00100151 (2) CITY OF CUPERTINO R et +<: a
nun.mrvc nivtston PERMIT 'CONTRACTOR INFORMATION '• "
BUILDING ADDRESS - • PERMIT NO. l• '
- - o
OWNER'S NAMH:
NLIhIF_ DRIVE. ACME '8' SOhIS SAN7ITATIO /ELEIL'"I'Ft F 010015 1
SANITA n3. r LNO..' ,
x. 1ES80 Sa 7TH ST' . lel/c Lc+�00
❑W Z ARCHITECT/ENGINEER: c'• -BUILDING PERMIT INTO
$.
r�y FF� (408)2752263 •BLDG ELECT e PLUMB MUCH
Z m Y LICENSED COM RACTOEt S DLCLARATIOM1 _ _ Job DCSCrI tlOn 2
°Z Ih by Option thtl e:J J 1 1'Chapter 9(eommc g, p - -
t+
1-1H lidiSect 7000) 1D' n3of[lot Bu w -nsP 1 . at,Lode aid aryl ten s � '
t fell d fl I
�K�dLic as Class •'(V TLI .# O .
Dal
3 ARCHITFCr s DBCLAItATION '
Innacfaa m
ny pr ,eh.ul ne netea a,paNe ..an q'ew•2 dSo„J .. TFTEMPf?OWER POLE
,t
,,W o o Licensed Poodoi....al
OWNER BUILDER DECLARATION
m-m [,here
h eby.R door l .eo,uI theFrom t L' Law In,the _#
Z C Poll giscou(S I 5 7031 Business ard Prourcom.1 Code,Any city or county .•4 '
$O
which l pe a a t II 1demolish,' V Y I structure
o
.p I I I q II rpl' ,f r, hp tl tl g d patter -
that he licensed wp t to the pruvri f the te t t License Law(tel ter9 '.5 Ft. Floor Area Valuation
... enbwth Su.Inn7oW)ofeb mo [Ile
Ii 1 .Cade) q _ _t ', -
lrl
hatlthu is cxcm I thcrefrnt
and the basis for the aIle• i
ed exemption.An violation
of aceto...than
l.5 ny any uppliwdl fa$500th:!eunJma the uppliwm to n civil pclialty
on.,,Icon.e(nun rye pgndreaaeknre(.soo). . . - APN Number Occupancy.&pe'
❑I fth V p tY YC PI y rwill d th w rk d the interim, IInsured, R d f ser.7044,Business 1 Code The C I t 'I' L J t o work
himself
egUlred Inspections •' a
I'property Wl huW p th I d 1 kti If ,3P,217002. L71 -
,. or'through his own Ca11 y .1 'd dth I. h p tents are not intended r c _
oll'ered for sale If I nwr,cr the hadd i g it on, ve rent is sold with n one year r a f
coapt! m buille will house theburden ftlmh 1'dnrh 'ld
np 1rp .p 1 1 tl g 304 —. ROUGH ELECTRICAL,"
❑I - flh_ 1 pri. m warimisely ccI Meeting 'thl ed cormarturlIn SOI. - FINAL EL_ECTRICAI, ENERGY
on I net the p cjw(See'7840 Has nee.- n lProleract
ome,C de)The Contor.
LiwteeLaw dw,s rlplyt,,;in owner orTinkly who bala,to inr,rucs,thereou. - SOSFINAL ELECTRICAL - +,
and wire lontrust"bul qoh p-jars with a conhaemr(s) Hocu.sed 1ralnoril m the,
Co...,,I is'u License Caw
nm
' ❑I cxcmPl mWhr Sec ,H di P C for Ibis reason'
Ow Dadto .. ^
WORKER 5COMIFNSAIIUN DECLARATION /f••/
I hereby affirio orderpenalty lty f lqtfLay one_of the billowing J I kt ` .. <s V .2
7 a U I f Consent to 11 rc our W k r. - -
,,,,!,,have, it 'll h CI I nvatbn as Provtried in, by Seim 3700,of he I,I r Coda to, the - -
pef ranee of the work rin which Ihlx permit is Issued. - - -
r
s ❑1 auto unJ will mainmia Workci s Cwnpunantlon Insurmsa n.reyuimd by Section
3700 nr the Labor odc,for tiro perfnnntme,of the work Ibr which this permit is - '
i"ned.M Worker's Ga�n utton lnvunmcc carticF and Polite hcrare: n - - �(- (r
Y I +pea, y nem
Carziee�Yfi rKN C Paliey No.:' S 71 4 S • - - „ ,
+ C IWrIFICATION OF EXF,MITI'[ON FROM WORKERS' -
COMPENSATIONINSURANCE - • t' _ '
(Tho uYl
eor ce,d rat be canpletul if permil is for one hundred dollars
($10(dbr less) .r ^
I cearly than in the perronnaaee of lie work Int which this permit is issued,h
sad( I curploy any prison-in any manner so as to become s.trjact to the Workers' ^ - -
Counilwasurtion Laws olCalifornia.Date `
Applicant
NUTICLTOAPPLICANT Ir tt mak gal' Cn'1 I fL pi- y I uIJ � _ '
bcco nc sublcena theta k C p I p n. fm 1 b Cd y fust '
_O Q n,nnwhlte..rttplyw3h I p ,:krr,nr❑'. p rsrvnnutied tea revoked. , .. - .
CONST RUCTION LENDING AGENCY` n
Ir
C 1 Beefy un r n
(but them I t r lending agency for the Pcfforrm
of ate work rnr wn ch[his penia t issued(Sec Sun Cis.C.)
L Q Lender's Name' .. -
7 Z Lend Address + -
f..7 I tlydstII dthis i,e' t dilas,thatch n Ions -.
Lr. F art t Iab tr l,with all city' J county unhounnock ada t ]as,,oclatin, ..
C c building consourtion.said hereby author represenrtves of this city to ever upon
�S
men r 'I - -
p p tyl i I v r], (W)agree I Indemnify andkeep
'U Vi . the fC p t dagainst
lI Jg t. t J . :which Yn;my city againstsaid
U City inconsequence
y nand gram gof
• .
WILL CO
S01[0j:B Nl:GULUpSIpfANU9RND WILL COMPLY WITH�L NON Pp. Issued by., v 'Date s
Siganmemi AApphdamniContryter - Dale Re-roofs ' .
- IIAZARDOU ATERIALS DISCLOSURE ,
Will the ii,fir t rI h 'Idib oectpart careerh JI ho J mut 'a1' ,,'type Of ROOF •' ..
n,dcdcd by the Criterion Muti a pal Code Chapter 9 12,roil the Health and Surety ' -
Cale,Section 25532(a)9
• '-
• Ed ye, `., ono Allroofsshall be inspected prior to any rooting mall
material being insted.
wll n aper t r I 1 m; b p I use equipI J when
va rcont mIf arroof is installed without first obtaining an inspection','I agree to remove. -
emirhr laantas dW aelhythBay AraiA Qndly Manage but, - - - .a v '
Vi,I t7Ytee =oNn all new materials for.inspection, Applicant understands ankf will comply with
. - - - all non-point source regulations.
1 bout read the howNous minitial,ou,nocntchta widerAhnptcr 6.95 ef.the -- -
Califnrniu HwlO&Snlcty
Code,Steel......25505,25599 and 25594�l understand that
Rebuilding does ne'ro'cully hnbentoorat.thet it is my responsibility to notify the • „ '•
....' t at he m,u,armts�which Iraq be met prier er issuance of a Cenir.cule of '-
occ(aj �y. 2 .' Signature of Applicant ' Date `•
1n.4_b- GAG,Lap' 7Gl2��a'0 All roof coverings,[o be Class "B" or better
Owns authorized ed strict ' .
- :. OFFICE