01010129 CITY OF,CUPERTINO ? .
BUILDING DIVISION PERMIT - CONTRACTOR INFORMATION: '
RUILDINGADDRESS. 4` '° PERMIT NO. '
1.fa7'J 3 UL:L:r1 G.-TFFE" MtdflpF]R f.4L1EV.-TTY _1
III3;ChICi (1:Lid1.Id1:i"a
• -OWNER'S NAME: - Ir- - APPLICATION SIIB DAI'E
S?CI'I(-IDLE 1.86A61L:P161IEi:N IRT7 i%1].J:3:L/r(i1E1a:
• ONE SANITARY NO. CONTROL NO.
/ ny It
v
AR&HWEC'VENGINEER: - - . - _ BUILDING PERMIT INFO
BLDG ELECT PLUMB, MECH
LICENSED CONTRACTORS DECLARATION'
ZO 1 h by 0 mat I a 1'c'nsed u 1 p f CI , J(c,mme 'tg• ` •. i Job Description - - '
C W itn sI m(Mp rn 3.f BI P r ssa le I ry li Ise
in fa°cl`., Delloflof t5' L « I•-1Ll.lI*ITi:f.(iild
la -ARCHITECT'SDELI AR PION
1 J f d Y pl' 'halllllbe.,a w uscJ as publin,recnid.. '
Re _ 1
�p a Lice. I Pmfua o al -
&o OWNER-BUILDER DECLARATION
u7 1 affirm th t I pl fr n the C t t L L w Inc-
C y toll: g dos (Section 1H
9I 5 B : d P [:.' .Cod Any 'ty lry I
�j5 A C wh h l ixu ,t Y II P demolish,I'. p ystructure
63m pnot I. q .m p�l It hP 11 II g Lrl nenl - ''I �•
thathe isap : Il n m tth c -s Likame L
' - '(Clapter9
("un g th Section 90M) fDl 111 B I professor,snCde) Sq. Ft. Fl - Varluanon
b $3800
that he is exempt therefrom and lh�basis for[he alleged Acimpviolation
y
n(Septiont7031.5 hyrllydppllaaoftfirape t' n klho.pll' tl civil penally - -
;3
more-anremanfivenmufreddenar,($500). APN Number. - Occupancy Type -
iGP1 i(d;:33.Idfr1 ,
❑1 f he n par toys'd s. .d : 1 p ion - .
will d th k d 1M1 a t : lbrooded IY 11- (See.7044,
Bae d P f.. Code TheO I t :L' L does (apply to an
oemployees. - Required Inspections • '
f property Whobuilds p ve ih I h J k himself
or ,ugh.his awn empl yees prov ded that such npmvemn t,are not intended or 20(.? -. L)NDURF'L.Gf,R r4.UNB I:NG
cantered for sale.If,however,the holding or impmvcmcul Is sold within tine year of - 30'1:, • 'W.101-1 r'LUI*ITiWNW..3 a
noconnotation,the wo...huilder-will nate the burden of proving that he did nor held or
nprov'RaparEseefsale.): ".50P FI:NAL. rq_uirf l,n, air-J.-ny .
- °I,as owner or the property,Inn exclusively curbacliog with licensed contractors to 4`50 .6. 't '
construct the protea(Sec.90,lL Business and Poor..tar,Gide:)The Contractor's - 4101 FTNN... ,I-L_l.11•IE;.I:hlfi-
License Law dues not apply to an owner of property who builds or improves therm,' ,
and h t t f such m.'ecls with contractors) h f d p :wnf to the
Com 1 c 1 -
°14ral w ,R&P Cfr this muse'.
Ow Dwe -
9COM-aleTIOND:C/]RATION
Ilmwhyatfi1erPe;ud,oi'pel rY a Ith fol leingdc,laortior, - r
I dose and will 1 id C y t t 310Consent t Il n f Work,,',
he '
Compensation p d J f 6h S 1]00 I II L b C d t the
perk fm work for which this proud J
°Ih J 'lllainl W 'k .0 pt I I: eq ' II S lion
3900 of the Labor Code,tin he part oma ueottt the wok f o which fit,s pum t s -
Curr tl.h1Y^ sI iC IfEXprohGh1I'TION Fl policy, M.r u � OOO ��Oj
COMPENSATION INSURANCE l(I/�pY- .
(this aaction need not be numicted if mu permit is for no hundred dollars
1 coop that in the n in anonrann she work become
ieh this permit a orke,I
shall not employ any person in any manner aei In to nccomc subject to the Wod;crr' -
Compenmtlon Laws of California.Date
APPlicam. -.
NOTICE Tn APPLICANT Jr.aft Ging 1h C1ao oPy ^
Z become subject tothoWt)TkCompetisationpsoI the Labor Codey.un .1 ..
,10nt with co.ply w 1h such provisiom,orth loornat.hull he road it revoked, '
u
nCOC Icons LENDING AGENCY _
1 h 11 ,n hereby that
them
i construction agency r ro
of It perfor nanLad 1' 1 h m permit issued f5 .iU997,Ci,C.) - a r
er's Name
Lend AJdtt,x - � f 1
V I ttIt
yballha ere dth ppl'm n nd,tt th uh ah f i tis - ' AI I �
W F
correct,1 egrc I PIY with all city 1nA 1Yordinances and state - eating IYY f1
C.) mbuilding en.tnnt on and hereby authorize representatives of[his city nl tenor upon
W
the uh(W) s toneP P We (Yp dk pho le.-lheCty fC I I 6 a , '
y liahil t J J6 s. I 1 p :. wh h Y'n anY w y c a uga nvs d - Biot
U 7� c'Ir m me grant m df,Piro' IU7911 \J GGJJ'
APPLICA UNDE NDS t U WIL,m ,Y WITH I L NON-POINT I 1-70 '
I r , UL ' s 'Issued by: � ate ('r V
.gt App c , - - Date Re-roots -
ALARDOIIS TERIALS DISCLOSURE _ -
w;Illnellppheamnrimurenuilamgeceupantsmre.rmlwlebt,nann,nalmal Type'of.Roof
as defined by the Cupertino Muvieipol Code.Chapter 9.12,and the Health and Safety
_ Cafe,Section 2553201)" x '• '
-
11 Ya, a>� - All roofs shall be inspected prior to any,roofing material being installed.
Will tireappy rotor,building ,squip tent d which .If a roof is installed without firsi obtaining an inspection, I-agree to remove
nigh d can coma ems a,delrv.d by the Bay Area Air Quality Management
,
lsnlm^ all new materials for inspection. Applicant understands and.will coin 1 with '
❑Ye - rrl�` ;,, P PP ' comp non-poitit source regulations.
1 h ad men nl n serials requirements under Chapter-(9s f the - �,
Cain HAIL&Safety CJ Section,2550525511 and 25534.1 rrm,,soatd mut .. "
ifthebuldi gdo"dol r, 'l - 'lentil❑ t'I y'xp 'Hl lye ffy We
t a l the aqui 1. h' n or h t prior to 's orf a Can fcate of
��� - Signature of Applicant Date ,
ter onamhoriz - , -D.,e ,, All roof covering to be Class "B'!,or betters a
OFFICE .