00080187 (2) -CIT1`4F CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. PERMfT No.
OWfdR'S 1,10590 STOKES AV APPI-ICAI ) 1, '
HONG SWISHER ALLEN E AND JUDY N "'''"R`
0-7. ARCHITIECDENGINEHIR BUILDING 1'IiRMI'I'INFO
c O BLDG CLFC71 PLUMB MECH
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LICENSED ON"TRACode,ar"CI...ofCION Job Description
�].O m I remby#lion that I an,licenced under pmvidole of n,Code, lcmnmcncow,
ml—u�l with Semfore110d afect.sinn3orthe Business and l'rul'cscinn.Cade,uud my license
ce 8 is in lull force and cRccn.
Ow U License Claw Lic.M
a Dwa ootraet"r REROOF
F=c-t, ARCIUTECT'S DECLARATION
1 understand my plans shall be used m public records
5.6 0 o Licensed 1'rnfasinnal �l
OWNER-BUILDER DECLARATION
3 M^— I hereby glare mot I ser I exempt f I,the Contractor I License Law for the
t_Z� following reason.(Saloon 7031-1,Business and Professions Cade:Any e,,y or a nay
-o whim requiresu ariont t t her,improve.denioNsh.or rapairrany structure
n5- pro t 1. leonine,nM1applicantf suchPe n fl ged statement
reset Ip t,,,lic p' Ill 11'.c t a r. l Law Chapter Sq. Ft. Floor Area tilu�ition
(vomg me,c, with Slam.7000)of[)is kion 3ofthe businessand I -Code) i7
or that he is exempt therefrom and the basis for the alleged exemption.Any violation
II Seat 1 tans by any nmprewn forst pen,dt lamecw me appneant m,o civil penally
of not a,oremall live mndmildolmrxa500) APN Number
Occu at, e
111.as owner ohne property.or my employees with wages as their sole compensation.
sem do me work.and me..mere is on imaodml.critical h,r sale See.7044, 32649001.RZQ�uired Inspections
Business and Professions e docs
CodThe ConmenoT s License Law not apply man
of property Who Melds o es improves thereon,and who dosuch work himself ,
o,ill ough his own mnpluyccxProvided tont such imprn courus are not Warder or
offered for safe.If.Imwever,rive building or improvement is slid within one year ut 305 — FRAME
completion.the oner-builder will have the bu den of proving that he did not build or
w
.pnwe for porposa of pda.t, _ 307 — INSLILAT ION
01.as owner ofthe pmperij.am exclusivdv controlling with licensed convectors to 601 — ROOF TEAR OFF
construct the pn,jttt(Sec.7044.Business and 11ndes.inm Coda:)The Commewr's
License Law its,.m, pply e,an own or p,,,,any seta,builds or imps"e.thereon. 602 — ROOF PLYWOOD NAIL
and who contracts for sue,project,x;th a codtractorl licensed pursuant in the
Cotaramor's Liceme Law. 603 — ROOF BATTENS
01 on,exempt on,Sec. .B k P C t'ur this comm,
604 — ROOF IN—PROGRESS
Owner Date
WOIt KER'S COh9'IiNSA'TION IIIiCLr\HN'ION
1 hereby union under penalty of perjury one of the following dedam,ions:
ID I have and will I,inmin u C.volicone of Consent m sdl'-'msura for Worker's
Cnmpemmion, as provided for by Section 370o of ,he.LaMu rode. go she
perlmmance of the work for which this pertain is issued,'
and will maintain Workers pe
Con, nsmbn Insurance,as required by Section
3701)of the Ia,wr Code,for the performance or the
work for which this panni,is
er and Policy nn.b,,.m
icsneA.hl As FU+� lieYe Nurt'� L Cl.�
Co.
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IHIPICIIONOb EXEMITIONP OMWO KERS
COMPENSATION INSURANCE
(This section need not be acmNcl if the permit I%for one hundred dollars
(III Pit or Iess.l
1 certify that in the prHom,ana of the work for which this permit is issued.1
.mol cot amploy any person in any mann,so as ,,hvenna,%noI......the Wel,... -
Co.penwtinn L s,of California hate
Applicata
heard
NOTicant OAPI'LICAN'll II;alar making thisCmlticam of Exemption,you
M1"ourewbject,o t he wok"'.C t"vene"ionpmvtsfons of the Lahor Cede,yilu nest
Q0 forthwith comply with such provisions or this permit shall W decn,cul revoked.
FCONS'TRUCT'ION UHNOING AIFNCY
> IlmrebY affirm that there is a contraction lending agency for the perm
foonce
of the work for which this permit is issued(See.301 Civ,C.)
0. Q I-cnder'.0 Nnmc
= Z Lcndcr's Address
V Q I certify tow I have road this applic,nion and ante than the atswe information is
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context.I agree u,comply with all coy end county oulmo ncex amt.late Inw.c relating
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to buildings nswerion.and hereby authorize representative%of this city in enter upon
Fr� she above-netaioncJ pro,ny for inspection pmpnxs.
p, IWe),,eamss'e.iudenndty and keep harntle.0 the City of Cupcnim'against
Vi liabilities,judgments,costs and evlwnses which muy in any way acerae against laid
y L City in consequence(if the granting of this perm rt. ✓��� ��/
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: k Date
SOURCH REGULATIONS.
SignwmaotAppretm✓contramm Data Re-roofs -
❑ALARDOU,S MATERIALS DISCLOSURE
Will the application'
future building mx.para slow,or handle hoardom..coal Type of Roof
as domed by she Cupertino Municipal Code,Chapter 212,and the Health and Safety
Cade.Scahm 25532(a)? _ / -
oyes /?4" All roofs shall be inspected prior to any roofing material being installed.
Will theapprcao u,mm,e buffro,occnpnnl an mluipmetaor devises which If a roof is installed without first obtaining an inspection, I agree to remove
nit hvmdous air concur mmans as defred by the Hay Area Air Quality Manapcmcnt
.stole /, anewn int ials for inspection. Applicant understands and will comply with
YesDint source re ns.1 1 of d,he larandoos mamdnls rx4mmman,,under Cramer h 95 or the
. iog so"'eyCodeSmsions''S5o ill it13. 25531, hly'I,smnd tom4Ap '
wilding ,citnmure hwco n,te,P, Imusefbil'nylonmifytheareofn require. s ria nen tar' issuance of a Ceribcam nl
P' ay _ - Signaturt Date
0 oraamori. agent Date All rool'coverings to be Class "B" or better