00120123 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
1{UILDING vilijVISJJIa WUNDERLICH — pr:RMO NOt iJ='IA '
OWNER'S N41MGERTY e APPI.ICAT10N g4111 H/2000
PHONE SANITARY NO. CONTROI.NO.
S A-N A1VC_1 Sc to ti
WO ARClll 'rBCIIIiN(ll Nlili R: BUILDING I'IR1,111'INFO
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W❑ IfLU(I CLECI' PLUMP MICR
FEW I -1 LJ IUI CI
y LICENSEDCONTRACIOR'SDECLARAIION Job Description
I Mien IGnn d,at 1 am limnxod under I'Cru t 9lcomttcricin
yes pmvProutu o per g
F,mFw withfllI, (and ItllisisionLrflheEll<inssnunJPOmfessionsCsxle.nnJmylicen,e TEAR OFF TO FOAM
a
i..m mu lirrec and eve t. 3� Lie.a �—Y-•����
a Licensee claxx
3 d° Datc��'>� �_ S DEC
I' ECLALA���L ..
Lei nRCIIIII:C
�f ndemtand sur plana xnml M a,ed as pantie rm.rmx /
Idn p p Licensed professional
e, OWNEm cocci t front
ntte DECLARATION
L'm 1 hereby.suet that 1 am eeenga iron+the Contractor's oniCash:Any c law for the
t->.2 bdlah es,nos ntlSa.III ,J un mE.alle.s and
.moo.dpsiorsistaylilymammy
SG uiir ras,ioa InrmittocanxwvL xncr,iImr,c Jcnn+liill or,a,iraddx,.cl arc
i3m prod Ic I. I II II+I II 'II III :, Jfl•nsm .
tnnM1 11 II d I 10 t I a I 1 (Chapteroc) Sq. 1't. Floor Area Yitllyat,�on
(nthathes eempttnonom and tDiv<oJof the Eged exemption.
Any viC,dd Y J J.(�r
or io is swop.therefrom amm and the t ci>it the allsubjects
the
applicant
Any l violation
ofSection m.ion 3031.5 v any applicant forit pctmil mhjens the applicam m e civil penally
m net more m:rn Eve hundred dollars Insall. AI3 Num�,e Occupancy Type
❑I,d ownerok, pmpetlK ormyel+1 It,,,x,nd,wagesux Iheiesolec(Se.7044,
will An Inc wnrk,and ILC emucmm C nn Inh.•n%Li or w Law roe xnot(Sec. to ant �g rr
woeofandertyWhoo.bilirlM1Cn�licac..annselawdt,sum,lapplymf ^05 - FRA
o(it
rorhisoyWhoi,esarLvided t att suchandwho Antsevertortenied or 3
ered for-I n It.canpinym..par lded that such imrmsm i,+emx arc not intended or 307 — I NSI JI AT I ON
offered for cele.11,however,the building nr:men ofpr%n sola he did one year o1 v
iomodinn.theaw,of,Alder will have the burden of proving that he did not Mill or 601 — ROOF TEAR OFF
mpmrc 4n purpmc nf,ula).
ori.as ew act othe"I'losny.am caaa,ivcly e,+,nraedntr w;:ll I cen.ed centrads,,l„ 602 — ROOF PLYWOOD NAIL
Lnao-acl Ihu pti)ccl(sec,70,14.13 in...and Promxxfonx Co f,The Comina,or x 603 — ROOF BATTENS
ice),c law doC art apply In of pmny who hood,oe Il,rpn es herein+.
and our comm:xl lire.auh n^IN' +swlm
ill,a soulodeef9 licensed Imrxaam no the 604 — ROOF IN—PROGRESS
Contractor's Liam,e law.
01 am eaesnpt under Sec. .0 h 1'C for this ri
Owner Dole
WORK17R'S COMPENSATION DECLARATION
1 Ma•Ly u0il'm anter pcmilly of.......one nr l.a tollowing Jeelarmionx: ,
1 have anti will mainwin it Cedifeute of Concern to sdhinw e for WnrIwr'v
nnpenwtion, as prnvidrd rnr by Section Pip of the laMr Code, for the
rfotmance nr tette x'orA lirr whicr Infix peon..is issued
01 have and will maintain Worker'.Compensation Insurance.as required by Section
Pal of the Lahor Olde.for the perfnrmmnce of the work for which this permit is
issued.sly
//Worker'x/C oou,snvliun Inummce canner and policy fainnhcr areVVNit: 5 :
Carrier:( T CERIIII ICA`T ON Up li%IiM141f1N F _4?
COMPENSNriON INSURANCE
Crni%section need not be completed if the permit is for one hundred dollars
(S1010)or less.)
I ccnify thin in Inc limit)rnmnce of the work rnr which this prior is issued l
.Wdl nol employ any pervon in wry msmne,no;is to act it,en i,cr nr Ire Workers
Cnmpmdallou bowl of Culifnrno fare
Applicant
NOTICE TO APPLICANT:If,after making this CeniGeme of Eserapnien,you should
eovubyect In the Workc's Compensation provisions of the Iab,n Code,you must
C O Mme forthwith comply with such previsions or this permit shall rte deemed revoked.
z
E•+ ^ CONS'ri ION LENDING AGENCY
a I hcrchy ufEm,that there I,.,collntmation lending agency tar IM performance
o1Are wod,far which thin parotin ix mi...I(Sec NN7.Co.C.)
Os Q Under%Name
7 Lender's Address
V Iccnify that l have read this application and late.hnnhe above infm maim is
ounces.I agree it,comply with all city and county ordinances and vote laws relating
U rebuilding c,namnion,and Wrehy amkniae representatives of his city to enter upn+
the aft,rve-meminneJ pntpcny for inspection purp+so.
a
�y ps
(o1c),cen, avu,antanuoy' I keep1 I'. IncCity if ilpn raglid
UW Cityi ' 1Jk I: P c.w1'i 'y Ingwy. .. E'ansl nested
7 tiny seen.egae c r he j_ranniu,tl otate - I .
APPLICANTUNOHRSTANDSANTIWILLCQMPLYWIrHA NPOINT Issued b �pe AA) ,70rvi Date 11-l�z90
�(nCi t�CC REGULATIONS y'
��L_or —�
s�gnamre.,-Apprcamcnmmcler Um,: Re-roofs
"A"bri'Us MA'1'IiRIn LS U15CLOtiUNIi
Will nm applicam or future adding occupant xtomor M1aadle nary,Jumnimed:J Type of Roof
as termed by the Cui atiao Municipal code,Chapter 9.12,Iced the Ilculth and sunny
Cod,.Section 255321u]f
DYex All rooks shall be inspected prior to any roofing material being installed.
Walsh appEeantorfuture building«=upantamequipment ordes sertwhich If a roof is installed without first obtaining an inspection, 1 agree to remove
emit bacallou,air vo,aandurds as defined by the Ray Area Air Quality Ylanagemmnt
.Di mr! all new materials for inspection. Applicant understands and will comply with
0Ye, all non-point source regulations.
1 have read the ha,andoo,Inow6cl...qulmmena u nk,Chup¢r 6.95 of the
Culdornin I lcWlh h Na fay CoJc,Seclions 255115.25513 i 1255]4.1 mokst n Idau -- //•
it the M,udingthen not cnrrcaeyhavea lcanmL hate:.„mym,pan,ihlity tinnily the ��'
weapant of the tcyuiremcnw which must be nor prior m iseuamcc of a Ccn......•of !!!..- / f
°" Signa u of pp scant Date
j ��
netur 1 treat Dale All roof coverings to be Class"R" or better
OFFICE