06080085 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS: - PEAMR N0.06080085
1053 0 BARN PERMIT ISSUE DATE
O ERS NAME:
FRED CONKLIN
SANITARY N0. CONTROL NO.
ARCHI'IECP/ENGINEER: RAIDING PERMIT INFO
BLDG EIPCr PLUMB A4ECH
loo UCENSEDCONTRACOVSDECLARATION - Job Description
Id 1 hcmbr•Burr iEm 1 m Broad urukr PMOm Of C"'PW 9(commando{
N Section"IX1U)of Dhivon 7 of the Bodmv W Pmf"Wru vu
Code.W my Io-
infuliforaWeffs REVISION TO ORIGINAL PERMIT #05110005
A Uete `oo REVISE TRUSS CALCULATIONS FOR SFDWL
H Dare GarnDEC
A
ARCHRF,CTS DECLARATION
i a�� I uMuaanJ mY P1am Wll he u,cd u 1uNk ranrd,
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u Llecmed PrtY�iOml
Im OWNER-BUILDER DECLARATION
I hcrob"aR Nat 1,.•.nl,lpl from Nc Cano•.arl MLaw f«ibc
:0C folbwiny ma,on.(Smian I117I3,Badw W fhafcmam Calc:
Myy dry or coumy
$ which ii,s t • .W.w c«ulauc4 Wm.impmK,dcmuluh,mr.dg m"woo or
Irisniu Os pales rt w the the•Wooi of fo,Coopermito fikadpud,meroenl Val$"4742
S�C Nat heulxemcd Sion!oohs pf rWo ar NcrO Bno :,tx low(ChaMcr9 Sq.FL Floor Area
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dolhu LS by
IA"gpL W Nc buuru the•l,t eaelW My HaWinn of
notmm fmbu ,4O<1dntr«•Pemllwbm N •wkblb•awpm,Rrar 5Occupancy Type
^���^qe N•n rnr bid d0°"'�0Q} 37537069 . 00
❑1,u..of dk prvperry.a my—Ploreo wiN maw u Ne'v ok wnpenadm.
ww ,Newo,k.WNcuwmReifn«wrcnhdaraQer dror,ale(see.rou.Badn<„ Required Inspections
W Paofe.a„n.Calc The Caou•cwA Li lav dao no,WWr w m awur of
"u 'who WiN,Or uo,.dv WMbodms wdiw hwudfu Nmath bu
awn ernplaYea,pfd Nu uoPmKmem,art oor InerdN«aBurd far We.ff.
how .Ne boUdi,m BnproK uold wi ore yeu of pkiim me ovrcj. .
bWil wW uvO Ne biedrn of Pm 9 N•r he did nor brow nr icn o fm pupos of /+
L u owner of the m7ny w acl®Kly cone nj wiN lusmel mnu•cmu b C
ft
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S 7044,Boden W Pmfess{om CO,,,)Tho Coou•.K,L,
c.•v Lw da�mc applynmowe of v ,oywbo hriW,u irn r dcrcao,W
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WORK S COMPENSATION DECLARATION
1 hereby aRuly ander pointy of Prdj me of Ne follwin�daWdanr. '
1 bsK W will mainuin o CuriBeu of Comcm b,df-I.m fa Warter,Compen-
udon,u ProvidW for by Section 7TW of de Lab«Code,for Ne perfar.uec Of Ne
.art f«whkb Ni,permit u Iuad.
C I NK W MU.,iouin Wer ,COmpem•dao 1Mm,ra.u ngmted by Sectim
7700 of We Labor CoM.f«Nc perform n^^of Ne wh fa whkh Nu P.mir u iso d
Mr Workers Campr";r000 oro anis"Policy numb.am:
Curer: Polk"No,
CERTIFICATEOF EKEM PTION FROM WORKERS -
COMPENSADON WSURANCE
(Thu calm reed•«be mmpketl U Nc Pmoril u turns hmwrN do0an(51 W)
1 acrify Not b Nc prrfarrraoa a Nc wart for whkh Nu pamii u i .I"I ou
empby,nypeloninMymenary�y bap�oewpfxtlo NOWorkn'Compemulm
Law,a Calif _ [�` //AG
Appliom %��—
NO ICE TOA LICANT:If.afer n a nj Nu Ca F.io of Eaespti«i,ria,hww
bccone wbj=m Ne warts',Cwpcmadun proK of ua tabu Code,you mor
,JO rorWwitb mmply w i1, h prorivrm a Nu permit"i be cl,Od
matrl
zN CONSTRUCTION LENDING AGENCY
4.. Ihemhy Mir-.des dem u•,.W.KLmn kndwp•Fnry fa Ne p«fuma cuf
!Yi> du wrk f«N h Wu pvmit u Wood(Sec 7097,Cir.C.)
aO t�dar,Awe
a'z Lender,Adams
U O 1 rtify Nat I lure mad Nu•Wi'Lion nrW Ww Nu de WaK iofomullun u
WiWinS on lac .wd brmby urY,nd rcpr ouln .f,nd,uk u.w uvindb
UU abow-nOOmti nMcrtyhor ir , Nonrc mprc,cnuliK,of Nuolylasourupon de
r 0. ahoK-mcndwed poperly far impcctim purymc,.
(W.)16ru o uK.Lod.rufy Nd kap hanokss Nc Cry Of CuP-13 ,pdmr
Hf/1 IUMlwa.joo:m .coaWcap^"^,whxhm•yInmyway.a(aiml, Ciq /M
U APMICANT UNDERSTANDS AND WILL COMPLY WITH AL.NON-POINT Issued by: Date
SW ULATIONS.
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3�/�D6 Re-roofs
„['SYR or Applk•rUConu •L;r
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WiB Ne Wlb mfw«c NMI.,a avpot,rarc m h•odk heurdom esti"
u defiled by Ile CupeniOo Municp,l Code.Cbupuc 9.12.W die Ik Lh W Safe"
k.Sermon 25572(•)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya �Na
If a roof is installed without first obtaining an inspection,I agree to remove
Will ft applkwl Or fuv boildlnp onapam=cquiPo e a dela,whxb
emir h roino,w mnumimou n&Jk"by Bm WY Amo Ali QWIrY Mmgrro m all new materials for inspection.
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I hm mad the hvardau mw:ruu mW imanm„uokrChaprc6.95 of the Uifar
ilia Hcabb&Safay Code.Smiau 15505.25577 ad 25514.1 udcmaod Nm 9 ho bloke,
dos mr curtcmly IuK•¢nano Aar Ir or my rtryuuibiliiy w mdfy the or uoWt Of de
rtquhemenu uuRhmclpdormruvan¢of Ceni earOccupaacy. Signature of Applicant Date
All roof coverings to be Class"B" or better
Owmr« Na,vrG,pcm ' e