00090080 (2) CITY OF CUPERTINO • - - :-!;
BUILDING DIVISION ' , -PERMIT' CONTRACTOR INFORMATION:
BUILDINGADDRESS: - - ` ( PERMIFNO. -.
OWNER'S NAMIr2146,•DEAN C r_. RLL SVPSUNZ3r 'APPLICATIONS ..
TONE: • RIOW AI") " • .� - •ANI'1'ARV NO.
to .
O�O ZQARCHITECTIF.NGINF.F.R:. BUILDING PERMIT INFO
•BLDG ,ELECT PLUMB r MECH
in¢a
I'ICENSFD CON I'RACTOK S DPCI AltAr10N
a by Ir Bal :ed J p of Chapter n b _ _ I Job_Description .
IIS t 700FID "t 3 at d BrearesiandP f '. C Ie nnJ id,down, -
a f1el " enlr a X5409/
x°
d° )a, cull RE—ROOF, WITH WOOD` SHANE CLASS
In LL O v _ t ARCHITECT'S DECLARATION -
m anderamnd n y pp e,xhill]be used ax Pable,records
Wr
Licensed professional
OatNYR Br1ILDCR DECLARATION
' w=�u. Iherebyaffirmlkll� Int - theContractor License: L for the � � •� •4 � n •
ahollowing reason.section 90315 Business and landfirsoans Code:Any ey moahty
wh ch requires a permit to f,aller,improve, I 1 h p it any structure i,. -
w 3 Pr' I II reg ti PPI fir hp 'tt 11 a.'g d t t men ., „
that he l ...dpmrand to the,ar-man,ofthCmuriade,Liewea,L (Claptor9Sq. FL' Floor Area Val'7
..
(commencing so do Seclon 7000)ofDvi.'tt 3 of the Busre and Pride,io is Cod,) t '
or that he is exempt llrerefrnan and the 6nsis for the alleged exentpdon.Any vlolwinn t}
Lf SaetiLn;ID31.5 by any arplicam Por a permit suhjcets Iho eppllwm m u civil,inalty
Lf not ntdre than five hundred d.11m,($500). APN Number - Occ pan - -
..❑1,no owner of the ;•.. -.t .
P Fa Y rl y ' g Ih ' I p 70 .. .. .,. •`i
,ill l n k l th I t induced n e r sale rpp y toa0. - 3570902-4 red Inspections
Bu.' - d Professions Code Tt, ro nl I I I d t an
ownerughtod7ppenyWh l Id lnned Ih ndwh e h mudded r • - '
Orth through h: 'f, Illy, po"del the( I_ p - n [dw LemnchrV
nncelf 31e IC h theb 'Id g p neral 11 within y riot
�. pit n h Id dlated nnha rnov
n,Ind eadmtn Idor 305 -- FRAME. a .
rap ero napLxeLl Ie) 307' = TNSULATION
01 _treat,ofn n rear 1 xl Iv claranderaij, .,it licensed"num I .t, 601 " :ROOF TEAR 'OFF
t t thep J t(S 7044 H d profession,C d )TI I
C ' t . r '
Glc Law does hotapply lit an too n f prolierty who-nld p xm 6031: ROOF PLYWOOD NAIL
. .
and 1 nt m, tx with contractor(s)II pa rent t the 603 — ROOF BATTENS.
Cont a e r i' L t
❑1 exempt under Sec B d P C lar this}et.on
' 604 — `ROOF` 1 lool,PROGRESS.'• ', ;p
Ow r Dom • - , .c
-:WORKER'S COMPENSATION DECLARAI ION -
I hereby amet a tder Iwnalty ol'perlury hoc if the firlirexhigheidaroaddicall:
1 hate and will houlu'n o Certfcate of Consmt m elf'rearo,far W. kis - -
'omp n m po,ickd fra, by Serlitan 3700 r the Labor Cale' for the
,oupormarecartlic,,ank far which thisp ire ....d.
+❑I haverudwll ne t' W ke 'C P :t' e,asregtned M1ySertuad
3700 of We LaM1Lr Cod far(he p f man,,,afthe work for wh eh this per n I is - J
'med M�/yl/r�A/�rvC P :'uta ln.wr and Pal>'cy nu nbe1r.a/�re rp/ '
Garro V/•III{ft/LL{L Pnl'cy No. V/C)^�O'II Ir� t:r �t $ - _ r
• CERTIFICATION OF EXEMPTION FROM WORKERS' -
• COMPENSATIONINSURANCF. "•A "t. "
, (rtis ,ei n nceA nal he remodeled ifine permit is far Lna handed Jnllun ' -
I Notify then in the perfomumrene iha work 1'became thi.permit a Worker,' • -
skull t employ y k Y r so vs m become suhJut m the Workers n -
Cot p maTnv Laws of C I'fnrn a.Date c }:
Applic E
NOII come subject
u j APPLICANT Ho Worker's
Compensation
nprC sirars fon Lampunn youuthulJ .
become comply
utsev p,or
p . nx afore Labor Cale you nw4 w i
I Z'O fonhw th comply with 1 p inn:.nr Ih pe ni t shall be deemed revoked -
, z
CONSTRUCTION LENDINGAGENCY `1 h by fl t t d .vu I len f g agency I the'pe fonnance
W Leah work for hlchd .porno's itsue,l(See 3092 C'v.C) -
� Q .Lend .brute, „
Lend AJd ssto
� (.
f..) .l eenlythat i he read thispplicat d onarthatth ab e'hararmijimsti,
'..W Fm carrowt.1a8 to comply with all city and commy Mami had late Ioe,,hehotih, -
QV tobuilding tin,and heeby authorize pu.enrTc,oefl his city m enter upon
c - c
the h t nn i ned property for e"e" ,P Poxes
p•t (We)age.to save indemnify aid keep harmless the C.d,of Cupen'no age
FI VJ City into. 'ud•memo costs ran in c which' •judgments. expenses h' h may in any w ern nn said
,
-way nc e ago .
t„1 City in co,u UNDERSTANDS
ofd granting oN I permit.
APPLICANE WIL DIMPLY WITH ALL NON-POINT
' sovace REcuLATlorys:r � "Issued by:�•- . ':Date '� I
Signature fAppl'c mVC nba ILr s PI "Re-roofs '
HAZARDOUS TERIALS DISCI OSURE -
Will theappl'ca t or fm h "
r ngoccupamsmreoh
rutdhilcowdoua nateail t�Type of.ROof
acdefned by the Cupertino khruiciplilCoda_Chapmr912,and the Hcalth and Safety _
Coda Section 25532(a) " • a
Ely ox - -. AfNo '1 - All roofs shall be"inspected prior to any roofing material being installed. . .
Will(he apphcudltlrntmrebuilding occapintuse equipment(it ne-coo,which If a roof is installed without first obtaining an inspection, I agree to remove
emilhvunlous air wntnminams os defined by the Bay Arca Air Quality Man agement
all new`materials'for inspection: Apphcant understands and willcomply with
❑yd, " _ all non-point source regulations.- '• ,
I have read the maz does t teal:requireareav,under Chapter 6.95 of the
w i
Callnl Health&Bre
l rnet,Cde Sections 25505 25533 and2553q understand ht
Ifth h IJ'ngJ of currently alert It titi. tyresponsibilityt ilythe.
ocupam of the re mIcher m which must be met Tun to s e of a Combe ue of
oecapaner. a Signature o• pplJcant Date
Q-'l4r�:' ,_
Ow-• atmo..ed ih - Date All roof coverings to be Class `B"-or�better