00120119 CITV0F,CUPERTINO .-
1{un.nmc Dlvtston PERMIT', -CONTRACTOR INFORMATION'
BUILDINGA C/ OcIPERMITTINGy. SS24 'ANNARBOR )R 0�'e
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iL � , 9,
OWNER'SN`ts , 4 APPLICATION SUB DATE
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-.�PI ONE: - - _ - ✓y SAN,LAR,NO. CONTROL NO.
iCCZ ARCHITGCTIBNGINEER: • BUILDING PERMITINFO
.0O BILDG ELECT PLUMB
MECH
' 1CTO 'S
ECLARAPIONL CFNFICO NTRA
Job Description
-thuenyufnn o-1l I d P f9(wnn
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einf u force
aredeeRE—ROOF
Lie eI Lici#
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0, nly AIiCH,I,}'I1'�LCT'S DEC
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Licensed f:' V. . _
S o Re OWNER B 11 FCI ARATION I
u� I weacity affirian that pl I Ili C I �l 1 Law rnr the y - f._
t46 fill y (S I 5
703' B aadPor CJ AY 'b �,
'G h q fire
l rn u l c ,w l Ile P I I:h p; y t cine --.
Q Iu 1 1 9 I. 9 :Ili ppI' tf p 11 y dtionct
that he I 1 :dp It Inn ft c I t L i Choi9Sq. Ft F1ooiArea `. Valuation
nSee,
f n g fill 7116 f 11 i f ud P f Code) I .
(Init exempt land basis tl alleged pt ny 'ilNn, k11600
^' T
Section 90315 by any ppI tl p 1. h)ects theappl m c
anlaral Pronly �,
nal ,I„..minr"en 111II :(8son)' APNNumber �`�fn Occupancy Type,'
❑1 as roftheprgnnY nr nYemplLY wth xngcsas Mairtibiaco npelsal on .i C.FJ�I�„i 1�'�
9. oo t •.. .�� ,
will do he k I : 11 d d ff it 1 (S 9094 a n '
Ba" d P f C I I lie Contractor s License Law dt)es not apfly I Required Inspections
fp p tyWh h Id. p tl aJ h Je. , ch kh' If -
305 - FRAME, _
orvthrough his owm cnpl y l "Aid N,...h au,nocands t iticadedor
offered for at,,IfboyeatiYer,the n ldng„ mpn,temen is Id within one Car of a ,307 — T.Ik151JLAT T.GiN
,ear,1clion,th h lk ll hivedoc harden cfpmvny but lie did Ibuild it
hnp m-pm: r:Ir 601 --' ROOF TEAR”OFF, .- - . 7
El rin groper,, 1 v ly tin ng with licensed it I -:m 61?Ji: ' ROOF GPI,:YL.IOOD NfU L
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m I t the I J P'side
S 7044 B J P f-. C I 'I Th Contractor's
' _ ..
Lic 1 d :- I apply t - fp P ry t ld p' sthereon. 603 — ROOF BATTENS • _
awn q r p retie wth a n�etnrt,) 1 p d'c 04 ' ROOF ]'hl'-'PROGRESS
Contractorsn�L� L fJ '
°1 �•d - B&PC fonh'u' - • •• l...
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Ow er Dal �. =�� S' a _I•' - ,1 y.
KRIS COMPENSATION DECLARAPION,
I herchyrfifirial Under.gre Pty l terjuryoricrthe Following dret'ions } . .
� ° t have and will oraidan c Certificate of Consent O I f'n r W,k ', .q
O Comp : p 1 1 lot by Section 3700 r the Labor Code, rn the
pe}f mnce,fohe wo kfor whmn th spe mus issued. - ,
' ❑1 hove and will mainhtin Workers Com wanes Insurance,us re tired h Seelio • ,
pnn 9 y n
,we of the Labor Code,for the performanca.1 he work for which Ihix pennil is
•
,wed.My W..
Compensalimt h,xuranee caviernW Policy mwheroar -• .•s
is
Carrier: Polio No.: ` .k.• .. , y •. �'
CERTIFICATION OPEBLMPI'ION FROM WORKERS' Y 't
COMPENSATION INSURANCE ,
(q hl - ci n,eW til be wmplded rticpermil to lirt une hundred dolhirs _' `
1 certify Ihat In the P erroonalace of the work for wadi W s per^l is issual.I - - _
shall not employ any person in any valuer so,es to becume subject to the Workers 1 2 -
Compe is n o l L tws ol'Cnllmoa Date '
A,diwand - -
NOTICE TOAPPLICANT II fte,saki asth is Crerfificate ofE ntpf y Qatfld
hec n object theta k C p :t ,flbel h Code ) n
- •
� 0 forthwith vnply with Linda pm,Won,or th is pe at hill fde,declined rucked
-
F y CONSTRUCTION IENDI NC AGENCY
1hereby R nthtul I tlendings,C,) for the perfor nan[F t
Loon word for hall da,pini'-s issuW lSu: 1097,Clv.Ca , F'•' t q
Oa Q Lenders butte _ s.
. Lend :All - 4 '
r..) ir
certify tl (I lic,c read din;uEflifiliou aid alteduabrabso, idnionstioury f '
[y
correct I 8 in craftily with allcity rod county ordinances aral.pl laws retailing -
V t.holding Lonagroclion, adhereby atiffiod -p scnatves of this city luenter upon - ,y
q
the h d
d It fyP nJk Ph I ::Ili Cly ICP t y I .. ..• ' . s
TSN %-FAPPI,ICANT
hlf : 1 qua t, g 14B,which ,ayanany 1 actinic roull.t 1. ,
V n a 1 rm I --�� r�
1) ND 1 CO ALL 140 1Mf 4crred by�e_ 14N7�q..t�G1 `�% pate'
URCERL _ DLL.. � -�&u ma..,of pplic ret/ sot mnlr - Date Re-roofsARDOUS MATERIALS DISCLOSUREWintheuppl'etnl era pure bt ld,g Occupain Mile Lor E le h c 1 awnulType Of Roof Jhy the Cl pen' M "pal GOdC,Cbupler912 ..Attie Hrvlth vld safely ' _ -
Code,Section 25532(a)'
ove - t- - All roofs shall be inspected.prior to any roofirig material being installed:'. r-�...
Will the a,pricanl or rota..building Leetpnm also er,uncilm,t or devices which If a roof is installed without first obtaining P an ins ection;„ g
T agree to remove.
mill I . n ti Lad dby thetiny Area A c ItyM agement -
. n`.I' I all new materialsfor,inspection. Applicant understands and will comply with,
°Y all non point source regulations.` e
II dWcl 1 I al reg e t d Chtpt 095 Ilhe
Call if 'oH Illi&S tyCd So
clins2550525533nd25534 drI dthat �/ 11
'fth bas to des t t t t II tit'. Y 'infusibility,.1," I rY the ��( � (Y7
est pant n req r em ahTh I 1 tet pr ret a of it Cenificute Lf a
Occup;^ - -* - , '„k•
��� 'gnature o s'c'ant Date -
atd,nra Date All roof coverings to be Class;"B" or better,.. .. ,
OFFICE-
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