00090117 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
OW'NER'S NAME: APPLICATION SUB DATE
IFIVRINE, 10468 VISTA KNOLL BLV ROOFING CON 'R40TIIORS INI,(*X611p 011.7
n-Z ARCmTLCTifNG1N_� CYNTHIA F IP-2/4? SARATOGA—SIJ NYVALFRE)09'V+11n.31P12000'
E O O BLDG ELECT PLUMB MUCH
m
FF j LICENSEDCf1.N9'RACroR'S DECLARATION (408) 777-833jbb Description
O Z E 1 hcmby vllirm that Iran
IiccnaN under pnrcisinn,of Chapnr Y(tt+mmcncing p
aith Seclirv700dlofDivision 3oflhe Buxincx.vnJ l'ron-mo Cada.anJmyliceme
<m^;� is in full farce and effect.
R o 6 U License CDsa Lim.p
Date mm
Comn
ce u O g ARC ]11'1'ECI"S DECLARATION
I anaentand my Plano shall he used as public,mord,
%LL}
w�`co L"cantl11ba.ia::al TEAR OFF SHAKE/ 40 YR. CLASS A FIBERG
°i°•o owNER-BwhDE1<DEr.I.ARA33ON
w I harmby alnrn,Ihm I am cxemn,IFuab m1 caaoamm,ea LImeT,nm law I... W1
r-5< hallowing ma.an.lse"isl
an703S.Bu,mes.nml l'n 'c„ Gam:am:Any eiiy,,r,,,anly
ESO which re,ai,cs a permit m mnxwcl.:ller,improve,demolish,or repair any urucmm
6�$ hatheslcensedpurowntiothe thmapplisofthe CouniemtOLicense aw(Chmmem
mal uram,ienaedtSectinlmmeproDivisi n3ofdammcmr,LindPrimawma,Cefv Sq. Ft. Floor Area Valuation
or that am a is a with Section om and
Ie basis o of the B alleged
ex and ionbAny vi lotion
or SecM1m is exempt therefrom and We fico for the alleges exemption.Any l violation
of im ma]Bbd v any applicam'for a pem,it whjen..the applicant m v civil penalty
or na'mom man five hundred anna'a a5tgy. APN Number Occupancy Type
C 1,as owner of the propcny,or my employees x'ill,wages a,their sole compunsalion.
will do the work.and the stmctare is not intended or offered for sole(Sem.70.14,
Basun,.,moa pianissimi,Cove:The Contractor's I.ima,na Law does not apply to an Required Inspections $1 1849
tw , fn , ,y whob Id 1, w.t d a , 1 1 - krnxalf
cr Th lei l' npl y : p I l d p ' I' T I s or �A
ollc I far-I .11, x ,I b I I' y t':sold '11 y t f n 7�
m1 l pl i b Id ',Ifl to 1 II ,Thad rl 'n la,r 32613063. 00
immo,c I T b a]..)
CI.torwisairufnic ptpenr.Ma icalMiscly coadrux,fin, ithl vcontractorst "05 — FRAME
»tm t thepnjm,(s low Basin... d 1 1 .ton,Cada)Fire Co.,mc,m J
and h coramc: us,
' cnhprpuny whobuildspraWit)th - 307 — INSIJLATION DO
and who aw does for wch pan ins with m um,recmob licensed pursuant m the _ .
Cmm�cmh Livcme law. 601 — ROOF TEAR OFF
01 am exempt ander sine. .B a P C far this mason
Owner Dare 602 — ROOF PLYWOOD NAIL
WORKER'S COMPENSATION DECLARATION 603 — ROOF BATTENS
frothy all...ime,pemaTrof rjaryamot mmbillowing d,damlani, 604 — ROOF IN—PROGRESS
0 in I ha, ml win,aW a cenioemm a1 e'aa,anl ,o"If-insme for Wo,k,,,
c....tpa„xaaioa a, p-,ldcd far by S,,iot 370p of he Labor Coam, Wt 1111
lurfnnnancc of The work for which this permit is iorod.
01 hme and will maintain WnrkeL.,Con,lwnsalinn Insumneq as required by Section
37181 of the WM,r Code.for the perbarmam of The work for%bach'his permit 1.s
issued.My W kcr'.Com minions i rmme came,a�ndd policy number six
Carrico - N `T policy No.: pc'2����
CrR�of EwiMI1r1ON FROM WORKERS'
COMpENSATION INSURANCE
pTis section need no,be completed if the pormit is for one hundred dollar -
alab or I...) ,
I ccinty Tba,iuk bur the perfonnunce nl'Ibc worw ', is perod,is usual.1
Tun ,
,h of employ any perwn in any numner nh u , ice,to 11,c W alo,"
Cnnigmsaline Law,of CuliTomm.Dam
Applicata
N(n]CI!TOAI'PIJCANT:ILoIL.rn,aking This Ccn l it c r Lxcm1Lamrynushn m
hvcnme,Wjc:nu,he Worker"Co,npeom aprovid. of the LaMa Ctdm,you masa
Q fonhwiM comply with.wch Provision.or rhix pem,i,,all M themed re.nked.
z
F to CONSTRUCnons LENDING AGENCY
1 he for affirm that Were is o construction lensing agency Inr'he per4+n,mntt
s of'he w for which'his pemm (Sec.1(19].Civ.CJ
Q Lends:,Name
�
Lender's AJdrens
V C 1 certify that 1 have read this appllenllon and state that the above infor n boli is
�6 Es armcl I ngrm m Cn,rply with all airy z I county ordinance,T1s mats laws relining
Q V inhuidball,onxu'uclion,mrd hmreby nnal orisa,r,m,,nauive,oflhi,aly to comrupon
the nbovenentoncd pmpcny for inapca,i....pmpo,a.
F„ L (We)i'me la nave,adanmihy and kccp hmnda,,0m Cilyef Capcnino agbmu
rn hums Teas,judg nc... tts,s and c,pcnms which may in any way uccm..gains,.said
CITylnun„myucnccof'hcgran,ingof'hixpermi�.
APPLICANT UN RSTA )S AND WILL COMPLY WITH ALL NON DIGNT Issued by: ( Date
1; '1 iav E== tlR �o y _
Signamm c`6cetm na Re-roofs
H9 or future
MATg occupt store hummous Type of Roof
m de.Sed by,hc Capcnino Municipal CWe.Chapmr 9.1?,and the Health and Sviny
Code. 0 Yesn 255R(aT! C No
All roofs shall be inspected prior to any fooling material being installed.
Will the al,nhamor brute mdmn8occaparia,runipmen,or urvice,whiel, If a roof is installed without first obtaining an inspection, 1 agree to remove
,nit huanloo,at rnnuminunu,n defined by 01 Bay Arta Air Quality Manugwnanr
,,Limp? all new materials for inspection. Applicant understands and will comply with
Ora. ElNo all non-point source regulations.
I have read he haardnus'namrials rcyuim,nars under Chapter 695 of tfitCut
Kith, uia Health s of cpr .Ctslc.Sura mirmi605at itis a ics,ro 4.dity to xmnd lbs,
ifthebuildingdoes notmnts whaveatenant.that,itis myssunce off rnmifythe —lJ
occupant of the requirements which mail be nm,prior m issuance nfa Certificate of
Occupancy' � Sid, ati� u�pplicant D•
oxnm, aathad.edmsant Date All roof coverings to be Class "B" or better
OFFICE