01030024 CITY OF CUPERTINO3 ` �`'''"`
BUILDING DIVISION PERMIT CONTRACTOR..INFORMATION
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❑IJI6DING AUURESSI i@656 AMULET RLWnnnc;' _ PERMITNO. .
ROOFING 0103002:4
•OWNER'SNAME: - ' :`'S•. -„t - APPLICATION SUIT DATE
ORv ' r 03i0E,/2001
-PHONE: - vViPfA SANITARY NO. CONTROL NO.,
O O ARCHITECTIENGINEER'. 5 - BUILDING PERMIT INFO
'BLDG”=" ELECT PLUMB MUCH
{S y y LICENSE U CON]RACTOR'S DECLARATION � ' ' ,lob Description
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hereby drrn lint1 I ued I ' s fCM1pl 9("ounn �'ny -
:vin Sec D fmt Bi Ir fission, nd nyh �: " " t• ' . ° .. -
De r 11 r n r�9 c r T'EAR',OFF SHAKES—RESHEET . ADD. 30# PAPER K.
I�i B n-Iso ARC4IRLLT S ULCLARAy _
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Se eN
4J0I ecused Prf nl
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OWNER-BUILDER UBCLARAfION
G7 I by IT m Ih I I Inpl treat the C t a I Luerso Law 1 (lie _ e
Z Q toll y pal,ca.rS I 703 1 5 E J P f ' CJ Ary 1 e my
O ,lbach recippe, pro n t fter ura,o,r,deapoh,l,car re'af,say.I t -
pno ed its issuance,alsoq the ppb t for suchpernat totile,signed suplarecon, _
laid he 1ri,crued 1 t t Inn rth c t t 1 (Chapter 9 . r Sq.Ft Floor Area n' uation
(t n g lh9 I 7070) fD 9 fth N : P ef :Cd)
initial h mil Ih f d th h. theIleg J pt n Aryviolation - 5 s'
.ofS I 703156) p
) pb a,dtap Ill.object lhwpplwattt,ae'vlp ally _
of nor none than pop hldnddollars f9500, : 5 -'APN'Number �Q e upancy'Type,r
°1 d oche al the m m Iemployee,iended i ea fe edf r sale( notion,
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n. -V
P P v.,any a pe
will J the k and In t vmhe s not'intended J offered for snot apply
7044, 3264 Z 9. OL
Ba. . and e r.-' .civ The c t I ' Law ,,not apply t ` _ - Required Inspections-.
fp pe qta l Id. id :a I n 1 n Work It- .
o�d through n' ply :.p 'aalEl to p- t t intended 305 —' FRAME,.
othe d for sale.If,l awwo,,the b,rld'nb itnpn.c neat s told ahin one year of '
«vupleflon,@e owner-bunAerWill base the burden ofproving that lie did not build or 307 INSULATION .
11 Improv For In rpo,t of o 1 ),
601' 7, ROOF .TF_AR OFF.
°1 of the p ty I :' lyenl I g In warted I I RI ,
container he project(S .7044 Bronio,undl ,ohne,Cadet)The c iat s ' ;.602 — ROOF PLYWOOD NAIL
Lo L des ad apply I w er I p,.Perry who bu IJ 'mil e, thereon. -
and I e fo . ch, ; t.'wan contract E.) 1 ei ed pa,sant tothe 603 '— -ROOF BATTENS
Curvets',Liccnso Low. -
01ran asemptande,sec.- - .B&PCfor this reason 604 ROOF INn=PROGRESS
owner • � oat ' '
WORKERS COMPENSATION DECLARATION t -
,
, l hereby after n•
der Ifully ol'pepnry o,a of the followingJ ra
latio„ • a
1 coca and will n cal 1,Cert ere of Conwot inelf- for Wok r
` Ccopensanan, is provided fur by Section 3700 of the Lahor'Codc, far the -
pert inf tl ork for wblen th s peon I,c IsweJ -
Ihave and will npiripedW w,' C,mpaviation[insurance q ' dbySection
01 of the Lobar Code,for the1perdoneraince of the work for which this per t is ` - -
issued My IS heLrs Cme,ca,i on Insarnnce ca'r'er and Policy,number
Corr crPolicy No.RE'S CDU -•1�/I(, •. x
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE Jt." .,
This tion need not be wmplmerl it the pe tit is for one hundred dollars _
- is1hot-'lost.7 -
I certify thus in the performance or the work for which this apermil it o1w.1„P -
,hall not v npmy anv p..r on in„ny manner ao en m nrrome sanJect m Int wo,rert . -
Coinpen•atmn Laws or cmimrnm.Dale -
' Applicant -
NOTICETOAPPLICANT:Jr,aflw,m,king this Certificate of Exemp,ioo,you should
` hecomemh]ucl Ink de W C p t p of the Labor Coda pianoyo,
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forthwith courtly with such positions or,h's perndt sbmll Iw deemed revoked. '
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CONS Itt30NLLNDINC AGENCY -
I hereor which Wm Nene is a ums,mu oa lending n _ -•
, n In a rn�rorant err rmltna
ai onnt work for wmdt oda permit is is<tred(sm.3097,civec.)y p
,CWT Q Lender's Name -
. U z 1 end
I 'n'fY lhot I l' dol pill' I If ll lhotlh h f lot's - q
W try airzcl I b t Ely with'll loy and county ordinances and.t, lating - -
the hl b t dp property
r hereby or p0 ection e ( ftl 'IY1 t t
po
Fy p,y led)thoop t my ondk ph ml,:theCq fC p t g'tsf ,.
liabilities,
dym er I and experses which day in any way,accrun,against said s
U Z. Cit)to coarrojecancecd the granngof'Ni pr nn •,f
APPLICANT U' STANDS D WILL COMPLY WITH ALI';76701
NON DINT ° P� ,r<9Iy701.e c� Date. t
SOURCE LAT Ns . , ' 6 �_, Issued by:�-'ISZ,
Signator t Appmat Cotlitor --'e Dne Re-'roofs _
AZARDOUS MATERIALS DISCLOSURE - r
Will the oppnaul n n yl' 6occupantore orh dl hu 1 nd fa1.' 'type of Roof.-
isdf dIr the CuKil Mnvpul M Caper 9,12,aIto H lthand Safety
1 '
Cod ,Secti 25532(a) r 5 a
°Y ' All rootsshall be inspected prior to any roofing material being installed.
Will the 1 pf ,t or future building c nano ase topapareat crIeviets which If a roof Is,Installed without first obtaining an inspection;l-agree to remove
end,o[andr. ,ttml It defined by th Bay Area Air Quality,Manegemnt - - 5
District? I - `/: all new materials for'inspection. Applicant understands ana:will comply with
�F all non-point source regulations,'
I ton"'oted the IF 1ot's paperial,ro'cirepowal,tande,Chapter fi 95 1 the _
y Calif n a Hr Ilh&SaElyCot Soralitai,25505,25533 and 25534 1 radermoulthut -
FlIstlativildia,doss not currentlybase a l t that t y p bibly it,polifyth �•
n.
uc,.Paulor innicars sit ennow n netprorIo-aaonceoraCenirtftlir
"au' -
_ Signature ofAp icant Date
'Own"'neamo e e,,, 3 �> ':All roof coverings to be Class"B”or better -
:`OFFICE