00070122 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ApIIli RICHWOOD DR COSMOS ROOFING PERMnNO.0007012
OWNER'S NApy APPLICATION SUB UAI'1:
VhRAJEIKAR 450 SAN ANTONIO RD 07/20/2000
Its a 10NE: SANITARI'NI1. CONTROLNO.
(415) 493-6373
GO C ARCHITEC1'IENGINFI R: BUILDING PERMIY1
T'INI
❑❑ BLDG 1311IiCl' PLUME MECH
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FF v j LICENSEDCONTRACPOR'S DECLARATION Job Description
CO=GI hereby affmn that I am licensed under provision,of Chapter 9(commencing
ml-W withSeeont(L.I'uol3o(thefavors,andProfessionsCeeandleylicen5eRE—ROOF
�zz6 Ii«nuli fl rre ander/— I.ic.p_/_!J _ 0O
rC
0 H Dale/� l�OV cnnlndnr
ARC EI I'Ibe'1"S UECLAR_A _ _
_
C t` g I undcamnd Iny plans ah:Jl he uncJ as pontic re....cailx
w O C Lieerwed lionesntonA
K OWNER-BUILDER DECLARATION
allimn
a a 1 herehy l that 1 aexempt rmm the Contractor'.I Liceme law ror the
7. fnilcu g reaw,n.(Section 7031.5.liminess and Prdeasiors Cotte:Any city ler county
I,�Ep which re,firs,.permill t t,allm inuiplivir.dcnnolikh,orocipairy Imucome
of prior to itlrc, I. y thicalinicial forsuch world II,fl a vigil:rt nem
fell he is recr,rdI II the I n I(lie CoullklAl Law(Chtrpter9 Sq' Ft. Floor Area Valuation
(a,mnelec tgwth SectionINS)tf DII vien3'It the Bu' Jl oles oCode) $2720 '
I,,mal he n cmurpl theml n and me bash for the allcgcd i,muluion.Any violation
ler Section 7031.5 by any applicant for a fit%objects the applicant to a civil Penally
(if not more than axe hundred dollars asap. A PN Number Occupancy Type
01.as owner oche n.or to emloee%with wa their side cont ten, 36908044. 00
pn,pc Y > p Y gcs w pen=s
will nc the work,and Ihe ode I e is not intended,License[.;,,; ore hale[Scc. I"an
Ermines and i fty Wiil,th rerun i ulvvl0 mrsLdw Lan:docs h ,rk l m am � Required Inspections
owner of,rmperty Will,noires m nopmrcn n udh nnJ subs enc,nem wank Ided er 305 — FRAME
or offered
r hn own cmpinyce[l pnrvldcrl Jot inch rencrupein Is vols wi nal line year or
comple for sale.If.bowevm,lite wdvet a irdenof prol'n sold within nor year of 307 — INSULATION
intprove for thepose of sale.)r will have the burden of proving that he did not mild or
mpm.e en puthn�ur,me.1. 601 — ROOF TEAR OFF
CI 1.as owner nftne property.am ceew.ivcly contorting with licensed contractors to 602 — ROOF PLYWOOD NAIL
consumer menil(See.two,Rosiness and Professions cera The Camman,s o 603 — ROOF BATTENS
License Law doe al apply m an owner if ptoil who bmikk on mNrti oc folmon,
at It ho contracts nror such project.wile a eortruamrtsl fecowd por.;lmtl In tire 6@4 ROOF IN—PROGRESS
Cnntmaors License I.e .
❑1:,in eve If under Sm. .Il&I'C Ibr m,x mew,n
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of Perjury one of the following dcclaratlona:
❑ I have J Is'll "Aim4ill if CenwidII W rA
CaI ,rp f by S U IM1 1 1 C fir thele
(/
pert �rI theort.Ir which this I I'.%s%u of
J
3I have and off maintain Worker's Compenvation In,umncc,as,neRuiredl by Section
00 of the Labor Cee,for the perfonnl of the work tor which this .oil is /^
ucd.My.Worrkeerf'%Compensation Insurance carrier and Policy manner am: 'g )
Carrien.7(�µCb Jw'w^ I'ot ic,Not,J_ — d � �it.2-� v
CFR'I'IPICAI'ION OF EXENIP'I'ION F OM Wol inti'
COMPENSATION INSURANCE(I his w•etion need me M completed if the permit Is I'ar tine hnndlcd donuts
S100) it less.)
I remit,that in the performance at the work far which his permit is issue,I
shall not employ any person in any manner so as to become%object to rAcr:
the Wo
Cnmpersauun Law,of Cmifort Date
nppncam
NGl IC,.TO APPLICANT.IL utter ntAir,Phis CeniOcule of Ps,o,d nn,yon.hotdJ
Q Oheroinesondem come Wodcfs C.... mnoon Provi=ions of the Labor Cute,you room
fort n ur,ly with ouch pmvisin I,or this Pennh=lull he dccmeJ revel
CONSTRUC'NON LENDING AGENCY
a1 hereby affirm that them is o construction lending agency for the performance,
of the work for which this permit is issued(Sec.NPI Ci,C.)
ALcnder's Name
7 Z Lende,s Addm,,
U O I cc dry the I have I—I thin u11111i'llion nnJ s,am that the above Irbil Is
Lu f., correct.I agree In comply with all city and cct my ordinance, au1 stale laws miming
V to building constructionl and hereby authorize rcprcnenmtives arils city to enter upon
} RI the above-mentioned pro,coy for lonfi tin proposes.
[•" G (We).,me to leve.indemnify and keep hate the city ur Cupenims again,
W liabilities,judgments,costs and expenses which may in any way accrue against said
t, Z City in c nscyuenee of the granting of this Permit.
APPLICANT UNUERSTANQ. WILL COMPLY WITH ALL NOI�T Issued by: Dil(0
SOURCE RF.GULAI , /��/�b
Signature of nplliemnuLtin,neor Date Re-roofs
IIALARDOUS MATERIALS DISCLOSURE,
Will the applicant or inmm building occupant ,am in hatndlehaatdmis mammal Type of Ro
as defined by the Cupcnino Slunicipat Cee Chapter 9.12,and the Health and Safety
Calc,Section 255330,^
D Ycc tSN! All roofs shall be inspected prior to any rooting material being installed.
Will le nlicuutnrfomrchuudio,esculuse ccrimmmlmdevil which If a roof is installed without first obtaining an inspection, 1 agree to remove
mlil w�lcn it; I us fell by the Bay Arca Air Quodity Manugememt
„,,,,;hc„ulnas tilt all new materials for inspection. Applicant understands and will comply with
D Yes . Il. all non-point source regulations.
1 have real the hmardaue mmenals mvulmmems under Chapter 695 of the //
California Health k Safely Code,Sections 25505.25533 and 25534 1 understand in l //. -2
if the building does not currently have a clean,that it is my mspansibil'ny a,ratify the D / as o0
occupant of m
the mill reems which must be mel prior to issuance of a Ceti Rome of
O'cii,e,. Signature of Applicant _ Date
Owner or rullor ed agent Date All root'coverings to be Class `IB"or better