01030005 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
Bun.DINGADDRPT10371 MIRA VISTA VWR-0a EXTERIOR SOLUTIONE
IURNIITNO 01030005
OWNER'S NAME: APPLICATION SON ON]'IT
BRUFFEY BILL AND EASTMAN PATRI - ].77] SMITH AVE 03/01/2001
PHONE: f� as//2 SANITARY NO. CONTROL NO,
(408) 35B-1233
G s 2 ARCIII'I'LCUENGINEER: BUILDING PERMfIINTO
0❑°❑ IAEA' ELECT PLUMB MECII
yj LICENSED CONTRACTOR'S DECLARATION Job Description
°z`T,C I hcmby A ,tout];an licensed und..provision.ur Chapter 9lcmumnlacing
ml- icl wish Scation'/1NXp of Division Jofthc Rusincxs and lh fcssio7rvs�Cale,and myliccnsc
yS i'in fall RarecicedFiles, n'fT� 3�1
d aU LicenseCWcx / 1.ic.p T SHAKE TO 0LB FELT AND CELOTEX
t- Call,—��/ Commn�{
W 3 u.y / ANCIII s used
as public
1 understandmy pmrrs xnml x a.md an Pamir recallla ��-�� t Z �L YW 00{7• '
r
dp O IJ ,d1 11 fio,sionel
a.
o OWNER-BUILDIiR DECLARATION
I herehy anion that 1 am exempt Iron the Cootmnor's I.icen.c I,aw for the
C 3¢ allowing meum,(Section 7031.5.Businessland Professions Code Any city or amnty
S C whinbonctore,ri vF,anm,On,lmI h r.' - de o1Wh. P y:mmloe. .
tic
printt)its loonareve,also requires the applicant lot ch varril Ilifill,a signed statement
that he tivemsedr :ua,t the r.......v mine Coleman,t r',Lietao,on w (Cle,aer9 Sq. Ft. FlfnxAreap- Valuation
(unnntenang with Seddon ANNA of Psimon 9 Of the Business and Pmfi ssioos code)
OF mat he is exempt therefrom and the basis lar the alleged exemption.Any indmionQ p $10200
of Sectimr 71131.5 by any appliemn Iia a permit subjects the applicant n,a civil penalty
of net more man rive hundred dollars Wild). APN umber Occupancy Type
0[.;to owner ofthe property,Or my calplayets with wages a%theiT sme com,reastition. 357020422. 00 e31C/Z.
II do the k d file smanclare ,intended mored for sale Sec.71HJ.
[to, 'Profis,ion,Gee:I he c a t Liverse
'I does nil
in
Required Inspections ctions
owner progeny Who Will at d m dor such work
fin i 305 - FRAMEor through is ncropl pelvided that rowenorns a,,Fit initiated Or
dere If.n-b .in building improvement is Told within.one yea,at 30 - INSULATION
nal ti tie r-n Id u have men d r proving that l did maid ,r
linporiou ba_Pp' 'f"I
601 - ROOF TEAR OFF �J
C1is rth tritely, I lively commili,wilhrwrised ronanni,ons 2 - ROOF PLYWOOD NAIL / l �C
Li,netmat the Pr!jCa(See.IIWJ.Business and Profession,code)The Centimeter's
cense Law Joos not apply to air owner of prnpery who Walds or improves thereon, - ROOF BATTENS
ho o
and w . nusuc
es for sh PrIi"is with a comraatrov)licensed puraval,o the vJ
Contmcmrs license l.aw. E04 - ROOF IN7PROGRESS
❑l as e'clop,till ,B&PC!minis mason
Owner Dare
WORKER'S COMPENSATION DECLARATION
I hereby Haire under pcally of perjury one of the following declamrim,
❑ 1 lluvc mal will oneunTon a Carnfteme of Cun¢n, ,,self--incam for Worker's
Coar,mos non, to, Avoided far by Section 370X1 of the Lams Cada. far he
nvrlirnnawe of the work for which this permit is issued -
xJhave and will maintain Worker',Con,vii,o ion In.wrmnce.as required by SCenort
i of the Lahoi Code.lin the Per(unreme of the work far which,his permit is
11 J.My Worker' Com icon Inwrum care IF d Policy norther ora
riMe11 20 cr/o.IN` .5�1�/1�2238 9/
earrcr:�j ,e 1G_rarer I10
I'lI1CC NDSAI[ONINS RANO WON LNS
COM1IPENSAI'IQN INSURANCE -
T Iris,stun.,red n t In nmrplomJ if the permit ix for one hundred dollars
SI 00) ,,less.)
I cenity drat in the performance of the work for which this permit is issued,I
shall not employ any Kbon a.xev manner so as to become subject e,the Wo k,,,'
Cumopenoadon I,.mwa or Culi Grmin.Umc
Applicata
NGI ICI!'1 O APPLICANT:It.Mitt making then Ccrificmc of Excnrntion,you shoo Id
become alb oo aide,Worker's Conrpemmion proOcinre of the Labor Cods,you mood
Qlonhwith comply with ouch provisions ar this Penni,shale be devoted revoked.
FC(INSTRUCI PON LENDING AGI!NCY
a I herby action that there is u mmtrvamn lending agency far the perfnmranee
of the work for which this permit is issued(Sec.3097,CO.C.)
Coo Q Isnder Name
D 7 LcnJo's Address
V 0 1 canny that I have real thio applineion and state that the aboveirefomrmian is
R. E.. corse.1 agree to comply with all cit and county o,dimonsI and state laws retailing
!�
no handidng eonWaaion.and borer,Falil repre,coutivex nr this city In enter upon
yrJ] the ah—u-nnenfianed p,c,.y for inspection p mIc se,.
po (We)imueto save.indcmnlfyanJ kccp harm wa the City of Cupertino agaime
V1 i n"I'll,'r •menu,cows and •xpense< rid ny way aecme against mid )
U L City in m pmnee of the gra r/ /of it �c t /
API' CA 'N AN $q Ate HALLNON lIK sued by: Q ate
SO /
'len mornpnreanUcomloaar Re-roofs
IIAlARUOUS MAl1iNIA1S DISCLOSUNIi
Willthe applicanterlimmm.lwnionstzenp:nn.earn nr Handle hxmNnus material Type Of Roof
a derecd by rhe Cuperino blunidnd'r.le.ChaPmr 9.12.and tar Health ane sxlc,y
Calc Section 255320W
0Yes IXGo All roofs shall be inspected prior to any roofing material being installed.
Will horn,he;m.menoo,Noblingocenp.rm a,,egaiptnealmdesice,which If a roof is installed without first obtaining an inspection, I agree to remove
emit heeaNam air counterm n,os defined by the Ifay Area Air Quality Managenmm
Disnrict7 all new nlatqials for inspe, to 'cant understands and will comply with
❑Yen "o all non oi f source r gul' io _
I hese rend the hniardonx mmerials requirements under Chapter fi 95 of the
California Health&-Salny Csde,Sa"a 5 15 kllldl 55)a.l understand that -- _
ifthe bullJim ow.notcurrc tlyh:.:n aeyamaiidityto nnufy u
acupam d rico e f a L'e Tea til
ove _ its dtureofApplicant Date
-21 ormamni..rd agrmrt nn� Il ' All roof coverings to be Class "B"or better
OFFICE