamct the project(sec.7834,Business anti Promotions Codco The Contracmn F,@4 — ROOF -IN—PROGRESS
'tecmc Law dna m,t apply to an owner of propwy who builds or hopmwcs mereon,
and who rnmr.:cts far ends Pntjeen with a wilt mcmr(n)liccnscd punuup]at Ih<
Contractoh Liccmc Law.
❑I am ental,under Scc. ,B&P C for this mama
Owner Usm
WokkiiR'5 COMPENSATION DECLARATION
I hcmby alb I under pcoub,of peijony orelf the fallowing deelurat',—: ,
❑ 1 have and will maintain a Certificate of Comma In self-inume for Worker's
Cup,wt,u.inn, ax provided rut by Semon 3100 of the Labor Code, fur the
I ..nmce,I the wort:1,ishidt ibis pend"is i.eued. �'•���
37hu.<anIT will maintain W'oI Coimpenwtion Insurance,as required by Sect
ot the Labor Code.for the performance Of the work for which this permit is
I...al.My W..Icecess�Contpcn,a hnumnec Carrli}er�nu�ll["'lily'It' r'u�er U L_I
Cartier'• """l hu'4n Policy Nn.{i�VVV�`+
CERTIFICATION or r.xEMvTION FROM WORKERS' JUN 16 2000 D
C'OMPENSAT'ION INSURANCE
(This section need not be coniplad if the permit is for one hundred dollars n
($IaB ar les.) y
1 certify]hat in the lerhmnanee of the work Iia which this permit is issued.I
,hall not cmpiny any perxnn in any manner In as to hecome subject tin the Wnrkeri
Coullso wion I,tlw,of Cul'damia.Dom
Appal bast -NOT ICH TO APPLICAMBdf.alter making this Cenili.m of Gxnnptinn,you should
become come subjectn the Worker's Compuma]ion provisions of the L.at ar Code,you mus]
Q Q forthwith comply with such pnrvisions or thin permit shall be deemed revoked. -
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CONSTRUCTIONLIiNDING AGENCY
ai 1 hereby 1((611 that]sereemis au cnnsuuarm
ian lending agency for the perfoance
W of the work tiff which this pcmu]I.iwacA(tin•.7097,Cit.C.)
L A LtnJer's Name
I � z LcnJcisAMlrcu ,
V 0 1 artily that I vol,cad d:H uppllca0on and.tum thin the above int mtmfion is
aw Es come,.1 agree m comply with x11 city and county nmllname.and stare lawn relining
Q t.7 ]o Wilding construction,: th
and hereby auom<reprtxnmtives ill this city to enter upon
Ft4.] the airvo-men]ioned propcoy for inspection purpmes.
0.] (We)ugrcem,ov,u,&o lfytmd keep halork"the City of Cupcninu aguinw
to liabilities,judgmenu,coss and expenses which may in any way accrue against said � ��J�
City in mn.equcnce Of the grunting of this pe.i,. V
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-Poi Issued by: �� Date : UO
SOURCE REGULATIONS.
Signamrc of A,p1icrrVCummmu1 Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
WJI]hc:t,h,irm at timot building oecupen more antandle lmynma nencdal Type ofRoof
m defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Stallion 25572(x)7
❑Ycx CNo All roofs shall be inspected prior to any roofing material being installed.
Will lheappr<:rotorPrime nttiliirgoic.,notm,emiprimntardevices which If a roof is installed without first obtaining an inspection, I agree to remove
moat haaurdous air contaminants as defined by the Buy Area Air Quality Management -
ol.tden all new materials for inspection. Applicant understands and will comply with
C3Yen ONO all non-point source regu ms.
I have mad the Imeardaos materials requi voica s under Chapter 6.95 of the
Culdhenia Health&Sale y Code,Scehon.255115,25513 and 25534.1 andurxtuml that
if tire building does not currently have a tenon.that it is niv re.plmsibilify to nmit'y the " ` LL+LZ �(,� U (7V b I/
clai,vtnt of the na,mor ents which must W met /�'>1
prior et issmnce of a Cenilica¢of /
Occupancy. Signature of Applicant Date
oxmerrm notimixed.,,it Date All roof coverings to be Class',"I3" or beuer