01100064 INO
CIBBUUILDIING DmSSIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10690 HALE PL CALIFORNIA SECURITY ROOF NG 01100064
OWNER'S NAME: APPLICATION SUB DATE
CRUMP RAY W 90 UMBARGER RD 10/10/2001 :
+�
ONE: SAN TA Y NO, CONTROL NO.
p'• (408) 363-6400
W O O ARCHITECT(ENGINEER: BUILDING PERMIT INFO
E w BLDG ELECT PLUMB MECH
�.h Z LICENSED CONTRACTOR'S DECLARATION Job Description
j Z In C 1 hereby aRrm 0.11 am licensed under provisions of Chaser 9(commencing
withScedon7") (Didision3oftheHa,ills,sandPolossicauCode.andmyliechae. REROOF.
.O 6 is in full force and e1c1y Lic.% II
11 �Ce"ecl"" G-O REMOVE WOODSHAKE, INSTALL 1/2
a O Oma 5 OECa
ARc ITECTSDECLA o CDX PLYWOOD & CELOTEX 40 YR.
g 1 understand my plans shall be used as public recon.
j O O License Profeuional
t�r
ON
OWNER-BUILDER`-'so 1 hereby affirm exempt from the Contract
Contractor's License Law for Ihel
L�< following reason.(Section 70313,Business and Profession Cade:Any city or county: '
k F C
which resumes a permit I construct,el alter,improve an
demolish,or repair y atnacmrc
i3� »pratI t also req theapplicant for such Parrott file.signed nut t - .. _ . .._ _ ___ _. .- __. ._ _ _.� ..__.... .._ -
twi rte s I' sepahuanr m thi p W:lana of the Con ors License law(Chaps 9 S FC Flo r-Ar[eea r• $15 7Va11'ation
(commencing with sec) ]000)of D vision 3 of the ink,.w ervvr�slons Coda). L 1)''A', t !._:1 Qi 1,/(\ Q+J'l f i<.���. I.t l;+ ' SS 00
or that he Ice exempt therefrom and the basis for the all gad uemptmd.Any violation,
of Section 7031.5 by any applicant for a pmol subjects the applicant to a civil Penalty
of not mare man fide hunme dollars($500). 32 641 FSO Ap00N�7u b r Occupancy Type
.❑ll,as owner of the and
the s a hi employees with warn a their sole compensation,
Balt Basin.the worKana ns auuctnre C not mends n eBLaw tar sale(sec. toa4,' Required Inspections"
ousner and eery"alts Code:The Conmmoro.License low don ltd apply w an 305 - FRAME - '
.. owner a(propmy was wiles or impedes thereon,alta who dna such work nded or.or _ 3 0 7 — INSULATION - .
offnd through his awn emplothaws ret. Wilding
that such improvements are not me,year
or. _ i
offered for ole. w wooer,the wading a improvement n cold within oro year or;' 6 01 — ROOF TEAR OFF O\J LAS Ilae'ISa'D
completion,the owner-wilder will have the wrdcn of pavin6 that he did not wild m ❑
improve Tar paf[be prole). 602 - ROOF_ _PLYWOOD NAIL_ 7 q nn q _
OLes ,th. rjectSex.nyamallusivelymnmctricansoseenseoCometorsm 603 - ROOF BATTENS ( OCT;-'L 2001
comwcrtheoes no Sex.7044.Badness altaerty whoWilds
or Thevettnctm: 604 — ROOF IN—PROGRESS
License Ivo does not apply m an owner th property who wlice se improves thereon„ ' ' `
�'.
and who mtmacss for such.pmjecn.wim a Conossror(sj licensed punuem to the. _
Conaenara License Lam. . . - -__ ._. _. - - BUILDING.
❑I omesemp under Sec.. B&PCfarthism, n INV ' 'II;"LCr
__ Ownoi •.. t . .t Date . . .
WORKER'S COMPENSATION DECLARATION
' �l hereby affiml undo Penalty of perjury one of me following declarations:"
. have and will marbtain a CeniOrue of Cmhe m to self-inure on worker's
inn_ Aamunce of as pork fndfar wfirM1by Section 37W of the lobe Code, for the.
K _ permit is issued.,
C I have and will maintain Worker's Compensation Insurance,a required by Section
37W of the labor Coat,for the,performance of the work for which this porous is
Cron rkers Compensation Insurance carrier end Policy number are
roues M W , _ -. IL)U.✓._. .. _ _ .. _.
Y
Sa %Ned Policy No tIk rl'I a` (':" t"t•�`.
CERTIFICATION DF,EXEMPTION FROM DRK '
COMPENSATIONINSURANCE - Vis' r e t
a Rhissection hodnot w completed ifthe permit is fn ane hundred dollars
(SI)07 n leu.)
,.:;. I certify that In the performance of the work for which mis pemtit is issue,l .. -- •..•.• I 4 - •.. ._- . ..
shall not employ any person in any au ner so n bun subl m Workers' '
Comprnsadma1 reef Califomie.Data
�m/"
Applicant
'NOTICE C P.If,alter making Ilii I me o prion,you should .•
lineation subject to thc Workers Campcnsetia rovision of the labor Cade,you must
0 fo
nhwith comply with such provisions or Chia pemtit shall be domed msnked, t'
CONSTRUCTION LENDING AGENCY', the
" '-
Fat 1 hereby pmt this th _ I a stood(See lending Q f the perfomunce
of work fie which this R r s issued(Sec 709]Civ,C)
a'Q -Under s
.T Z. .. Andres.'
nmC
Lentis',Adtlrts''
- .. .._ _ _. - .. . ...1 ._... -. . . .
C.7 + I certify mat 1 have read this application and state that the above information is
I:nd�,t somatic 1 agree to comply with all city and county,ordinaaces anal state laws relating
0•U m wildingconwction.and hereby subarix representatives afthis city to eater upon
-W the awve-mmtianed property for im,extion purposes._
gy. (We)agree to save,Indemnify and keep harmless'he City of Cupertino against
'Vi liabilities,judgmems•cow and expenses which may in any way accrue against said
U,Z City in Conuquene of the grunting of this permit.
- APPLIC 'NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
- S EReGULATIONS. ' Issued by: Date
Applia1AZA DOU B , pamsmreehand 'ILa rdpsvmetmiel Re-roofs
WB 'HAZARDOU ATERIAL.S OSHRE
me Wirt ar r t w lain sac Type of Roof
Can ,
Seby the Coleman,Municipal Cad Chapter 9.12.and the Health and Safety
2A532(0? ., c -. ;�sl' 5 . sn .s.;',,,t•
e Stas on
All roofs shall be inspected.prior.to any,roofing material.being installed. . . .
Will the applicant or future wilding occupant use equipment or devices which s ,'
crit harardous air contaminants.&flood by me Bay Ater Air Quality Man.gemcm If a roof is installed'witli'out first obtaining an inspection`;I iigree't0 remove
D.Inez' - all new materials for'inspecuon Applicant understands and will comply with
�/F ❑Tea
ON.' all rion-point source regulations:
read the harardaus materiels requirements and r Chapter 6.95 Si to
California Health&Safety Code.Sections 8505:25533 and 25534.1 ucerswd that _
if the building does not currently hada a season,that it is my responsibility to notify the -
akcapant of the ne uhx7m x which must helmet peoG msu
isance of a Cenificam of •�O���f��
•� tRcupanc. t
Signature of Applicant ._ -. Date
r mun.re.,an, Date All roof coverings to be Class "B"or Better
_ ... .. OFFICE