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00090003 (2) CITY BUoFoPFHrN v BUILDING N PERMIT CONTRACTOR INFORMATION: HUILDINGADDRESS ((`` P ,,/` PERMITNO. 'c•��C GO 7' Stye- J 1A 11N Q1171090003 OW'N'Ixs bi;A�592 POPPY n ' APPLICKI ION SHE DATE 569 bl©! 4r� /ri/- 2000 HONE: GRAY EDWARD _ SAN]TARY NO, CONTROL NO. mO0ARCHITECT/EN'GI.NIiF B U...DING PERMITINFO ❑ ❑LDG fLECI' PLUMB MECH UU I_I 1=1 1=1 t^ j I,ICI!NSF,DCON'FRAC'IOR'SDECI.ARN'ION , Job DCSCrIpt 0 0 1 hereby affirm that I am licensed under prop senna of Chapter 9(commencing ytj Willi Sretion 7(m(pof Dlvieion 3oftbe3Winces; 1Prol'—onv C,.R.nndln,license �r mllfnreeaaJcflr � 77�/7V:3 z S License Claes CC�� Lm.a a°LL )ale Conlon"or 30 YEAR COMP Y- ©�\RCHITECI"S )ECLARATION & 4 1,ttmtrsrnnd.oy plans revel he treed;,s po:hut secures 1� r p z Licensed professional OWNER-BUILDER bond the DECLARATION O a v, 1 hereby.(Sen that I am exempt ren the Coniaa.i C n License Law for the whnwi nopose,n.penount 7onsu livate,i prooc.fe,rami Gde:Any rifyort'ouray ore _which ey pe nit s consummate,I It a t J \h lair Y cert pdt, t t , .n.: a f ,pr,I. a n rK it t etc signed ed,t:,Kill e. (coli r In,un, 1 p Ise t Ii t t.L ' I (CI per) Sy. Ft. Flood-Arca Valuation (commencing,enh Section 11x0)ofU onion3ofthe Bu ides,endion.Axons Ctde) or mm he is 31.5 b any anuli anI sen mrd,.far ubj atirged e.rmatmo Any violnion of S n more 71131 S by any applicant dollars a Penni,subjects the applicant u,o civil Ixnahy nr sen:nnre than fivt noo,dred don:,ro(s5lxn APN Number Occupancy ype ❑I,a,owner ofthc prnpeny.or my employees with wage,m their sole compensation, will do the woo k,and no,arulu—is an intended Lir olfi cd for sole(Seer 9014, _ ss. Bmim,a and Pndtssmo%Code The Curb ors License Law sex.nor apply to an squired Inspections owneral looTeny Who hold.or improves mi and who does such wore.himself Through his own enmloycc,powided(la,sass,improvetam,are no Imendtd or oBe,ed fon..ale.If,hnwevrr,me building or impm.emen,is,old within one year of 305 — FRAME eNem...set—.rohodder will hose dx h—d,tiol ooin,mut tdid nal moldof a,powe far proton,of sued. 307 - INSULATION ❑1.asowarofthe p... erly.ameselusivelycomrecm,gsoimlieerwdcontractors to 601. — ROOF TEAR OFF prl comnoc,meto (Src7044.Bndncss and Pmfedons Codt:)The Contractor. 602 — ROOF PLYWOOD NAIL License I.ow does an apply o an own,orpralxrly veno mold. a'hopth roves ereon. and who contracts for such pmjens with a.mmracto %)licensed pursuant to,he commetor,Liam,[.it,. 603 — ROOF BATTEN ❑I am cselnpl under Sec, it s P C for this reason 604 — ROOF IN—PROGRESS Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penally of lerjury one of the following declumtionn: ❑ 1 have and will mnintain o ccniBcate of Cowan,to sell-o"me fur Warkcr'n Cmrl ematioo, as provided for by Section 3101 of the Labor Code, for the pod nrmm.im of,he work for which this perand is issued, . Cl I have and will maintain Worker's Cntnpeosa,ion Insurance,us required by Section 3110 of the Labor Ctdc,or the pc,d'onnnnce of the work for wmcb this permit is issued.MyWorker',Compemeion Insurance enmer and policy numMr are: Camer,4N IiR1TI11INiMPtst PCN - yUG O¢ PROM WORKERS' COMI•ENSN4ON INSURANCE on,senior recd nal be ronmla,rd it Iht re it,i,for one nnndoed doll., (S 100)or ll 1 eer ify that in me perhmnnnee of the work for which this pvrolit is issued.I .hull not employ any poison in any manner so as to become subject b,the Workers' Con senseion laws of Culltomiu.Date Appnemd NO'I'I WI0 AI'I'LICAN'1':IL after.....kind obi,Cunifiratt of Exanplian.you should _ became subject m the Wader',Compemnim,proc'ieions of the La a"Ctde,you must Q Q fnnhwim mm ply with ch provisions or this permit<hall be deemed rented. FCONSTRUCTION LENDING AGENCY C } I bechy affirm Ihal Ihcrt fix a ematruction leri ing agency for lire perfimnxnce R7 of the wok for which mit permit ie issued(See.3007.Ci,C.) 1 ❑ Lender's Name Z) z Lcndcrl Address V Q correct. ,,ndy that l hove Ind'lot,aPFlicadon nd,oane dial he abw tc lot..nation is rrect. :r. F I agree to comply with all city and county on inarres and static law%relning lJ onbuildingetn,stmction.end hereby aumonec representatives pt this city a,enter upon } W the ebnx-mcmiannl prory'ny lin incpenion puH,tnts. : (•a p,t (N'c)agree msuvc,indnnnify:md AetP hannlcs\the City of Cupcnino again. lianiliticc ludgmenW,n:Yln in cxpmud which tory In any way ntcnm ugnincl roil T f„) Z, CI "'ponce of the gaming vf,M1i>permil. 7 / O LICA ERST D LLL COMPLY WITH ALLNON-POINT Issued by: Date URGE ' N . S •oto nfn lis vcoo,trai Date Re-roofs 1 ZARUDUS MATERIALS DISCLOSURE r.II ser a i o.,doer,miming txrnpamt shirt nr n::,,ser n.ramou,mnedal Type of of as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety . Cocl,Scidi i25532(a)1 0N El Yoe, All roofs shall be inspected prior to any roofing material being installed. Will the opplicaolIn male Killing nrr.pa't all rgaipmomordo,sweswhich If a roof is installed without first obtaining an inspection, I agree to remove .,,it h...wits,air nmmminanrs as ddincd by the Bay Area Air Quality Managenem Dbm,l'r all new materials for inspection. Applicant understands and will comply with 0Ycs 0N all non- 'ource regulations. I have read,hr hoecNons m:arrials a,cu rcnent undo'Chuprer 695 of the Calimoria Health Y Safety Code Sections 35505.25533 and 25534.1 underarmmat if the building dtxs not currently haoc a senor,,than it ix my resq,roibllity u,notify the occupant of the requirement which must M sen prior m issuance ill a Cenllicuta of Occupancy. Signatu c f App •ca Date Own,,n,aon,oa,.e I agent Dam roof coverings to be Class "B" or better