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01120048-DP" Dt aSt CITY OF CUPE[ZTINO 0 G*04-f CITY OF CUPERTINO PERMIT APPLIICATIOloI FORM 4 -015 ... Date: � -C Buildin �Addiess: • •.... � .. . � .. � - - . 22 a Gtow tj 12D . ' caf �- It g �A • ` Owner's Name: C�ATtH2- l NJ I< 'D ((Ss Phone #: zb(a) 29 2 - g g Contractor: License #: e-CPTR,A-f-7C - Contact: f2IcIw Mi2v D0A i71J& Phone #: - Applicant/Contractor: ding Permit Info: Bldg Elec Plumb Mech o ascription: Residential: PVIDrr 31� U.QAL F?FVrS�Av& iRWvAQw0.9 Commercial: Sq.Ft. Floor Area: _ s Sri $ /Sq.Ft.: MECHANICAL P A- ArchitectlEngineer: Valuation: I+/144 K/16 LID tAW? -M�L1 u64-4 8�i45 — Type of Construction: v� Occupancy Group: ?--3 Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > l OOK to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCO.NSTAX, Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTA-XBQ Con. Tax for Bg Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax - Resi/Mobile BUILDING BELEC1000 Elec 600V < =1000A ELECTRICAL• BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy WELDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 "CITY-OF CUPERTINO , BUILDING DIVISION PERMIT - - CONTRACTOR I INFORMATION: BUILDING ADDRESS: P PERMIT NO - OWNER'S NAME: A APPLICATION SUB DATE bATHRINE DILTS 1 12/12/2001 fONE: S SANITARY NO. CONTROL NO. ARCHITECTfENGINEER:• _ _ . BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION J Joh. Description I hereby .ifm, thin 1 am licensed under provisions cf Chapmr 9 hsmdngb.bmg with Seaione andefDivision 3 o the Business end Professions Code. and my license R REMODEL /REPAIR: 1? _ D a Lea i DRAIN _ E SD ECLAr A i D AUG 5 -+ I ndrnwnd my pl n h 11 M us d a p bl cords , , ' 5 Q Licensed Professional - - OWNER BUILDER DECLARATION ` 1 1 h by aRrm thin L am Business m Ne C ions Code: s Any city Law for my B D1�� h.., A e, m - - - .... . "... "....__ _..._....___, _.._._._._.._._.._ ... 5 F(- F]OOILACea ,r a anon 'thodromed., wit pSeelon,7000p f DbeiasollhethB lianas License Law (Ch B Code) 5 thine T applicant l 3 4 b b : :t < ^ ' ^i' <.: Occupancy Type ❑ 1; as owner of the propeny, or my employees with wages as (heir sole cump[nsminn, -wll d the ork7and the structure 's it tended or offered for sale (Sec 7N4:- - -' -- - -- - - - - Iecti - owner of propeny Who builds or improves thore.a. and who does such work himself 1 102 - P PIERS l or through his own employees. provided that such improveme,ns are not intended or _ _ 1 - 'complemn, the owner m Ider will have the harden of proving that he did nor build cur 1 104 - R REBAR 1improvefor purynu r _.- ._....__._.,_,__,..__ -,...- - n - ---- hide- -"- .._ -,.." . .BOLTS...__..... - ...- -_ _ - . m 106 - S � �1: PI'':i owner o ... _ ._ .._? � 2.. " -__._ D °' 01 and exempt pt unl law. ^'= „• 2 203 - U UNDERFLOOR'. MECHANICAL ow RlLlu' S' Z 2 204 - U UNDERFLOOR FRAME . I 205 - U UNDERFLOOR INSULATION. T I hereby nrfirmuoaerpecan> nrperj�i :yddgitemsrowwmgaalara,iona: 3 301 - R ROUGH PLUMBING 1 ❑,I hove end'will mvinlain' "a'Cenifcure of Cbl.Z,ri to self -insum for worker's 3 302 "- T TUB Tic OR SHOWER Compcnsatioq -as provided for -by Section 3700 of the Labor Code, for the 3 303 - R ROUGH MECHANICAL p gmwnenrinew °rLrowninnlmapmilixiayd. 3 304 - R ROUGH ELECTRICAL .OI h. i 305 F FRAME ei d MyW rkcYS'Compc a ninsura ce tamer nBP lay numher are I I � Tx330076_.1 . j - ?HINOLSUDLO`WTNTSI ' ;,.l.�•1,r.. t CFRTIFICA EXEMPTION OM1 W"O"KERS 3. 0. 8_..-__. S i PDTi:¢e5un naa hOi ben dimple,ed if me permit is cote One nanamd emlux 3 309`EXTERIOR L LATH. a LATH _ 1 nfylhan person in ce of the o1. for __310 - -.. --INTERIOR L _ shall 1 .r1 -,,wI% i m 3 13 - R ROOF NAIL' Idul CE TO m 3 ELECTRICAL - ENERGY- - mire the Workers Compensation this C 502 -• F FINAL PLUMBING ENERGY -- .. ` `"- "" 503- "--- F FINAL-MECHANICAL- ENERGY:, 1-- -- ' b 504 - F FINAL BUILDING .ENERGY' - bf the l .. ___ .._.. ,.0.e�. ...__.. F FINAL ...ELEC-TRI GAL... .. , Address 'I, � 506 - G GAS TEST `'" ' ; ; 5 507 - F FINAL PLUMBING toInedd 1 ,gone Igpomply with all b b t 5 0 8 - F FINAL MECHANI CAL petin r 509 - F FINAL GRADE . liabilities Jadgumom c°56 and 'apa uses which may in any way Bernie against said 5 510 - N NA NG City n od Cq [n[[ Ot lh gmnL ¢ Ot lh a p[Ir1111 ' Issued lfyi4' - N 11 .sD��l D nun i Dim R Re -roofs 'fit II the appl Cnnl fmremld'ng occupant see or hand) hLrdbr material T Type Of Roof codes tOn Z3ScvnVC n yy g y s - .�• - '. - ' " °Y x 5 r ' i ' All roofs shall be m mspec[ed poor to,any roofing material being installed . wroth[ PC(sa 1_ pot R ho'Wing`c pama.egaiymemord:,�[awniC'h I ._ con haaaidoue air comammanrs as tefb d by the Bey Area Air Quably Management Dim IgYa , a all new materials f for inspection. Applicant understands and will comply with °'' 1 e, , ' a all non -point source r regulations:.. ,II 1 h lh rcad1th hazard - s ections 2 2 50 r ifd elm,a H ...• -.•• ._._ ." . .... ... - . .. ..... .. ...... ......." ...... .. of the most he etprlSmyrespnnslnll a iodficamof . D w` 7 Signature of ApRlicant D Date roof coverings to be Class B or better 7a S jb 1 i 7b 1 1 a� f- ario� CUPERTINO CITY OF CUPERT O - PERMIT APPLICATION FORM p)o ,Foo/ APN # ' -L — 10 — O 1 3 Date: � �� ^ p Z Building Address:gS/ f /` �DdLt', ��,4^f 1 vLQ ) � 952�I T Owner's Name: l V-I I/1 e. I I f S Phone y(VOS) -)SO- ` 1 Contractor: i J� —D e- f +S License #: Contact: Phone #: Ap lican Contractor: Fax #: Building P rmit Info: Bldg Elect Plumb Mech Job cription: ` Residential: Commercial: Sq.Ft. Floor Area: $ISq.Ft.: BCONSTAXBQ Con. Tax for BQ Zone ArdutectJEngineer: Valu :l NYType of Construction: Occu ancy Gro t ti (X BUILDING r � Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/COnun/ uasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax - Resi/Mobile BUILDING BELEC1000 Elec 600V <= IOOOA ELECTRICAL BELEC1001 Elec 600V > I OOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi - Family Res MECHANICAL BNEVRdnTI New Multi-family Res ELECTRICAL BNUCOMME New Conzn Electric ELECTRICAL BNUCONMI Md New Comm Mechanical MECHANICAL BNUCOMMP New Conun Plumb PLUMBING ,# IT I 0r 1 of3 Bt- 7 i oaz � 0 C LLI �U a OF�r-ea OZN r.,4� OPU ' 3 U. Lp Da y a0.0� �z4 0 a3= 7oz F� O a4 W O W F O (� w a U 04 CITY OF CUPERTINO BUILDING DIVISION C N.TYtA;CTOWINFOR TION: 't pp IT �e'J.� ,. {yl — ' n4 -.w t�i,-s�' r3 -'� a•Y! :till . V— BUILDING ADDRESS; PERMIT NO. 22951 LONG DOWN RD CATHRINE DILTS 02080014 OWNER'S NAME: APPLICATION SUB DATE CATHRINE DILTS 08/05/2002 PHONE: SANITARY NO. CONTROL NO. ARCHrTECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMS MECH LICENSED CONTRACTOR'S DECL.ARA77ON 706 Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license NEW STAIRS is in full force and effect. License Class Lic. M Dale Contractor ARc— timuT's DECLARATION I understand my plans shall be used as public record.+ Licensed Professional OWNER - BUILDER DECLARATION I hereby affirm that I am exempt fmm the Contractor s License Law for the following reason, (Section 7631 .5, Business and Professions Code: Any city or county demolish, $1500 which requires a permit to construct, alter, improve, or repair any structure prior to its issuance, also requires the applicant for such permit to fire a signed statement A Y b J+trt arm}{ ea Valuation that he is licemwA pursuant to the pr"sionsof the Contractofs License law (Chapter 9 (commencing with Section 7000) of Division 3 orthe Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation 3 4 D ]- 3 V V of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than Five hundred dollars ($5oo). 101 APNl~'8'6ftATI ON Occupancy Type 01, as owner of du property, or my employees with wages as tfieir sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Cade: The Contractor's License Law does not apply to an 103 — UFER Required Inspections owner of property Who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or 104 — REBAR offered for sale. If. however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving doll he did not build or 10 5 — ANCHOR BOLTS improve for purpose of sale). 106 — SEWER & WATER ❑ I, ai owner of the property, arrn exclusively contracting with licensed contractors to 202 — UNDERFLOOR construct the project (Sec. 7044. Business and Professions Cude:) The Contractor's License Law does not apply to an owner of property who builds or improves [hereon, 203 .PLUMBING — UNDERFLOOR MECHANICAL and who contracts for such projects with a con=1w(s) licensed putsuanl to the XCa stars License Law. 1 am exempt under See. B & P C for this 204 — UNDERFLOOR FRAME mason t o ter �L l7S n B 3 0 �- ' %RICER'S 205 3 01 — UNDERFLOOR INSULATION — ROUGH PLUMBING W COMPF�t ON DECLARATION 302 — TUB & OR SHOWER I hereby affirm u rider penalty of perjury one of the following declarations: 303 — ROUGH MECHANICAL ❑ I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the 3 04 — ROUGH ELECTRICAL performance or the work for which this permit is issued. 305 — FRAME ❑ I have and will maintain Worker's Compensation Insurarim as required by Section 306 — HOL+DOWNS 3700 of the Labor Code, for the performance of the work for which this permi( is issued. My Workers Compensation Insurance tamer and Poli re cy number a: 307 — INSULATION Carrier. Policy No.: 3 0 8 — SHEETROCK CERTIFICATION OF EXEMPTION FROM WORKERS' 309 — EXTERIOR LATH COMPENSATION INSURANCE 310 — INTERIOR LATH (This section need not be completed if the permit is for one hundred dollars (aloa) nr Lc %.ia 311, — SCRATCH COAT 1 certify that in the performance or the work for which this permit is issued, 1 313 — ROOF NAIL shall not employ any person i a 'm in sa as t been a su jest to the. workers 501 — FINAL ELECTRICAL ENERGY r Compensatio ws o Califon . ate k April , 502 503 — FINAL PLUMBING ENERGY - FINAL MECHANICAL ENERGY WETO PPL CANT: If, after making thin Certificate of Exemption, you should subject to the Worker's Compensation pmvisions of the Labor Code, yva must h forthwith comply with such provisions or this permit shall be deemed revoker], 504 — FINAL BUILDING ENERGY CONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL E hereby affirm that there is a consuvction lending agency for the performance or the work for which this pcn6i is issued (Sec. 3x97• Civ. C.) 506 — GAS TEST Landers Name Irnder's Address 507 — FINAL PLUMBING 1 cartify that I have read this application and state that the above Information is 508 — FINAL MECHANICAL Correct. 108 [o comply with all city and county ordinances and state laws relating 509 — FINAL GRADE to building construction, and hereby authorize representatives of this city to enter upon the above - mentioned pmpzrry for inspection purposes. 510 — FINAL PLANNING (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, cost% and expenses which may in any way accroe against said City in consequence of the granting of this permit. 514 — FINAL UB C WORKS �� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N -POINT Issued by: Date S CE, ULATIONS. ri� S O _ 5 reafApplicanUContractor at HAZARDOUS MATER ISCLUSULtE Will the applicant or future huildin cupan. store or handle hazardous matcdol ai defined by the Cupertino Munici ode, Chapter 9.12, and the Health and Safety Re -roofs Type of Roof Code, Section 25533(a}? ❑Yes ❑ No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future b - mg occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit hazardous air contaminants eFned by the Bay Area Air Quality Management District? all now materials for inspection. Applicant understands and will comply with ❑Yes 0 N all non -point source regulations. I have read the hazardous materials requirements under Chapter 6.95 of the California Heahh & Safety Codc• Sections 2-55D5,25533 and 25534. 1 understand that i(Ihe building does not cartmly have a tenant, that R is my responsibility to notify the occupant of the requirements which must be mct prior to issuance of a Certificate of Occupant . Signature of Applicant Date All roof coverings to be Class `B" or better roraurhorizeda.-cnl D e OFFICE p` r 0v C k, U Z< ]v rn f- ea�Q �paC u3m� - r O E 3: H v d p•C � a c W�v �Z> 0 f4' LXC c diL t� C a Y 2 z C a CITY OF CUPERTINO CONTRACTOR INFORIV]fATH BUME)ING DlvrsioN PERMIT BUILDING ADDRESS: PERMIT NO. OWNER'S NAME: APPLICATION SUB DATE CATHRINE DILTS 12/12/2001 PHONE; SANITARY NO. CONTROL NO. ;ARCW CTIENGWEER: BUILDING PERMIT INFO = - BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Seniorce 70DO) the Business and Professions Code. and my license REMODEL /REPAIR• REPAIR & RMEOVE DECK AND and efDivision3of is in full force and effect License Class Lic. 4 DRAIN Date. Contrac[er ARCHITECT -5 DECLARATION I understand my plans shall be used m public records Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Conuzctor's License Law for the l following reason. (Section 7031.5, Business and Professions Code: Any city or county ' which requires a permit to construct, alter, improve, demolish, or repair any swcture ..prior to its issuances also requires the applicant for such permit to frlea segued statement . - - - - - - - • - - - _ _ S Ft 1oorA, rea . •. - - �' F •1 '; f ''k �• '- ation ' that b;R.lickrised pursuant to the provisions of the Contractor's License taw (Chapter 9 (ccmmericin with Section 7000) pf Division 3 of the Business and Professions Code} @, d L d ., +, tip,, t. 1..• &ti. .. + t li .+ cr: t. or that he is exempt theicffdfrt and the basis for the al[tgef? exemplibn. Any violation -of Section 7331.5 by any applicant fora permit subjects the applicant to arivil penalty :91 not mbre than five hundred dollars ($500). b Occupancy Type ❑ I, as owner of the property, army employees with wages as [heir sole compensation, - 101 - - OUNDAT - "" aired Inspections -will -do the ikon',' and the structure is not inurided oe Offered for sale (Sec. 7094," %Busiriess'and Professions Code: The Contractors License law does not apply to an owner of property Who builds or improves thtneon, and who does such work himself 102 — PIERS or through his own employees. provided that such improvements are not intended or — — _ - �- - - - -•1 0'3•' UFER ---- - - - •- — -- •-• - - - • - - .ofkered for sale: If, however, thcbuilaing or impim'emcni is sold within one year of , i dorupleiion, the owner - builder will have the burden of proviug that he did not build or 104 — REBAR improve for purpose of sale.). - XI, as owner of the property,-�rn- excius;�esp eantracting Who ht��scd "aori�etors,a ` ANCHOR -DOLTS- ' conslpret the project (See. 7044. Business and Professions Code:) The Contractors. 10 6 - SEWER & WATER i r , . License Law does not apply to an owner of property who builds or improves thereon, . "arid who contracts for such projects with a contractors) licensed pursuant m the 2 0 2 — _ UNDERFLOOR PLUMBING ' .. ... contracsars License Law. I' L] 1 am exempt under Sec. _ " B A P C for this reason 203 — UNDERFLOOR. MECHANI CAL n P.... o .�� Hatt =art 2- 204 — UNDERFLOOR FRAME ,o . waRxER's COMPENSATION CLARATION 205 - UNDERFLOOR INSULATION -r hereby affirm unaeryen�lry of perj> r one of,nc following declarations: 3 01 — ROUGH PLUMBING ' ❑ I have entl'will mafntaina Certificate of-Consent to sdf-insure for Worker's 3 02 - TUB & OR SHOWER j- Compcnsaiiop , -as -provided• for- by Section 3700 of the Labor Cade, for the 303 — ROUGH MECHANICAL {performance of [h1, '. for which this permit is issued. _ 304 — ROUGH ELECTRICAL ❑ I have and will maintain Worker'; Compensation Insurance, as required by Section •tbrLabor 305 — FRAME 3700 of Code, fo'r_the performance df the'work for'which this permit is lisiA. My Worki r'i Compensaton Insurance carrier and Pclicy number are: , -.a-�. .. .,L. A, w,..,•r,Y .._ _mot ..,.- y...,4 - .. ..._ eerier•' -'�' .,ttL i�a,'�.'�' it�� :' "cso,itY Nn' ..: •, - -' - ...__�. ...... •. _...ti, - ._. .. ..__. _. ._ _ _,_ _. ..1_ ,3 07• �! � INS;[_T,LiPfiTI QNf ' •�... �+ 1L '� S ':C RTIF1CaTIaN aF E7{EINPI]ON FROM WORKERS' n^ - "'COMPENSATION -1`' k: r ]' �. , _ENSATIOCE :. . _ t -- - - • , _ ..... - ' %JttF r °(fhisse�tion rived no[ be' completed if the permit is for one hundred dollars _� - - ._...__ - _._ .- •- - - - - -- — — - -- -- -__- -_ - - 309, ` -� •EXTERIOR LATH (" • ''t ' - ,(s(oo)orlcss.) .I 4er?ify that in the performance of the work for which this'ptm i is issues, l `shall 311 — SCRATCH '%COAT. I • -, 0 iiofemploy'iny person in arty manner so as to become subject to [he Workers' . ' ' [Compensation Caws of CalifOmia. Dale 3.13 — ROOF NA I L _ -Ap iNOIICETO APPLICANT: If. after making this cer6ficarcofExemp don, you should - -'-" -501- - '•FINAL 'ELECTRI CAL -ENERGY---' , -- -• - - becbtj,e subject to the Worker's Comparsation provisions of the Labor Code, you must ' forihwith'comp:y vritb such provisions or this permit shall be deemed revoked. 502 —. FINAL PLUMBING ENERGY i __ FINAL MECHANICAL--ENE GY_, _ „_ ... `..�I,- •CONSTRUCTION LENDING AGENCY 1 rcYCby affirm that thereis 'a'constiuction lending igeacy for the performance r 504 — FINAL BUILDING ENERGY1 ' bitlre Work far which Ni Per_mit is issued: (sec: 3a97,,citr. -c) :' : t' • - 5 0 5 — - F -I NAL - E'LE C -TR I CAL LindeYs dara5s' 'r'LL ter, i' , ", .:,• ., 5 0 6 — GAS TEST •4.'' _, S T' .. I certify that .1 have read this appiicarion and state that the above information is corral I agreetq,comply -with all ci And county ordinances and state laws relating 5 0 — FINAL PLUMBING i . t0 bdilding Consmicliost, avid hereby'audiorize representatives of this city to entc� upon 508 — F I NAL MECHANICAL l Ac? vc•mentioiaed property for inspectiop purpose s, ' owe) `gie 'fo save; mdemmfy and keep harmlc�t lhE'City of G7lpertiti0 ggains[ 509 — F I NAL GRADE liabilities, judgments, costs and expenses which may in any way accrue against said 510 NA P NG City iii consequence of tlid'glanting of this$,[ nit._ , i P.PPLICANTUND:RSTANDS WILLCOMPLYWITHALL'NOId-POiNT it •Z' Issued r 4 - N RKS Date rONS e Be of �9p�licariueontrAna�— KDaie;; I ' +: u }..7•n i }�A7r9�tOd,3�TMATERIALS DISCLdSURI;.' „'�, ' . . Re -roofs Utheappiicairt' oEfulivebuildingoricupautstoimk andie'hizardousMaterial. "Type of hoof v: _ _ ,,....._. ... ... _ -- - = •- =- -:.. -- pa's defined by, the Cupeitilio,Mariicipal Code, Chapter 9"12, and the•hsealth and Safety _ _ ' Cold Ser iiart25532(a)?, i f ' 1 i - ' -J- ' -ry ”' ` ' All roofs shall 6e inspected-p material being.i stalled. epr�itant oT ,titre building occupant use egvipment or devices which g - If a roof is insialled; without first obtaining an inspeetidn''Pagree'tor remove ' emit hazaidous'atr coritainiri as defused by the Bey Area Air Quality Management Distiict7�Y I . all new materials for inspection. Applicant understands and will comply with I., i - : ' : all non -point source regulations: -- - , 1 haJe''ieadihe•haiardous hla[uials reghiremchs'under Chapter 6.95 bf'the edifornin,Health & Safety Code: Sections 25505, 25533 and 25534, 1 understand that -•ifAt building does noccurrently have ate na 4 that itis myresponsibil ky to notify the ' otcvp�gt of the rt:quirerrients which'must be mei prior toy issvatice of a Certificate of PCCU Fay,''_ _ Signature of Applicant _Date wncF, j au th orized agent All roof coverings to be Class +B" or better' r4