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06030056CITY OF CUPERTINO �r11W, 1 s0 =y'�� �`� " ' T�I�AeA� BUILDING DIVISION P�'RMWRACTTT _°" 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 --- -- - - -