00090151 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: 1'EIIMIT NO
Fu>e2ioe SoGcr7io.ccs rNc. &oo90/S/
WNCR'SNAME`1375 RUMFORD DR APITICAI ION 5�7tPI090I 51
/ 77/ SLZT� 4&le-
reolve: DEIJCHAR DONALD AND SALT_ TRUST SANITARYNo,09/2fiy7c9 00
�SfF� ode '� 9S//2
G e[Z ARCfIITEC IpNGINCBUILDING I'12RAll'I'INTO
C 11 O �S Q •- �Z 33 III D FLLC'I' 1'I.UMx N117 11
U T UU I- 1=J I'�1 I-1
�F2n
L O N= Iirmlih t iD licenON I sed OR'S
DEion%of haps[ON Job DCSCrIpI On
Oa_o Inorth(a)of that1um.1the sunder p d,]11 nxof Chapter9ndatmenense
¢ F tv with Section n 7araof Division 1.1 the xusincs,and I'ndessinm CsNe,nnJ my license -
S —] Iden full farce and elA p
SM x a Liccnw CgI u 3(— Lie.a / ! _
d.u6.N Date/"�`Z'Y A I'5'in cl�ni{ X � dGfi CECE OOD SHAKE TO GIRPSHEEt - Ile'r''/�
$ °4 I understand my plans.snag rte aced as mbb,record. GLA,$S �• g pJOOD C
SO O Idwnwd I"od"lomd .�n
W o OWNCR-Ii UILDI:R DGCLAR N I r y
1 hereby alrrm mat 1 am exempt form the Cnmmco r',License Low for he
F z_r G,IWwing reason (Scc,inn 7031.5,Business and PrOcsslnns Code;Any city or county
S s O which require,a pd nil to con.tmc.,alter,improves demolish,or repair any structure
priorto its issuance.also requires the applicant for such permit n file a signal statement "W
d,a11'.vnear„cdprisa.mOutdo,pmsnx.a..soobad CommcmrsldcaavcI.. Chap'c'r9 Sq. Ft. Glecn•Area Valuation,
(commencing with Section 701X11 ofDivision l of the Business and l'mfessenns Code)
pq �.3'eY1a r
or that he is exempt thmfeem and the basis for the alleged exemption.Any violation 2 5 Q U P-e.5
Scminn 7031S by:my:mplican,for a Permit,uh,i....]he nppllcam u,or civil penalty
no not more than live hundred dollars($5(A). LAPNumber Occupyjy�Tmb
❑Lac owner of the property.or my employees with wagesaa their vole compemmion, ✓ -
will do the work,and the umc.ure is nal intended Lir oflered for sale(Sec.70.1.,
xasmess and Pmfce,iond Code The Ccmmmm,License Lave does rte,apply In an 30641049Riyored Inspections
r of pmpery Who braids or improves thereon,and who does.such work himwlr
,it homgh hes own anployacs.provided that wan Inipmvcmen.s are to intended nr
offered for sale.It.however, he building or impmvcmcm is sold within one yea of
lrepletion.meawner-huilderwill havethe burden ofproving that he did not build or 305 - FRAME
.npmec rot parpo.c ofwle.),
307 — INSULATION
EDI.as owncr of the proper,am cselmively con recting with licensed contractors It,
,nsn..c,mo projcc.(See mu.,xnsoness and Pmlesshms Code)The Colo 601 - ROOF TEAR OFF
License law dues nor apply to an owner of pmpeny aho builds or nnpmves thercnn:
and who contracts for such pmjec s with a contractors)licensed pursuant to the 602 — ROOF PLYWOOD NAIL
Cminurfoo"Licunw Low.
❑I am exempt under Sees .B st P C for this maxim 603 — ROOF BATTENS
owner Dare 6 F'
04 — ROOF IN— ROGRE �S/
WORKIik'S COM PENSAf10N OL'CLARA'IION S j�
I hereby amen under pen:dty of perimy one of the following dederarons:
❑ I have and will maintain f Ccni&ac of Consent m,e Labor for workers ` ///I
Cnnormancn it cep provided far by Section 37fN1 0l the Labor Code, for the
,performance nl.Lac work for which Ibis I,armi,i,inwcJ.
have nmd will maintain Worker's Cont,scoon of Iavumnee,us rcquhed by Section 01VO
.71x1 of the Lelen'Code•for the perRemance of.he Bud,for n'hich.his penult ix
u I My N',rkerx Com lion Ivo. nil Iblicy number arc:
Car
H S so�o7e. licyNo,-r6kIV 2-3
C13R'rIFICAfION Or C%I71"BT1ON FROM WORKCRS'
COMMINSATION INSURANCE
(This section need not be contplmed if the permit is for one hundred dollar
(SINN)on loss.l
certify that in the Performance of the work for which this permit i,issued.I
,hall nm employ any(ninon in any manner so as on becrnne subject at the WorkcK
Contpensmion Laws o]Coulomb..Dore -
Applicant
NOTICE TO APPLICANT If,aftertanking]his Certificate of Cscar tion,you should
been o"uhjcat n"lic Wn.ked C...ulamvmioa pryom non
vl,inr me Lubar Cndc,yon e,
�Q 0 fnnhwhis comply with such provisions or this permit.shall he deemed revoked.
.�. CONSTRUCTION LBNDING AGI:NCY
' 1 hereby mmrnt Ihm there is a romlmminm lending ugenty for the performance
W of the work for which this penis is issued(Sec.11197,Civ.C)
y ^lies Lcndcr',Nome
5 % I<ndcr',Address
V Q 1 certify tha 1 have rand this applicution and state mol the otiose information i, -
D. P ev rren.I agree m comply with all city and county nnlinanec,and,tae law,relating
Q ij to building construction.and hereby mulattoes,representatives of this city to enter upon
the aNnamcmional pmpcny to,In"codiun purposes.
(We)agree m sove.lndcarady and keep handcs,me City of Cupertino agnin,t
t0 liabilities.judgment,,roots ane cope m, vii r ay in any way accrues against said
U z Coy in s name nnhc gra ins li n
UNOERSI'AN A^ YLN I,NON-P NT Issued by: Dille
5Q p�d
.y arc nrnp�h�ant/c6.nmc,ar - - - — nae — Re-roofs
BALARDOUti N1ATI:RIAE S DISCLOSURI! -
Wd,don, Thn'tnn,r brame M1udding occapxm snnc or handle harridan,material Type of Roof
u,AcfincA ny.he Cupcninn Munpal Codc.Chnptcr 9.12,and.he.Elcal.h and$nfnty
Cwdc,Section 255320V n
EI yc' All roofs shall be inspected prior to any roofing material being installed.
Wil the applicant orfuture Emittingoccupant trseequipment orde%ices which If a roof is installed without first obtaining an inspection, I agree to remove
Grail limitations air contaminants as defined by the Bay Area Air Quality Stenoganent
D'.„ lic
D"O"'? ,/ all new materials for inspecti n. A pant understands and will comply with
0Yc, NN° all non-No to Dotes regulati Is.
I have rend the boaardoms materials mymlrcmcat%nndei Chapter 6,95 tot
California Heullh R Safety GNe,S Minns 25505.255p amf 25534.1 undersand Ihm
ifdcbailryy I doesnolcunently ,.4 ti�e.rn}requn,ihilaymnntt the 9 .2
seance (of 11 pti. a vel :h ,. pr .n i"oner fa Cor itic.ac.
D' l` tura of Applicant Date
`'� All roof coverings to be Class "B” or better
i er al amaammi,ed agcmt _. Da
OFFICE