06030056CITY OF CUPERTINO
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T�I�AeA�
BUILDING DIVISION P�'RMWRACTTT
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V�Q�
BUILDING ADDR FSS:
PERMITN0.
ALVES DR
120948
.R'S NAME:
PERMIT LSSTJE GATE
VICTORIA EVASHENK
03/21/2006
PHONE:
SANITARY NO. CONTROL NO.
ARCHr1ECf/FNGWEFA
BUILDING PERMIT INFO
BIDO ELECr PLUMB MFLH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I Icmby i fnrm fat l un liras, d undo pao s of CNpa 9 (commcncin6
Cif SccIroncffm Diwlon3nrdlceun�]and Pmrtmnn+cnan..ndmy B�m.�
COVERED PATIO-REAR YARD/OUTSIDE ISLAND/NEW GAS
in fall face andal erta�
Lkanma.
FOR COOKING
Dai Cou.ada,
ARCHrfECfS DECLARATION
1 undersand my plan, tlull ho wN u Ili& recada
Llccrucd Prufetioml
OWNER-BUILDER DECLARATION
I looby affirm fat I sm exrrnpt from clic CoatrmmY] Licenm Law for ft
7.1ro , .. (Scniun ](1313, Baan. end Pmil cion, Code: MY clly IX cam,y
which ro,o. a pomp to cawrom alkr, ioi m . hmwm. a ncro:x my wuclum
prior to its iuuancc, aLm"ifi ,the applicator for each permit to fk a slgmd mom"I
Ft. Floor Area
Valu
twkisliceR,adplormattoftpinonwt�nftxenntr s�eroelsw(etmi,,9
Sq.
(commcncf[ with Scclion 7") M Division 3 of tllc Min. arw Pmfrasiom Codc) or
dost h i ,•....p Ihertfrnm and the basis for We ,Ik[l uemptlon. My violaYo , of
nt'!00
Occupancy Type
any
mtchiarc Mueela0�Il mbjmthcapplicant badl pcNlA of
fWf50
3
❑L u acneof the propoty,amYornproycu. "+Wutak mk m,npeasWm,
Required Inspections
wiBao the Pdk LMWre l4ocar'. llded«nrt rAk($fG. 3B B1Y11YL
loci so
and Pmfevlau cmc: Tl,e cmtraetaf, IxeA]e L.w elan, n« apply m an awita Of
Call
arwwho do umchwork
caopenYwhoddld,IXimprosesch impr Orofff dlima[6M,
awe empby taut such Im vat f WlN o Mend for Rain B,
is mid vld,,m
buiplovwl
bmre,W. We n, or impovpnte,LL u mid orifvr arc year of c«afo, the owned
builder wW haw the pvdcn of povfY W I K Md not build «impose fa pmpae w
aw O
BI, as Imam. n Cold Beamed mnuanms m
Fl a
l..project cssune
H sinnua and Code) The Cantxu U.
ct Buda and
e9as.va the projeo (Sec
R f ��^9Tf:
i
' n am ny who
wtapptybNowaa Npopcny Cli bwld,arnint sContra,,nd,
wito mCdof
an
wlq ewllecLLlIXmeh pajeCL, YiIh aeMll6bf(])IkNYd pllaW nl bide Ganlr.Llera
V
Lkea¢
❑I porde Sec .B&PC for tht, reason
ay/i/'e"S n
�i�i��
i a
WOR COMPENSATION DECLARATION IQ
jjj p [
Y� f:t f�
IbvebY a/Brm ulerpwlty of perjury arc of the fonwin[Qeclanlbne
eV� fle®_.
❑ Ih,.eal wiu m.inwn.cwrtemarcmattlmsH-It..,—r«w«t<x,campen-
arp
sabon, u provided for by S cera 3]W of the Lsfl Code, for the pofamommo w Ili
-
wak fm vhinh this pamil is harcA.
1 bion, arw wN maintain Woka's Co npawlion Irtmra . as q i.d by Scc6m
3'3`00 M the labor Cade, for the perfomarac of the w In, whicl, Nu permit &..a.n.
My Worker's Compenwion Tn,vrso cit cartia mid Policy nambcr ase:
Canis: Policy No.:
CERTIFICATE OF EKEM PTION MOM WORKERS'
COMPENSATION INSURANCE
Crblsm mrico not be c«mlesol ifthe pcmail 1, fame hulled dnllan(SIW)
-
m let)
1 anify fat in the pformavice of ttr Cork for which this pcomil is .„",.,t. I ,hall not
cmployanypouonlnstry, gp�[ajhttm�abjM ad Wortrn _CompcvLLlml
II !!An
Appllumu-V ItC_�a'''f1I C,l
a' AC IrVL
NOTICE TO APPLICANT. If, after matin[ dolo Ccnifiete?of Eumpim, ypu should
be rox subjai to the Wast i Compeeawn pmvialau w the labor Code, You muu
fathwiN comply wif,uch pro ons or Nis permit shall be domed revMed.
CONSTRUCTIONisacrrIF.NDBJGntaganY
I that themtra agexy for Nn,pM«marixof
frpbYactor
(SccurikMin[
the wok far which Nis permit I. meed (Ser. 309'!, Civ. C)
IsndeY]Name
lcweri Addles,
I c fy dut I tiK red dn, application all nate that the abo. inform W m'v
rnnctt I ii t in comply Cif all city and county, ondinar ,ts and sum laws Noting on
bfldin[cOn Lim. and Mmby aulhodm mpresenutis of this city to crWr upinitc
fm
above-mcmior�propny iii ctimi prrt
(We) agrte to save, indemnify and kap barmku fn, City d Cupnuto agwmt
j liabilitin,judgmrnu. toss and expcee whkh my in any way accmc a[aiut sand Gly
Inca mrre orthc pendng of fu NmOiL
3.Z..1�Q G
AP I ANT UNDERSTANDS AND WILL COMPLY Wrni ALL NON-POINT
Issued by: Date
0. REGVLATIONS. _
-
-Re-roofs
`
. -- - -
Sipwum of ApplkaHAZA HAZARDOUS
H/sLrfor.bMATERIAfSDsaam,o3URE
"Type Of Roof
Win the t a fM n al
pare a milk haallom mamtay
bWl in,Co
i 1, Cbtiel
ddlrcd by the Cupenim Muninpal Code, Chapter 9.12 el Iht Rolf all Safny
a C.Ipm
SccrionCIyc, M532(.)7-
All roofs shall be inspected prior to any roofing material being installed.
�Te a-�
If a roof is installed without first obtaining an inspection, I agree to remove
Win dre applicant or (.lure building arupam um wOi,.t or hvirea which
pmil ham doo ab cmtam1=11 as dcBncd by fn, Bay Ma Air QuaRly Man,[cmert
all new materials for inspection.
Disuic,' � ,/
❑ Ye i C—R
I hese mad fn, Ite>udwsmatcnaH rtquharcns umkr Chaom6.95 Mfc Califo-
nulkalth&Safely Cash, Sectio,uiL'O X533a125534.1wwersutd fsif fn, Wiwc[
d¢sMcm1Y N,c•-,,.. Wit' myomon,IhI111YmmdfY Ute �upanl of Nn,
mqu' b food iflaa�ar ca,;r
Signature of Applicant -Date
All roof coverings to be Class "B" or better
owhp«wmddroaagent --- -- - - -