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02120090196 I� ny5ny�t `Lp GCe !�4 YYYYY i CITY OF CUPERTINO �Ux`I'QRII2M�1'TIQ' BUILDING DIVISION PERMIT _ BUILDING ADDRESS: - PERMITNO. 9 ( 'S NAMR: PERMIT L55 aw A.3 E: SANITARY OL NO, ARCHITELT/PNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 t� LICENSED CON`MZ_MR'S DECLARATION Job Description I hereby affirm that I am Ii mmd under provisions of Chapter 9 (commencing lN Section, 7000) o f DIA.i.. 3 of the Buss nes. and Prole W ons Code, and my license Is with In fall form and eftecs ADDITION/NEW ROOF &'FRAMING - License Class Lie. As Dam ADD 50 SQ.FT. LIVING SPACE,, 677 SQ.FT. GARAGE ARcxrSECTSDecuRAnoN I understand my plans shall bu used a public records F1NAl® WD NU V 2 Lleelued Profeuiaml OWNER -BUILDER DECLARATION I hereby that I esemPI from the Camnetars Ucume Law for 'be .fibre am Business ROfcW um Code: Any City m county 5 2003 L W following Ryon. (Section 7031.5, and which minima a permit to condrom alter. Improve. demuluh, nr repair any suuctum =pdmmiu Wuanm, Wurequires lheapplicant for welt permit to fill. aired wmmenl I111I1.0 d punuanl m tie pmv smnA Of the Contractor's Umn. Law (Chapter 9 S Ft. Floor Area q' (commeming with Section 7OD01 of Division 3.f the Budneaamd Profeamm Cron) m C7 that M is exempt therefrom And the basis for W alleged eamptian. MY violation of Section 7031,5 by any applWnt for permit subjects the applicant to a civil penally of APN Number Occupancy Type not mom than On hundred dollars (3500). 36205032 OO 01. a owner ofdm property. m my employees with wagcsu thclrwle COMMAIauon, • will dothe work. and Lmcuclun is Out ImendedoreEered forsale(Sec. 7044. Budnm Required Inspections q IS e Concmrs Uneon se I+w donot appy m m owner of std Profesdmu Cart: Thm Property who builds ofimprowathemon, andwho doenuchworkhimaelf orthrough his 101 - FOUNDATION own employees. provided Wlsuch Improvements are notlnmmled orertemd for We It. lO2 — PIERS - however. Lha building or Improvement Is sold within Ann, year SeOf compledW, the ower - builder will Mw the burden of proving that he did sot build or Improve for purpose of 103 - UFER 3'velymeeling1. 104 - REBAR L amvneiofthesec.?O •.mann; and eo KWON with 710--=Lcontra-eral- Lb mrumLaw 105 — ANCHOR BOLTS whomCede:)TIsevesthe on, esnselnwdwnotchplymsn ith.orproperty wM1udedprsuant ora Wereon,wd, doesnoapplyinoan,wner of Property who contracts for such projects with a eonvacmrtG licensed pursuant m the Conuala8 106 — SEWER & WATER . Lkanal.w• ❑lane under Sec , B l P C per this matem 202 - UNDERFLOOR PLUMBING 3 ` o .203 - UNDERFLOOR MECHANICAL oN 2 04 - UNDERFLOOR FRAME WORKER' Et s110N •cL Thereby aRimt under pe sh ori dwyomoftharnllawingdeclarauom: 205 — UNDERFLOOR INSULATION I haw and will maintain a Conquests of Cnnsenl m selRlmum forWorker'a Compen- 301 — ROUGH PLUMBING - n0on, u provided Ire by Section 3700 or Ne Eaton,Code, for the perfarmanea of the 302 - TUB & OR SHOWER work for Mich this permit is WWd. 303 - ' ROUGH MECHANICAL ❑ 1 haw ad will m mmm Wafers Campematlon Insomlm, As requited by Section - 3700 of tits labor oxic,imtise perrmmanee of tits work for which this permit is Issued. 304 — ROUGH ELECTRICAL MyWahera Compemadon insurance anter and Policy number am: 305 — FRAME Cards:EEXEMPPolPolicyNu.: CERTIFICEO TION FROM WORKERS' AT 306 — HOLDOWNS COMPENSATION INSURANCE 307 - INSULATION MISsectionneednothecompletedtidepermitlaIntonehundreddollus($10() 308 - SHEETROCK W I wtiry the In tits put..,= of the work for which this permit is lamed. l Nell not 309 :- EXTERIOR LATH 9D t Ined. annerse era a2,.,n he wmkcre&penadun 310 — INTERIOR. LATH ' lawiofcilfoml Appfip.nl 311.- SCRATCH COAT N017CE70 AP CANP. I m 7nC 1 h CenE m of Exemption, you should 313 - ROOF NA'I L have id, tie Wahrfa ore lion provisions of tits VM Code. you most V foMwithcomply withtucM1pmvhim tthispermitmanbudeemedre.nked. 501 - FINAL ELECTRICAL ENERGY ? CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY I hereby alarm that there is. construction lending agency for the Performance of 503 '_ FINAL MECHANICAL ENERGY the work for which this permit is Issued (Sec. 3097. Civ. C.) j LenderaAddo 504 - 505 - FINAL BUILDING ENERGY FINAL ELECTRICAL and rets that the above Iws miatiun h 1 =try the i Mve read thisty Ind comer'I=tryt cmnccl. I ayme m comply with all city and coumy ordinances and aisle uvea relating m 506 - ,-- GAS TEST building convection, and hereby authodre mpreacntstivea of this city to enter urns dre FIN PLUMBWG almw-memimed p;;;; for inspection purposes. y (We) agree in saw, indemnify and keep harmleu the City of Cupertino Agdmt may in any way amus against old City 08 FI t,AL n liabilities, judgments. Coos and esputsu which 5 In consequence of the anting of this IAMIL gr APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by:5 Date SOUR C,E�R ,oULATIONS. 110 \ 1l _ 1,a4k u t/0CA. 7 9 0 Re -roofs 514 a Of Roof Type NAL PUBLIC WORKS 'sitimmre o ppuandconn. m _ °� HAZAR OUS ATRJUALSO OSUI}E Will the applicant of future building Occupant sm a orhandle hanrdous MIUM Bred by dse Cupenioo Municipal Code. Chapter 9.11. And the Health and Safety Section 15532(•)? [3 yes, �No All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove WIII the applicant or future building Occupant use equipment or devices which colt nsnNaW dr con aminanu u de0md by the Bay Am&Air Quality Management all new materials for inspection. Dituic0 - .. ❑Yes O I have mad the hanednus mosedaismquirements under Chapter6.95 of tho carrier. mlaw HWlmhSafecy Cole.Secdmu25505.35533md1.5534.1und mmdgwiftie building does ata currently have a mnwt, mat h is my respamihllity m notify the occ intim Of the Date qui whkhmuA metp'ominummeoracmdramoroccuranC Signature of Applicant b All roof coverings to be Class "B" or better Owner o wtbodred gcot Dom Z Z �z ,U 3Wt— �oa za0C yoff �za o: 0Z C V Is7 C+ ► '2 UC wF �a U CITY OF CUPERTINO BUILDING DIVISION PERMIT h� s ( ��RM L AND D CONSTRUCTION BUILDING ADDRESS: PERMIT NO. 03050072 . 2130i COLUMT�TTS AV OWNER'S NAME: 1555' YOSEMITE AVE. #17 ""UM6/2003 PHONE: (415)822-8383 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH E__3 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing p with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. IN HOUSE USE ONLY License Class Lic. #REVISION- Date Contractor NO NEW PERMIT ISSUED, ORIG. #02120090 ARCHTTECPS DECLARATION I understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure ' prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of $1000 APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 36205032.00 [11. as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business Professions Code: The License does and Contractor's Law nbt apply to an owner of 10 3 - UFER property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improyementsare not intended oroffered for sale. If. 304 - ROUGH ELECTRICAL however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of 505 - FINAL ELECTRICAL sale.). I. as owner of the property, am exclusively contracting with licensed contractors to colistruct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law docs not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law, ❑ 1 am exempt,uqder Sec. , B & P C/forr this reason O er f Dale L^NMXE ' C NSATTOI EC ATION , 1 hereby a[Grn under penalty of perjuryone of�i following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance. of the . work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier: Policy No.: . CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Ibis section need not he completed if the permit is for one hundred dollars ($100) or less.) 1 certify that in the erformance of the work for which this permit is issued. I shall not employ any person r'pr�agy,manngrsso as Tone subject to the Workers' Compensation c''+ ' Laws KCa fomia. ,an / T./ NOTI APP 1 : tier aking this C ificate of Exemption, you should become subject to the Worker's Compensation provisions of the labor Code, YOU must forthwith comply with such provisions or this permit shall be deemed revoked. I CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) i Lender's Name Lender's Address i I certify that 1 have read this application and state that the above infornatiun is correct. I agree to comply with all city and county ordinances and slate laws relating to building construction, and hereby authorize representatives of this city to enter upon the ahove-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against j liabilities, judgments, costs and expenses which may in any way accrue against said City ' in consequence of the granting of this permit. i APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SO`URCCE REG L IONS, t iA�5(�4� �7�� oc�Re-roofs / Type of Roof Sign ore of pp i antlCotl1ractor e S4.1. HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant stare or handle hayardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)?, All roofs shall be inspected prior to any roofing material being installed. E] Yes `�No I< If a roof is installed without first obtaining an inspection, I agree to remove, Will the applicant or f'ut`ure building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? byes $,Nu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building docs not currently have a tenant, that it is my responsibility to notify.ycoccantofthercy iremcnts whit must be met prior to issu cc ofa Certificate of Signature of Applicant Date All roof coverings to be Class "B" or better Owner or authorized agent's Date CITY OF CUPERTINO _ BUILDING DIVISION PERMIT BUILDING ADDRESS: 21301 COLTIM2112 AV L AND D CONSTRUCTION PERMIT N00 3 0 7 0 0 4 3 OWNER'S NAME: 1555 YOSEMITE AVE. #1.7 PERMIT ISSUE DATE PHONE: (415)822-8383 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I hereby Chapter 9 Job Description affirm that I am licensed under pr visions of (commencing with Section ,7000) of Division 3 of the Business Professions Code, and my license is in full force mr frect. HOUSE License Class Lie. ti - =� REVISION --IN USE ONLY Date i o Contract NO NEW PERMIT ISSUED, ORIG. #02120090 ARCHITECTS DE ATION I and rstand my p ans shall be used as public records 1 Licensed Pn -s nal OWNER-BUI DER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve• demolish• or repair any structure ' prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation $ 0. (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 ��er0 0 Occupancy Type not more than five hundred dollars ($500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business Re eCLIOnS Required Ins a and Professions Code: The Contractor's License Law docs not apply to an owner of p property who builds or improves thereon, and who does such work himself or through his 101 — FOUNDATION own employees, provided that such improvements are not intended or offered for sale. If, 102 — PIERS however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or improve for purpose of 103 — UFER sale.)' 104 — REBAR O 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- 10 5 — ANCHOR BOLTS cense Law does not apply to an owner of property who builds or improves thereon, and 10 6 — SEWER & WATER who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law• 202 — UNDERFLOOR PLUMBING ❑ I am exempt under Sec. . B & P C for this reason 203 — UNDERFLOOR MECHANICAL Owner Date WORKER'S COMPENSATION DECLARATION 204 — UNDERFLOOR FRAME I hereby affirm under penalty of perjury one of the following declarations: 205 — UNDERFLOOR INSULATION ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- 301 — ROUGH PLUMBING sation. as provided for by Section 3700 of the Labor Code, for the performance of the 302 — TUB & OR SHOWER work for which this permit is issued. 303 — ROUGH MECHANICAL ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3701 of the Labor Code, for the performance of the work for which this permit is issued. 304 — ROUGH ELECTRICAL My Worker's Compensation Insurance carrier and PWdy number are: (` i{X � y 305 — FRAME liarfiEr: f-'C(M (.-� Poli No.: -V/ CERTIF CCA E OF EXEMPTION FROM WORKERS' 306 — HOLDOWNS COMPENSATION INSURANCE 307 — INSULATION (This section need not be completed if the permit is for one hundred dollars ($100) 308 — SHEETROCK or less.) 309 — EXTERIOR LATH 1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation 310 — INTERIOR LATH Laws of California. Date Applicant 311 — SCRATCH COAT NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should 313 — ROOF NAIL become subject to the Worker's Compensation provisions or the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 501 — F I NAL ELECTRICAL ENERGY I CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY 1 hereby affirm that there is a construction lending agency for the performance of 503 — F I NAL ME CHAN I CAL ENERGY the work for which this permit is issued (Sec. 3097, civ. c.) Lender's Name' 504 — FINAL BUILDING ENERGY � Lender's Address 505 — FINAL ELECTRICAL 1 I certify that I have read this application and state that the above information is 506 — GAS TEST t correct. I agree to comply with all city and county ordinances and slate laws relating to building construction, and hereby authorize representatives of this city to enter upon the FIN PLUMB I G ' ahove-mentioned property for inspection purposes. t (We) agree to save, indemnify and keep harmless the City of Cupertino against 0 $ FIN L t 1 liahilitiesJudgments, toss and expenses which may in anyway accrue against said City ' 5 t s WING in consequence of the granting of this permit. ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by:5 Date SOURCE REGULATIONS. 5 4 NAL PUBLIC WORKS /510 Re -roofs Si nature of pp tca 1/Contr0 rDam l� / HAZARDOUS MATENALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal.Code, Chapter 9.12• and the Health and Safety Code'. Sect 25532(a)? �e All roofs shall be inspected to any roofing material being installed. Cn prior which If a roof 1S installed without first obtaining an inspection, I agree t0 remove Will the applicant or future building occupant use equipment or devices • emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? , ❑YesNo I have read the hazardous materials requirements under Chapter 6.95 of the Califor. nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the . requirements which must be met prior to issuance of a Ccrtiri of oceupane . 7 Signature of Applicant Date All roof coverings to be Class "B" or better dwner or authorized age h. Date BUILDING DIVISION pE,i'RIV__Pl 8CP1L. i1 i1�1 Q 1YYd Vl�.: BUILDING ADDRESS: QQL,�PiIPUS AV L AND D CONSTRUCTION PERMIT NO03070117 OWNER'SNAME: 1555 YOSEMITE AVE. 417 PERMIT ISSUE DATE PHONE: (415) 822-8383 ONTRSANITARY NO. COL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH n O C, LICENSED CONTRACTOR'S DECLARATION hereby Chapter 9 ' Job Description P1 affirm that I am licensed under provisions of (commencing z w with Section 7p)) of Division 3 of the Bus nes, nd oI ions Code and my license is n < a t) in full !o c d effect. License sst N r l3 I�1.E�j7kI .IO'Nj�T "rII�' HOL]`SE iISE O i' - Z " D "a Datc Corer for .seatun7z`irrx;de'-ice' NO—NEW=P—ERMIT LSSED, ORIG. 402120090/03070117 �i az a �%% ARCHITECTS E ARATION ��.___Y-runderstan my plans shall c used as public records Lh Licensed Professional 1 OWNER-BUILDER DECLARATION m n O 1 hereby affirm that I am exempt from the Contractor's License Law for the Code: Any k W ( following reason. (Section 7031.5, Business and Professions city or county which requires a permit to construct, alter, improve, demolish, or repair any structure ul .. w xo prior In its issuance, also requires the applicant for such permit to Ole a signed statement that he is licensed pursuant to the provisinns of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation $0. az h (commencing with Section 7000) o! Division 3 0! the Business and Professions Code) or a that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 _bl L° 6-916rT.�,k,er O O Occupancy Type not more than five hundred dollars ($500). El 1, as owner or the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law docs not apply to an owner of Required Inspections property who builds or improves thereon, and who does such work himself or through his 101 - FOUNDATION . own employees, provided that such improvements are not intended or offered for sale. if, 102 — PIERS however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or improve for purpose of 103 - UFER sale.). 104 - REBAR E] 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See. 7044, Business and Professions Code:) The Contractors Li- 105 — ANCHOR BOLTS. cense Law docs not apply to an owner of property who builds or improves thereon, and , 106 — SEWER & WATER who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. 202 - UNDERFLOOR PLUMBING E] I am exempt under Sec. , B & P C for this reason 203 - UNDERFLOOR MECHANICAL Owner ate WORKER'S COMPENSATIONDECLARADTION 204 - UNDERFLOOR FRAME I hereby affirm under penally of perjury one of the following declarations: 205 — UNDERFLOOR INSULATION E]lhave and will maintain aCertifiicateofConsent tosel!-insumfor Worker's Compen- 301 — ROUGH PLUMBING sation. as provided for by Section 3700 of the Labor Code, for the performance of the 302 — TUB & OR SHOWER work for which this permit is issued. 303 — ROUGH MECHANICAL ❑ i have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 304 — ROUGH ELECTRICAL My Workers Com eegsa�uo Insu"(0nd P licy numhcf. a %/� Ca 'cr: � M orr�No.: F 3 305 — FRAME CERTIFICATE ON FROM WORKERS' 306 — HOLDOWNS COMPENSATION INSURANCE 307 — INSULATION . Cnis section need not be completed if[he permit is for one hundred dollars ($100) 308 — SHEETROCK or less.) 3 0 9 — ' EXTERIOR LATH 1 certify that in the performance of the work for which this permit is issued, l shall not employ any person in any manner sn as to become subject to the Workers' Compensation 310 — INTERIOR LATH Applplican aCalifornia. Date cant 311 — SCRATCH COAT NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should. 3 13 — ROOF NAIL OZ become subject to the Worker's Compensation provisions of the Labor Code, you mull forthwith comply with such provisions or this permit shall be deemed revoked. 501 — FINAL ELECTRICAL ENERGY z CONSTRUCTION LENDING AGENCY 502 — F I NAL PLUMBING ENERGY -� Ri 7 1 hereby affirm that there is a construction lending agency for the performance Of the work for which this permit is issued (Sec. 3097, Civ. C.) 503 - F I NAL ME CHAN I CAL ENERGY w� A Lender's Name 504 - - FINAL BUILDING ENERGY z Lender's Address 505 - FINAL ELECTRICAL U o '-'i 1 certify that 1 have read this application and state that the above information is 506 — GAS TEST IL, correct. 1 agree to comply with all city and county ordinances and slate laws relating to city 0 U building construction, and hereby authorise representatives of this to enter upon the— FIN PLUMB G above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against 0 8 FI AL ..y rn U 7-. liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. 5 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 5 ING Date SOURCE RE ULATIONS. _ � Re-roofs 514 NAL PUBLIC WORKS / Signature of ApplicanU_ Con! actor ( Date HAZARDOUS MAERIALS DISCLOSURE Type of Roof ' Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Muni 'pal.Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Yes No If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or rata building occupant use equipment or devices which emit hazardnus air contaminants as fined by the Bay Area Air Quality Management all new materials for inspection. District? ElYes u 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building docs not currently nave a tenant, that it is my responsibility io notify the occupant of the requirements which must pc m ri'r to issuance of a Ce ' ate of?76-/,L Signature of Applicant Date /gyp e r "B" - ens All roof coverings to be Class or better COs r or authorised agent � D`atc