06030116 CITY OF CUPERTINO ,� , - ^"« •"+'"'�"° ``
BUILDING DIVISION PERMIT JICQNTRA" ' WRIINT'ORMATION
BUILDING ADDRESS: , PERMIT NO.06030116
09
RS NAME: PERN(T I$IIE DATE
BRIAN LUCAS
F SANRA"NO. CONTROL N0.
ARCHTTECTfFNGINEM: BUILDING PERMn'INr-0
BLDG ELECT PI11MB NECH
0
o a LICENSED CONTRACTORS DEC ARAnON Job Description
1 booby.14W
m .I 1 w Bc a Pmvisiaos.f cWP 9(mmmcndn{ P
wiW S. 70)1)of Dirlm WNc Bmi.ud Pmfatsbm COOc.ud.Y 1k IS
;'za mNil ImaWert ADDITION 509 ' -MSTR BED/BATH/CLOSET/DINING ROOM
; q:q LkOa am IY.r
ARCi MELTS DEEcLARA=N GARAGE 123 '
i�<7< 1 mAeesan0 my PB^„hall be uc0 u wElie ree«Ot
iyU
-� Licensed fiafusioml
OWNEABUrIDF]t DECLARATION
�>• 1 hcrtbY&Karo Nu I mi
p o ralbwin{ruavm(S«nk
7G3 1.5,eB—i Ofroum thPeafm i..CretdL:.Ma y,hLyAawr far we
kamy
$�i whirl rtquirra,Pani,w ckNacl.Isa.®pve,OcmWiW.«mp,b,n/swcmte
.za prkrb iu iuuasee.Wo 'he WWkm'f..h pm.il to fik.,i{ned
-is< muhcnlia�aPa:.mnlw�Pra.isan,arro.cm�.,,.,«',Lka��vta.l•w9 Sq.Ft.Floor Area Val prp000
(commawlo{Wih Skim7000)af Division 3 Of the But4rr ud Psaf.b Cade)Or
futx he 1.&&crop. Mnlrm W de bash f«We Jk{c0—Id—MY vlahlloe of .
Scmlon 7031.3 by tO,1ppB f«a pennil ttbjms ihc,ppl !.w.civ PemsilY of APN Number ancy Type
Nu fnu hwdmd dollen(5700} 32602002 . 00
❑Ido work.
ek P�sY.a ary v.pby<a w cfT { rw O(4 7 ,B
v modsewmkt.Co Nestmauwwnat wes mndcd«o da f«ale(Sec.70m B Of /LL�pr3I{eqd Inspection
.
W P yf w Comm 73e Ckucmft I tcJ s Oo date ml,pelt b, Iib of U� Pe
WOPenpW, h k,«impro,O mh,M wto m 1101v«kh .ffl iI. IL
ova emp&OtfildingwENnsuch ImPsm dmUmce Im Of waQuee f«s.lm B.
hova.a.lb<btd the wimp., r amid within arcyeir arirn k f .Ortow«tI
wile«ww wA the Nudes ar Prnnn{m,t K eie rot dow«hopmse r«w�of
LL } �
L is,.of the paNuvd
mpmy.w esy c w ctie j w W ®
it ¢d rnetnaors w
C me pro)ect(See.70a..Bt .ad Profweks Ceda:)The Caouuo s U.
maseI OOO.Ot.ppty b,n w a properly wba wilco«Wmp eenm,nW.
rhe caAxucu fm suet pmjw.1N.cma,n«(s)Bcumed pm,u,m n the Conu,nars
L arta Aw.
❑ tun undo$Cie .BhPC f«th6rau
� r L�
Due k a o/
S Ef! ` OW
1 hcrtby Nim abler pally o(per3wy are of de folbwln{dcclu.tkm:
sank,r provided for by L mi 3'3700 of ee LWx GCOc.f«Wu pesf«m,p¢of We
work f«wtia'h bV pOmlli.'u lsste&
❑I h.se ud w 11 m,muin WOr s Comprm,dan Iasara U iW by Scalm .
3700 of the Lab«Come,for 0c,Nfaysm«e Or Ne wkk f«whkh this Parch u Vase&
My Work es Campau.dk buunnO anis and PoBcy w,O a art:
Cvrier. Poesy Nc
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
Cfbh seetik¢ed mtbernapkvd if We NOat t is fameEuMtotO nm(5100)
«kts)
1 wtify utas N We purwm,«x a Ncph Wu pmait b Lm .I sbN not
evploy,ny P..Oi. nY a•°sFrs°u Or6Ase®"{rlaiu Ne Wa 'CWnPemnon
Laws of CalifwNi��c
NOTICE TO APP :1.Jer.5W.,lhls CcNOam of E.,ttOO.yk shkbl
saome sobjca m we W« es cm,,Owlion Prod,l«o a(Ne lab«CoOc,yo.matt
,J Q fanhwiN enm iy wvh mad peovitlom m Nu P it Nall k d=ncd mote&
Z "-' CONS I/CnON LENDING AGENCY
P14 I hcrcby Nu.lW Nae h.kmnuik levdin{.ffnry I.Nc grfar.uae a
C > LKc ra which dds pamil b Ws (Sec 3097.civ.Q
W0 Lcnke,N.
0.Z un° e.Ween+,
U0 I mnfy luta I iu, rcW wi,,pplio,ik us0 tt.e e,u ue,bow larorrO sn V
lL c .I q.b comply wiN,Ii dI,W county Odin W auk Ian rtluin{w
widintca tion.WhmbYsuuorimrtpcscuk sor Numiy.kwrapktW
r a aM,e.mcnuane0 rnoperty far impwtian Pnpo
(Wa),tun.innify P ha d,c City Of CUN,tino,t.imt
E' me b demW tr Ii.pllinm. W mewn.
.cow Wupr avhkh..y Nary ny,mk.taimtsak Chy /. ��
U? APPd6,W,kNOEMT4NDS AND ILL COMPLY WITH ALL NON-POINT Issued by: Date p
SOURCLkEbu pp
0.06' Re-roofs
Si{erort o ApW HAZARDOUS MATERIALS DISCLOSURE Dak Type of Roof
WBI ft ,i vt1Orfut.Malin{«c,µmtttam«linehmNm,nubriil
dcRwd by Ne CuI MOOi.*Cade.CWPt.9.12 aM Ue HOlu v WdY
-,seodon27sR(.)7 All roofs shall be inspected prior to any roofing material being installed.
C3'.
Yu @t p
« Nnid�nt oavgal me cyolpR,O1«dcvlcn whkh If a roof is installed without first obtaining an inspection,I agree to remove
WRI de.ppiiant faaau
cma hvardam,ir cmumi.ts as Ocfued by Ne Bay ASO Mr Uu.11ly M,sutcmen all new materials for inspection.
Disssimi
0Ya U{No
I rtadhvasdru,mascria4 ieTohrmvm,smkr Llupn69f of1be Gli(w
Oit4 N S dy Swkm253O5, 777md2573s.1wd-mmd8 if Ncbuildkg
dm vac te.ima4 it'nmY w'y''']]��lily��n edify do asognt a ase
'wuirtmed. V . n O'oCC1y'OC�y O/_ Signature of Applicant Date
owntr«,aNarvcO. i,��//,�If� /C` L�O�r3�5fw. F'> All roof coverings to be Class"B"or better